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Basics of musculoskeletal health for dental hygienists.

Musculoskeletal disorders and dental hygiene practice have long been linked in the literature. For example, a 2007 study in the Journal of Dental Hygiene found that neck and shoulder symptoms and the risk factors associated with them increase in frequency from students to experienced dental hygienists. (1) The longer in practice, the greater the risk. Access spoke with a physical therapist and an orthopedic nurse about how to prevent, reverse and address musculoskeletal disorders.


"Dental hygienists typically experience many different repetitive stress injuries related to their work," said Rebecca Daly, RN, BSN ONC, an orthopedic nurse at Missouri Baptist Medical Center..

"Such injuries include neck, back and shoulder injuries, wrist and arm injuries and carpal tunnel injuries," Daly explained. "These can manifest simply as pain in the upper or lower back, neck, shoulders and even the upper arm; and pain, numbness, tingling and weakness in the hands."

"Dental hygienists sometimes need to sit leaning over," added Ethel Frese, DPT, a physical therapist at Missouri Baptist Medical Center Physical Therapy Department and professor in the department of physical therapy and athletic training at Doisy College of Health Science, Saint Louis University. "Practicing dental hygiene with the head forward and not using good posture can lead to neck and upper back injuries.

"For dental hygienists, repetitive motions such as elbow/wrist/finger flexion and extension, shoulder rotation, shoulder blade protraction, neck flexion, and trunk flexion and extension are all things that are vital to the job," Daly added. "Doing a repetitive motion over and over until the muscles and tendons grow tired can lead to injury."


"Repetitive motion injuries can be difficult to prevent," Daly said. "However, body mechanics and proper equipment are things that are key in preventing or lessening injury. You should position yourself when working with a patient to allow you to reach them without stretching or straining. Keeping all or most of your body in a neutral position (especially the hand and wrist) while working is best."

"It's important to avoid flexion as much as possible," Frese agreed. "Consider your own height and distance relative to the patient as well as the height of your stool."

Daly and Frese both advised taking breaks to move about and stretch between patients, or even during a long procedure.

"Whatever position you were using during practice, move the opposite way when you have a break," Frese said. "Pinch your shoulder blades together to open the chest. Tuck your chin: imaging touching the tip of a pencil to the tip of your nose, and then pull your head back, away from the pencil. Lace your hands behind your head, and wing your elbows out. Do a backbend. Walk around between appointments.

"Dental hygiene practice can be hard on discs," Frese added. "If you lean forward, you pinch the front of the disc, and the disc material moves backward, which can lead to herniation and long-term problems."

To prevent carpal tunnel injuries, Frese again advises counteracting the positions associated with practice. "Pay attention to posture, and move your joints in the opposite direction. Providing dental hygiene care requires a lot of wrist involvement, so whatever you do when treating the patient, do the opposite for yourself. If you are keeping the wrist still to maintain a pinch on the instruments, make sure to move that wrist during the break. Make circles with it in both directions. Keep your wrist strong: rest and stretch to maintain good mobility. And stretch your fingers--pull your fingertips back toward your elbows to get a stretch through the big knuckles where your fingers join your hand."


Once an injury has occurred, the dental hygienist has a number of options to cope. As Daly noted, "Injury incurred while working as a dental hygienist cannot always be cured, but there are many modalities that can help to alleviate the pain.

"Yoga is one of the greatest ways to prevent and treat injuries. ' Massage, chiropractic and physical therapy are also great ways to help."

Physical therapy begins with evaluation, Frese explained. "We evaluate for postural problems. Also, sometimes, the muscles are out of balance. We need to determine which need stretching and which need strengthening."

Daly advocated strength training as part of a regular exercise program. "Overall, maintaining an ideal body weight and frequent exercise with a focus on core, upper body and arms are also great ways to treat injuries and prevent further injuries."


The main take-away for dental hygienists trying to avoid musculoskeletal problems is prevention.

"Prevention is key," said Daly. "Once an injury occurs, it can be costly, painful, and quite possibly permanent, resulting in the need to find a different, less physically demanding line of work."

"Be aware of posture and positioning," Frese said. "Dental hygiene is a sedentary job, so implement a good aerobic program outside of work. Data supports that those who establish a good aerobic exercise regimen have less back trouble. (2) For dental hygienists especially, endurance may be more important than strength when it comes to back health." H


Photographs of stretches for tight shoulders can be found at

Photographs of exercises for treating carpal tunnel syndrome can be found at


(1.) Morse T, Bruneau H, Michalak-Turcotte C, er ai. Musculoskeletal disorders of the neck and shoulder in dental hygienists and dental hygiene students. J DentHyg. 2007 81:10.)

(2.) Laviviere C, Bilodeau M, Forget R, et al. Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine. 2010; 35(22):E1178-El 186.
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Date:Apr 1, 2017
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