One of the most effective ways to prevent MSDs is to maintain a neu- tral posture at all times while treating patients. Neutral posture encom- passes maintaining an upright head position while keeping the shoulders relaxed and ensuring the elbows are flexed at a 90° angle. The forearms should be in a mid-position with the thumbs pointing upward. The wrists and back must remain straight. Hips should be slightly higher than the knees with the operator stool tilting slightly downward. Lastly, the feet must remain flat on the floor.3,4 Maintaining a neutral posture can be extremely difficult, as several areas in the oral cavity are not easily accessible.5 Combine this with patient situations in which dental hygienists are forced to contort their bodies in awkward and uncomfortable positions to provide optimal care, and clinicians have the ideal scenario for MSDs to occur. Fortunately, various strate- gies can be used to help maintain a neutral posture. NEUTRAL WORKING POSITION Dental hygienists must consider the foundation of proper ergonomics practice. Prior to periodontal instrumentation, clinicians should first establish a neu- tral working position whether they are seated or standing. If seated, dental hygienists must keep their clinician seats tilted down no more than 5°. Over-tilt- ing may result in excessive curvature of the lower spine, resulting in serious injury.6 Clinician chairs that don’t tilt may be modified with an ergonomic wedge-shaped cushion to aid in main- taining a neutral posture.6,7 In recent years, saddle stools have become popular due to their natural tilt, which relieves pressure off the lower spine and allows clinicians to sit with their feet flat on the floor, shoulder length apart.4,7 When seated, dental hygienists should utilize a range of working positions around the patient’s head during periodontal instrumentation.3,4 This range, commonly referred to as the “clock posi- tions,” allows the clinician to visualize the face of an analog clock as a guide with the patient’s head being at 12 o’clock. The clock positions vary from right-handed to left-handed clinicians. Right-handed clinicians should sit between 8 and 12 o’clock. To improve visibility and access to the oral cavity, the clinician may move past 12 o’clock in specific areas. Left-handed clinicians should be seated between 12 and 4 o’clock.4 Using an analog clock as a guide supports the clinician in maintaining a neutral posture by providing better visualization of the patient’s oral cavity.6 When no medical or physical limitations are present, the patient should be placed in the supine position during periodontal instrumentation, and the headrest should be adjusted as nec- essary to allow the clinician to access both the maxillary and mandibular arches with optimal visibility.3,6 In addition, clinicians should not hesitate to TABLE 1. Chairside Stretches NYREE DAWSON, RDH, BSDH, MPH, is an assistant professor in the Department of Dental Hygiene at Howard University College of Dentistry in Washington, DC, where she also serves as junior clinic coordinator. She teaches dental hygiene theory didactic courses, ethics and jurisprudence, and clinical courses. LaTESHA McLEE, MSDH, RDH, is an assistant professor in the Division of Dental Hygiene at the Virginia Commonwealth University School of Dentistry in Richmond, where she serves as junior clinical coordinator. In addition to her clinical courses, she teaches dental hygiene theory I and community oral health courses. dimensionsofdentalhygiene.com July/August 2023 • Dimensions OF DENTAL HYGIENE 21 M any dental hygienists are plagued by musculoskeletal disorders (MSDs) and pain throughout their careers.1 The reported prevalence of MSDs among dental hygienists is as high as 96%, with pain most commonly affecting the neck, shoulders, hands, wrists, upper back, and lower back.2 Stretch Muscle Group Description Image Levator scapulae stretch Shoulder and upper back 1. Stand with feet shoulder width apart. 2. Bring chin toward chest and rotate head toward right shoulder. 3. Using right arm, gently push your head down looking toward your armpit until you feel a slight stretch on the left side of the neck. 4. Hold 15 to 20 seconds. 5. Repeat on other side. Seated roll down Shoulder 1. Sitting in a chair, slowly bend forward and reach your hands toward the floor. 2. Bend your trunk and head forward and down. 3. Hold for 10 seconds. Anterior shoulder stretch Shoulder and chest 1. Sit with feet shoulder width apart, clasp hand behind your back. 2. Pull elbows back and extend your arms. 3. Hold for at least 10 seconds and release. Doorway stretch Shoulder and chest 1. Stand next to the frame of the doorway as though you are about to pass through it. 2. Bring your hands up so that your forearms and elbows are resting against the side of the doorway; elbow and shoulder should be at 90° angles. 3. You should feel a stretch between the chest and shoulder. 4. Hold stretch for 20 to 30 seconds. Repeat on the other side. Torso twist Lower back 1. Sit in a chair with good posture facing forward with your feet flat on the floor. 2. Twist torso to one side, holding for a count of four and trying to touch the back of the chair with your hand. 3. Return smoothly to starting point and repeat on the other side.
