Active Research
Musculoskeletal Disorder Risk Assessment in Dental Hygienists

Purpose/Objectives. This study examined the relationship between environmental factors (e.g., working position, patient position, and scaling instruments) and poor posture in dental hygiene students.

Methods. A longitudinal cohort study was conducted from 2017 to 2019 to observe dental hygiene students' clinical rotation performance at two undergraduate universities. Samples of video observations (n = 1487) of dental hygiene students performing scaling activities during oral care sessions were evaluated using the Rapid Upper Limb Assessment (RULA). Descriptive analysis and exploratory prediction modeling were performed to assess clinical environmental factors that predicted higher risks of developing WMSDs.

Results. RULA scores (mean = 4.8, median = 5, range = 2–7) indicate dental hygiene students are at high risk of developing upper extremity MSDs. The type of scaling instrument, clock positioning relative to the patient, and sitting versus standing had statistically significant associations (p < 0.001) with the RULA outcome. In univariate analyses, clock positions 7 and 8 were the worst, having an increased risk of poor RULA outcomes (scores 5–7) by nearly nine times over working in clock position 12 (odds ratio [OR] 9.11, 95% CI 5.48–15.60). Multivariate predictive modeling indicated that the riskiest combination of factors is using a manual scaling instrument (OR 1.67, 95% CI 1.28–2.18), standing (OR 1.42, 95% CI 1.03–1.96), and working clock positions 7 and 8 (OR 8.4, 95% CI 5.02–14.50).

Conclusions. There is a need to consider the combined contribution of multiple environmental factors on working positions to optimize ergonomic training during dental hygiene and protect emerging dental health professionals from the negative health impacts of prolonged awkward postures.

Objective. To describe extracurricular activity participation and explore its relationship with college students’ health.

Participants. 159 college students majoring in dental hygiene or occupational therapy.

Methods. Data were collected prospectively at baseline, one- and two-year follow-ups. Self-reported participation in extracurricular activities over the past six months was grouped into eight categories: Fitness, Sports, Creative arts, Leisure, Social, Work, Caregiving, and Animal care. Physical and mental health were measured using SF-36, a valid tool measuring general health.

Results. Participation in fitness, sports, creative arts, and work significantly decreased at one-year and two-year follow-ups (p < 0.01). Work/volunteer activity participation was associated with poorer physical health (β = –1.4, 95% CI: (–2.2, −0.5), p < 0.01), but a change from nonparticipation to some participation in work/volunteer activity was associated with better mental health (β = 2.6, 95% CI (0.3, 4.9), p = 0.04).

Conclusions. Educators should consider the potential impact of maintaining extracurricular activities on college students’ health when designing academic courses.

Keywords. College student; extracurricular activity; health; SF-36; well-being

Background. The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression.

Methods. We recruited dental hygiene (DH) students (N = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (N = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasound, psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog pain scale greater than minimal clinically important difference) between DH and OT students using Fisher’s exact test. We used mixed-effects models to longitudinally compare the change in outcomes between three groups: DH students that develop and did not develop shoulder pain, and OT students.

Results. The incidence of shoulder pain is higher in DH students [relative risk = 4.0, 95% confidence interval (CI): 1.4, 11.4]. After one year, DH students with pain had the greatest thickening of the supraspinatus (0.7mm, 95%CI: 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4mm, 95%CI: 0.1, 0.8) and OT students (0.9mm, 95%CI: 0.5, 1.2). Anxiety score increased 3.8 points (95%CI: 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at one-year (relative risk = 2.9, 95%CI: 1.0; 8.6).

Conclusion. Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.

Keywords. supraspinatus; tendinopathy; anxiety; pain; shoulder

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

We examined the relationships between participation in different extracurricular activities and the overall physical and mental health in college students across a 2-year period. Participation in certain occupations was associated with positive mental health, whereas other occupations were linked to poorer physical health. Exploration and promotion of participation in extracurricular occupations should be considered to support student health.

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

Although multiple robust ergonomics tools are available to assess postural risk, these tools are often too general and do not consider nuances of specific jobs. This study examined the concurrent validity of a postural assessment tool tailored to dental professionals. Findings provide support for use of this tool to assess risk and identify areas for intervention by OT practitioners.

Background. Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist.

Objective. This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work.

Methods. An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work.

Results. Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters.

Conclusions. This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Keywords. Dental hygienists; clinical; ergonomics; research protocol.

Purpose. Dental hygiene graduates often experience significant psychological stress while transitioning from the educational setting to clinical practice environments. The purpose of this study was to characterize the duration of dental hygiene activities and tasks and explore efficiency within appointments, by students in educational programs.

Methods. Right-handed female dental hygiene students were recruited from two dental hygiene education programs. Each participant was video recorded while providing patient care during 3 sessions, once per term, over 3 consecutive terms. Activities, tasks, and student postures and positions were coded across the patient visit. Descriptive analyses were conducted to characterize overall durations and distributions across each category. Time spent on non-dental hygiene related activities was compared to other durations, as well as across the education/training time points and by patient type.

Results. Fifty-three videos were analyzed from nineteen participants. The average patient visit length was 155.06 ± 35.63 minutes; approximately half the visit was dedicated to instrumentation activities. Nearly 20% of the visit was categorized as activities or tasks unrelated to education or patient care. Although most participants completed the patient visit more quickly by the third time point, the percentage of non-dental hygiene activities did not decrease, and there were no associations between patient category type and the duration of the patient visit.

Conclusion. Patient visits were roughly three times the length of the typical dental hygiene care appointment, indicating a disconnect between training and practice. In addition to spending more time on hand scaling tasks, participants spent a lot of time on equipment setup and interacting with or waiting for faculty members. These findings have implications for improving efficiency in educational settings, particularly to facilitate a successful transition to clinical practice.

Introduction. The Rapid Upper Limb Assessment (RULA) is an ergonomic assessment tool used to screen for risk of musculoskeletal injury due to working posture. The RULA is traditionally applied once during a work task to approximate overall risk. No method exists for estimating a RULA score for work requiring frequent shifts in posture across an extended period of time.

Purpose. The goal of this study was to identify an optimal sampling method for applying the RULA across a long time-period that accurately represents overall risk.

Methods. Four right-handed female dental hygiene students were video recorded from three angles while performing hand scaling during patient clinic visits (88.97 minutes on average). RULA was continuously scored across the entire session, updating the score when a significant postural shift lasting for more than 15 seconds occurred. A time-weighted average (TWA) RULA score was calculated. Three sampling methods were evaluated: equivalent interval samples, random samples, and random samples selection weighted within “clock positions.” Each method was compared to the TWA using a paired samples t-test and percent difference.

Results. TWA RULA across the four students ranged from 3.4 to 4.3. Preliminary sampling averages using 10 samples were all within 0.2 of the TWA. Further iterations evaluating various sample sizes is ongoing.

Discussion. Preliminary results suggest that all three sampling methods provide a reasonably accurate approximation of the TWA score at the sampling rate tested. Future iterations of this analysis will be continued to identify the minimum required sampling rate to meet our TWA criterion.

Background. The authors’ objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care.

Types of Studies Reviewed. The authors conducted systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals.

Results. The authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise.

Conclusions and Practical Implications. The evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design.

Keywords. Ergonomics; injury prevention; musculoskeletal disorders; dentists; dental hygienists