Help for when teeth cause backaches

Pictured here: The dental suite of 2019 Hospital Design Competition Merit Award winner Petersen Pet Hospital in Hiawatha, Iowa. (Photo courtesy of Read Photography)

Dental procedures are an important part of comprehensive veterinary care but can place extensive stress and strain on the bodies and minds of veterinary team members. These stresses and strains can lead to musculoskeletal disorders that ultimately decrease productivity and can lead to loss of work time and job satisfaction.

Benita Altier, LVT, VTS (dentistry), encourages veterinary technicians to take an active role in improving comfort and efficiency in the workplace. In a lecture at Fetch dvm360 conference in Baltimore, Altier discussed strategies to reduce injury and improve productivity and workflow in veterinary dentistry.

Causes, consequences and prevention of work-related musculoskeletal disorders

Veterinary medicine is a physically demanding job and many team members suffer from chronic pain or workplace musculoskeletal disorders. These disorders are often caused by repetitive strain or cumulative trauma that begins with nerve compression and inflammation that manifest as aches, pains and fatigue. In dental procedures, repeated flexion or extension of the wrists or prolonged tilting of the head and neck are common behaviors that can lead to cumulative trauma.

Permanent damage can be avoided if the body is given time to recover and behaviors are altered to prevent continued trauma. In many cases, though, these minor aches and pains are ignored. Altier says she thinks this is because we put others first when we're in the role of caregiver. Ultimately, continued trauma leads to scar tissue formation and permanent changes in the nerves, muscles, bones and vasculature. Once permanent changes have developed, the body is unable to perform as efficiently, leading to reduced productivity in work.

In the case of veterinary dentistry, Altier states that we can prevent these injuries by altering our workflow and behaviors throughout procedures. While there can be some expense to the hospital in purchasing new equipment, many of the strategies she discussed will cost nothing to implement, such as staying aware of posture and adjusting scheduling.

Stay aware of proper operator posture

Maintaining a neutral posture while performing dentistry tasks is one of the most important things any person can do to prevent repetitive strain injuries. Altier suggests recording video or photographing staff members during dentistry procedures to evaluate posture.

Appropriate neutral posture is achieved in the following ways:

• Maintain a neutral spine with the head and neck positioned over the spine. The head should not be tilted more than fifteen degrees forward or from side to side for prolonged periods of time.

• The shoulders should stay lowered and relaxed.

• The arms should be relaxed with the upper arms in line with the torso, forearms parallel to the floor, and the wrist positioned higher than the elbows.

• The hands should be held with the pinky-side slightly lower than the thumb-side, and the wrist should not be flexed or extended for long periods of time.

The type of seating used can help to maintain appropriate posture. Altier recommends saddle seat-style chairs, as they help to maintain a neutral spine position. If flat chairs are being used, they should have a back rest that supports the lumbar area and the thighs should remain parallel to the floor while seated.

During the procedure, the technician or veterinarian will have to move out of a neutral posture to accomplish the necessary tasks, but they should be aware of the amount of time they are deviating from this posture. Micro-breaks of 20 to 30 seconds can be used throughout the procedure to allow the body to recover.

Equipment and instrumentation

In addition to the type of seating, having a work surface that is adjustable in height can help to maintain appropriate posture and comfort for all members of the team. Altier states that a wet table is not a necessity for dental procedures. Instead, surgery tables or lift tables can help to move larger patients, preventing strain on team members before and after the procedure, allow adjustment during the procedure and allow team members to sit comfortably while maintaining neutral postures.

Lighting and magnification are two of the items that Altier considers essential for veterinary dentistry. A focal light source and magnification can help those performing dental procedures to maintain neutral head and neck posture as well as improve visualization for successful procedures.

A variety of instrumentation should be available, including tools with different handle sizes. Dental equipment should be placed on the same side as the technician's dominant hand to prevent the need to reach across the body during the procedure.

Proper scheduling

Finally, Altier discussed how improved scheduling practices for both team members and patients can help to reduce stress and strain on the body. She encourages clinics to give all team members some dental training and schedule enough people to allow for four-handed dentistry, which improves efficiency by having one person performing the procedure while another records information during charting, helps to hold the mouth in position or assists with passing instruments.

Team members should alternate tasks during procedures to prevent the strain of repeating tasks continuously. This is especially helpful if some tasks require standing, such as taking radiographs, and others require sitting, such as scaling and polishing.

Appropriate scheduling of procedures is also essential to smooth flow and injury prevention in dentistry. Altier recommends that all anesthetic procedures be scheduled by technicians, as they are most aware of the time needed for procedures and the demands of each procedure. Care should be taken to avoid scheduling consecutive procedures for large patients or that will require extensive periodontal work. She also encourages teams to schedule extra time for each procedure to allow for unanticipated disease that is may be discovered during the procedure.

Participatory ergonomics: empowering the whole team

Throughout the lecture, Altier encouraged technicians to feel empowered to play an active role in improving the workplace for all by discussing ways to improve efficiency and productivity and reduce risks of injury. This process is termed participatory ergonomics. She encourages technicians to open a conversation during a staff meeting to discuss problems, collect ideas for improvement from all staff members, implement change and set a timeline for review. Many of the changes that can be made are free or have minimal cost to the hospital and can greatly improve workplace efficiency, safety and job satisfaction for all.

Dr. Kate Boatright, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian in western Pennsylvania. She is actively involved in her state and local veterinary medical associations and is a former national officer of the Veterinary Business Management Association.