Pain management – not just for the patient!

The demands of the dental profession can inflict both physical and emotional pain on dental practitioners. However, while dentists recognize pain management as a top priority when treating their patients, their own pain often goes unmanaged, sometimes with dire consequences. Here, we share evidence-based strategies to help dental professionals enjoy the same freedom from pain that they strive to give their patients.

Dentistry – a painful profession?

To outsiders, dentistry may not appear to be a particularly physically demanding profession. The patient may see you standing fairly still while you probe around with small, light instruments, and think: well, it’s hardly running a marathon!

Meanwhile, your back aches from standing, twisting, and turning all day. Straining to get a good view of the oral cavity has left your neck sore and your eyes tired. Your shoulders are tense from carefully controlling your movements. Your hands are cramped from gripping and manipulating instruments, working precisely in a confined space with delicate tissue.

Then there’s emotional strain. The concentration required to perform such procedures is tiring enough on its own. Add in the various day-to-day stresses of running a practice, the legal and regulatory pressures of the profession, and the many challenges of patient management, all in the midst of an economically devastating pandemic…

Well, you may not be running a marathon, but some days it sure feels like you have!

Clinician pain – the numbers

Unsurprisingly, around 70% of dentists suffer from some form of back pain. According to an article in the British Dental Journal, over a third of the amount paid out to dentists by insurer Dentists’ Provident is related to musculoskeletal issues. Pain can even cost some dentists their careers, with research finding that nearly a third are forced to take premature retirement due to a musculoskeletal disorder. 

Dentists are faring poorly when it comes to stress, too. In a 2004 survey by the British Dental Journal, 60% of general dental practitioners reported being tense or depressed, 58.3% reported headaches, 60% reported difficulty in sleeping and 48.2% reported unexplained tiredness. Alcohol use was common, and over a third of practitioners were obese or overweight.

The situation hasn’t improved since. Almost half of the dentists surveyed by the British Dental Journal in 2019 reported that stress was affecting their ability to cope, with some reporting severe mental health impacts.

With the unprecedented stress of the COVID-19 pandemic, it’s more important than ever that dentists tend to their physical and emotional health. Read on for our evidence-based advice on managing occupational pain.

How dental professionals can manage their pain and stress

Be strict on self-care

Let’s get the obvious out of the way! As a healthcare professional, you already know the importance of sleep, nutrition, hydration, and exercise. However, when you’re dealing with pain, stress, or both, it’s easy to neglect the fundamentals. 

The consequences of a lack of self-care can make both physical and emotional pain worse. For example, stress and poor diet can lead to weight gain, which can further exacerbate musculoskeletal problems.

It may seem simplistic, but take a moment to audit your self-care routine and make sure you’re consistently making time for these pillars of good health. If you’re struggling to do so, proactively seek support.

Practice smart scheduling

It’s not always easy to maintain a predictable schedule in the busy dental office, but some general rules of thumb can help to reduce physical and mental stress. Try:

• Restricting particularly difficult procedures to certain days or times when you know you’ll be better rested and energized.
• Breaking up longer, more complex cases with shorter, more hands-off appointments to give yourself time to recuperate.
• Avoid scheduling the same types of procedures back-to-back to minimize the risk of mental fatigue (and repetitive strain).

Take regular breaks and delegate

In a recent survey, only 50% of dentists told Septodont that they took a daily lunch break. The other half told us that they spent their breaks seeing patients, preparing the office, or catching up on administrative tasks. 

Of course, if there’s work to be done, sitting idle can feel stressful in itself. However, regular breaks are essential not just for your stress levels, but for the care and safety of your patients.

Consider delegating some of the less enjoyable tasks to your team, researching systems that can automate admin functions for you, and drafting in more support from your hygienists and assistants in the operatory.

