Because oral health professionals are prone to musculoskeletal disorders (MSDs), effective ergonomic interventions are needed to prevent work-related MSDs. But some preventive measures may not actually alleviate muscle discomfort, according to a Cochrane Review workgroup that reported more studies are needed to evaluate the efficacy of these interventions.
Noting that research on this topic is scarce and unreliable, Priti Mulimani MDS, MOrthRCSEd, FDSRCSEd, a specialist orthodontist, currently working towards a PhD degree at the University of Washington, Seattle, and the review paper’s lead author, says, “There is an urgent need for well-designed clinical trials, with long-term follow-up that assesses preventive strategies for work-related MSDs among dental practitioners.” Reporting in the paper, “Ergonomic Interventions for Preventing Musculoskeletal Disorders in Dental Care Practitioners,” published in the Cochrane Database of Systematic Reviews, the workgroup evaluated studies of ergonomic interventions in dental clinics in Iran and the United States.
Researchers report low-quality evidence from the first study, which assessed a comprehensive ergonomics intervention consisting of training, workstation modification, and a regular exercise program. Even with the modifications, the results showed no clear effect on clinicians’ risk of musculoskeletal pain in the thighs and feet. The second study, which evaluated the ergonomic impact of instrument design, could not discern a clear difference in elbow or shoulder pain over a 16-week period in subjects using lightweight, wide-handled curets, or heavier, narrow-handled curets for scaling. The workgroup concluded that both studies had shortcomings, such as poor methodology and short follow-up times. As a result, no definitive conclusions could be reached regarding recommendations for dental practitioners, says Mulimani.
Dentists, dental hygienists, and dental assistants commonly experience wrist, neck, and shoulder pain due to poor working posture and performing highly repetitive tasks. General recommendations to mitigate muscle workload include the use of ergonomically designed instruments, cordless handpieces, proper working posture, and good clinical illumination. Making ergonomic improvements to the work environment and maintaining a regular exercise routine, including stretching and muscle strengthening, are suggested to help with musculoskeletal imbalances.
Citing knowledge gaps on this topic, the team emphasizes that deciding which ergonomic interventions are most beneficial to a clinician or practice is imperative, as MSDs contribute to burnout, poor health, and early departure from the profession. It’s pinpointing the most effective ones for a given practice that is difficult. “Based on our review, there is insufficient evidence to make any specific recommendations about the effectiveness of ergonomic interventions in preventing MSDs,” says Mulimani. “In the absence of definitive, evidence-based guidelines, clinicians should exercise their discretion in choosing best practices.”
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