Introduction
Those involved in clinical practice, be it as
a dentist, hygienist or assistant are prone to
back issues. These include lower back and
neck problems which relates to how we
position ourselves while rendering
treatment. Differences can be denoted
between those rendering treatment
(dentists and hygienists) and those
assisting during treatment based on
how they tend to position themselves.
Hayes reported in a systematic review
that the most prevalent regions for pain
in dentists have been shown to be the
back (36.3-60.1%) and neck (19.8-85%).1
A meta-analysis reported a combined
prevalence of 53.90% for thoracic-lumbar
pain, 41.23% for lower back pain and
41.39% for neck pain reinforcing the issues
those treating patients in the dental field
are subjected to.2 The musculoskeletal pain
mechanism has been attributed to poor
ergonomic work posture and position
adopted by dentists in relation to their
patients.3 The prevalence of musculoskeletal
disorders among dental personal is high
and a critical need exists to enhance
awareness regarding correct working
postures.4
Why do we have a high tendency
towards lower back and neck pain?
Most practitioners subconsciously tend
to lean towards the patient when rendering
treatment to improve visualization.
Additionally, the practitioners tends to
rotate and bend their head to better
visualize the maxilla, instead of better
positioning the patient and using
indirect visualization (mirror) is a frequent
occurrence. As the practitioner ages and
it becomes more difficult to see small
items they tend to lean in further placing
more strain on the neck and lower back.
Use of loupes helps improve visualization
but also forces the practitioner to sit more
upright due to the focal distance of the
loupes. When the practitioner wearing
loupes leans in closer to the patient the
field of view blurs (goes out of focus) subconsciously
forcing them to sit in a more
upright position to bring the subject into
focus.
Unfortunately, most dental chairs due to
their design still allow the practitioner to
lean forward while rendering treatment.
This causes stress to be placed on the lower
back, the spines weakest area. Traditional
dental chairs cause the spine to curve into
a “C” shape placing strain on the lower
back. (Figure 1). This unnatural curvature
of the spine increases stress at the 4th and
5th lumbar disks, the classic trouble spot
in the back. The ideal angle between the
spine and hips is 45-50 degrees before
strain is noticed in the lumbar region. Use
of a flat chair tends to create an angle of 90
degrees causing the back to form the “C”
shape to compensate leading to the
tell-tale lumbar issues.
98
Taking the backache out of practicing
Author: Gregori M. Kurtzman, DDS, MAGD, DICOI
Gregori M. Kurtzman, DDS,
MAGD, DICOI
Dr. Kurtzman is in private general
practice in Silver Spring, Maryland
and a former Assistant Clinical
Professor at University of Maryland
and a former AAID Implant
Maxi-Course assistant program
director at Howard University
College of Dentistry. He has
lectured internationally on the
topics of Restorative dentistry,
Endodontics and Implant surgery
and prosthetics, removable and
fixed prosthetics, Periodontics and
has over 395 published articles. He
has earned Fellowship in the AGD,
AAIP, ACD, ICOI, Pierre Fauchard,
ADI, Mastership in the AGD and
ICOI and Diplomat status in the
ICOI and American Dental Implant
Association (ADIA). Dr. Kurtzman
has been honored to be included
in the “Top Leaders in Continuing
Education” by Dentistry Today
annually since 2006 and was
featured on their June 2012 cover.
He can be reached at dr_kurtzman@
maryland-implants.com.
Figure 1: Curvature of the spine when utilizing a traditional
flat chair forms a “C” shape creating strain at the lumbar
region.
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