Neck, back, and shoulder pain

Watch your posture

Holding a steady position for long periods means that dentists are prone to postural and static muscle fatigue. When the dentist is sitting for too long, especially when leaning forward repeatedly, the hip flexors are tightened, the glutes and deep abdominal muscles are underused, and the lower back muscles are recruited to compensate.

To minimize postural fatigue, try to alternate between sitting and standing as much as possible. Keep the abs engaged by sitting up straight, lengthen your hip flexors with regular stretching, and try to walk around regularly to boost circulation to the muscles.

Resistance and strength training can help to build and balance these muscles, but be sure to work with a trainer that understands the unique postural challenges of dentists.

Minimize strain

Leaning for better visibility can impact your neck and shoulders as well as your back. According to an article in Spine Universe, research has shown that working for more than 75% of the time with the neck above 15 degrees flexion is hazardous for the dentist. Despite this, dentists were found to spend 82% of their time working at more than 30 degrees. 

To avoid twisting, turning, and reaching, position your equipment within easy reach. If you and your team don’t already practice “four-handed dentistry”, consider implementing this approach when working with instruments to minimize neck, back, and shoulder strain.

Position the patient correctly

The position of your patient can impact your posture, too. The American Dental Association (ADA) advises positioning the patient’s head at a level that allows you full visual access while holding your shoulders and neck in a neutral position, and your elbows at a ninety-degree flexion or less. However, dentists often position the chair in the manner most comfortable for the patient, sometimes to their own detriment.

Dr. Bethany Valachi, writing for Dental Products Report, says that this can leave the dentist straining, twisting, or hunching to gain proper visibility and access, especially when treating the upper arch. When the occlusal plane of the upper arch is in front of the vertical, the dentist must lean forward. For optimal posture, Dr. Valachi recommends keeping the occlusal plane of the upper arch 20-25 degrees behind the vertical, ideally with the use of a double articulating headrest.

Use a saddle chair

Standard office chairs aren’t built to accommodate the dentist’s physical requirements and demands. Consider investing in a saddle chair instead.

Saddle chairs are tilted forward to create a more open angle between the spine and hips, supporting the natural curvature of the spine and taking the physical stress off the lumbar vertebrae. They also have a cut-out at the base, alleviating pressure on the coccyx.

Consult an expert

There are a number of professionals who can support you in your quest to minimize work-related pain. A physiotherapist can help you to correct your posture, refine your movements, and build strength and stability in key muscle groups. An occupational therapist trained in ergonomics can help you to arrange your work environment for maximum function, efficiency, safety, and comfort. Consider looking for those who specialize in working with dental professionals and understand the unique demands of the job.

Hand and wrist pain

Correct your grasp

Dental students are rigorously taught the correct grasp of instruments, but once practicing independently, many admit to going a little slack! If you’re noticing hand or wrist strain, it might be time to go back to basics and sharpen up your grasp.

Writing for Dentistry IQ, Julie Whiteley RDH cautions that excessively tight grip, inappropriate pressure, and hyperflexion in the fingers and wrist can all contribute to hand and wrist pain. Here, she revisits the foundations of correct grasp for dental instruments.

Stabilize

When you’re doing precise, prolonged work, take advantage of stabilizing techniques like finger rests and fulcrums to help maintain control without overstraining. Try to keep your wrists in a neutral position, in line with your forearm, and position the chair so that you can rest against the forearm for stability and support.   

Choose instruments wisely

Hand and wrist pain can be aggravated by using heavy or vibrating instruments, and those that require repetitive hand movements, swiveling, or torque. Instruments with slim handles can also be difficult to grip and maneuver.

To reduce instrument-related strain, the ADA recommends choosing lightweight instruments that:

• Have rapid/variable speeds to reduce usage time.
• Rely on minimal or no vibration.
•  Apply pressure, torque, or swivel for you.
• Have larger, ergonomically designed handles.

One example is the Septodont Dentapen, an electronic syringe for the administration of local anesthetic. It weighs just 40 grams and has a choice of two large, ergonomically designed handles for your comfort and ease of use. With three speeds and two modes of flow, it injects with minimal hand pressure or manipulation on your part. For those who prefer manual injection, our range of Septoject syringes features innovative triple-bevel and scalpel needles for maximum control with minimal force.

Keep your instruments in good working order

Dull instruments require extra force and can extend your procedures. This can be painful for both you and the patient!

Keep instruments in tip-top condition to ensure easy, comfortable use. The following signs can tell you that it’s time to sharpen them up (or send them out to third-party service):

• You need to use more pressure to make an incision.
• You can’t feel the “bite” of the blade on a test stick.
• When held under the light, the cutting edge reflects light back.

Wear properly fitted gloves

Don’t underestimate the importance of properly fitting gloves! When worn for extended periods, tight gloves can compress your nerves, strain your muscles, constrict blood flow and cause numbness, tingling, or pain. You may experience this wearing standard medical gloves, which are ambidextrous and designed only for brief use.

Your gloves should be loose across your palm and the base of your thumb, and you should be able to close your hand into a fist without feeling constriction. However, they shouldn’t be too loose, as this can leave you straining to control your instruments. 

Give your hands a break

Try to vary the tasks you perform to reduce the risk of repetitive strain injuries. This may involve smart scheduling, as previously discussed, or simply taking regular breaks during grip-intensive tasks.  

Your hands will benefit more from frequent short breaks, rather than just one or two long breaks. To maintain good circulation to the hands and wrists, we recommend a break of around ten minutes for every hour of intensive work.

During your break, stretch out your hands and wrists to relieve tension. Try the following:

• Circle your wrists ten times in one direction, then ten times in the other.
• Press your hands together in a prayer position and lift your forearms at a 90-degree angle to your hands. Repeat with the backs of your hands pressed together and pointing downwards.
• Interlock your fingers and turn your palms to face forward, then extend your arms while keeping your fingers locked.
•  Press thumb to thumb and forefinger to forefinger to make a diamond shape, then gently push them together to stretch the space between.

With each of these exercises, remember to only stretch as far as you comfortably can, and never to the point of pain. 

Eye pain

Use customized dental loupes

Research has shown that proper use of dental loupes can improve treatment time, quality and accuracy, reducing both visual and postural fatigue.

When loupes are customized correctly, the range and angle of declination only offer visibility when appropriate posture and distance are maintained. This actively discourages stretching, leaning, and hunching over the patient, while protecting you from vision strain and headaches. You can also choose illuminated models for even better visibility of the oral cavity.      

To work effectively, loupes must be customized according to any optical prescriptions or visual impairments you may have. When ordering dental loupes, it’s important to make the provider aware of this information, as you could find yourself straining to see through an ill-fitting device. If you haven’t had a recent eye test, it may be a good idea to schedule this first. 

Prevent dry eye

When focusing closely on a small area like the oral cavity, your blink rate goes from approximately 15 times a second to only five, and the oil glands in your eyes produce less natural lubrication. If this happens frequently, these glands can atrophy and leave you with dry eye, a painful condition characterized by tearing, burning, and extreme sensitivity.

Writing for Dentistry IQ, Jenefer Goffron-Mercieri RDH recommends preventing dry eye with regular use of artificial tears, daily disposable contact lenses, and the “20/20/20” exercise. Every 20 minutes, she advises looking 20 feet away for 20 seconds, allowing the eyes to relax and recover.

A final note…

Many dental professionals have used these techniques to relieve mild and moderate pain. However, if you’re experiencing persistent visual problems, severe pain, or pain that doesn’t seem to get better over time, self-help methods are unlikely to make any meaningful difference on their own. In this case, it’s essential to see a physician, optician, or physiotherapist as soon as possible – not only to relieve your pain but also to ensure you can continue to enjoy the career you’ve worked so hard to build. Remember – freedom from pain is not just for the patient!