A Matter of Degrees by Dee Humphrey, RDH, BHSc

It's obvious that magnification can increase the acuity of the oral cavity and enhance career longevity in dentistry. However, dental professionals must understand that ergonomically, not all loupes are created equal, even if they claim to be. Comprehending the ergonomic issues that can arise from using improper loupe designs has never been more vital to one's career.

My clinical career was cut short because I previously had a minor neck injury, which was exacerbated into a major issue after using nonergonomic loupes. I'm sharing my story so you can learn now what I learned too late.

Doing your homework is essential
I bought my first pair of loupes in dental hygiene school and was told by the sales rep that they'd enhance career longevity by maintaining my ergonomics. I stressed that I was concerned with neck health and wanted to do everything I could to preserve it. Loupes were optional at my school but I made the choice to purchase, even though I didn't fully understand the ergonomics of the design. I trusted that what I was told and what I was buying had ergonomic benefits, but should have searched out more information.

After three years in clinical work, I noticed a pinching pain that radiated down my left arm and I began to lose feeling in two fingers. I was told by others within the dental profession that physical ailments were "just part of the job." A hard lesson learned was that even though others have been in the profession longer, it doesn't mean they know better or should be trusted with your health! Be your own health advocate and do your research. I never should have accepted pain as a normal way of life, but I did.

Never accept this "part of the job" statement from anyone! The future of your career depends on your health. I should have kept in mind that pain is a message from the body, saying something is causing damage and needs urgent attention. But I ignored that message and neglected to seek help for my musculoskeletal disorders. Dentists and hygienists must understand that our profession places us at high risk for musculoskeletal disorders because of the awkward positioning, repetition, duration, force and contact stress within our jobs. You can choose to be a martyr, or you can have a long, pain-free career. The choice is ultimately yours.

When pain becomes a major problem
I continued working and tried to treat the symptoms with chiropractic care or deep-tissue massages, excusing the loss of feeling as "OK" because it didn't occur in my dominant hand. Within five years of starting my career, I was forced to seek serious medical attention and months after that, neck surgery was required. I asked the neurologist what could have caused my condition; he recommended finding a way to minimize tilting my head as I worked—perhaps a different brand of loupes.

After recovering, I returned to work and continued to use the same loupes. By the third month, I noticed little aches and twinges that I'd once felt before in my neck, and began to have trouble in my lower back. Within six months, I needed lower back surgery for a herniated disc in the lumbar region, which resulted in my permanently leaving clinical work.

While at a trade show in Oklahoma, I searched out the differences between loupe manufacturers, trying to focus more on the ergonomic benefits. I noticed right away that companies spent more attention trying to sell me loupes that matched my scrubs or ones I'd look more stylish in. Key ergonomic features, such as light weight and having the correct declination angle, was only highlighted by few companies.

The correct working distance and declination angle—having a head tilt of less than 20 degrees forward—must be a priority in selecting appropriate ergonomic loupes to prevent or alleviate chronic neck pain. It must be stressed that if the declination angle (how steeply you can look down through the magnification oculars) is not steep enough, you cannot hold your head upright, which would be the main cause for chronic neck pain.

Check for change before change checks you
After evaluating the loupe brand I was using, I now know why my clinical hygiene career only lasted six years. Questions flooded my mind as to what went wrong. If my current brand was as ergonomic as the company claimed, then why did my minor injury turn into a major problem? Was there excessive head tilt, which led to the destruction of my neck health? My neurologist seemed to think so and he never once said that neck pain was "just part of the job."

I recommend that dental hygiene professionals do a periodic ergonomic check on their current brand of loupes to determine if they're harming, more than hurting, your neck health. Take into consideration that a sales rep could improperly measure you, or there could be a deficiency in design of declination angle.

I recently took a job as adjunct faculty at a dental hygiene program in Missouri and decided to start using a different brand of loupes, as my doctor suggested. For the first time, I fully understood how critical using ergonomic loupes was to my now-compromised neck health and the future of my career. The differences in what I felt were drastic!

Using ergonomic loupes allowed me to oversee treatment procedures while standing over students and patients. I immediately noticed profound changes in my posture, which helped eliminate pain in my upper extremities. I could look down with my eyes, not my neck, while working eight-hour days without discomfort or pain.

I also noticed that I was much more comfortable than the students, who were using a different brand than I was. The students also noticed the difference! They observed that I could see from a greater working distance with no distortion of perception and that my light was more focused and brighter than theirs.

Conclusion
My clinical career may be over, but I'm hoping yours isn't. Learn from my mistakes and look into real loupe ergonomics before it's too late. Before you trust a salesman, a colleague or even a teacher, trust your own body first. If you're beginning to feel the little aches or stings of clinical work in your neck or already have neck pain, then it's time to ask why and revaluate your current brand of loupes.

Do your research on the ergonomic loupe designs and stop getting loupes for style! Know that the correct declination angle and working distance that brings ergonomic health. Know what an ergonomic posture looks like, and check it by having someone take a photo of you while working. Watching a video of yourself may also help to spot needed postural changes. Understand that bending the head more than 20 degrees will eventually do to you what it did to me. It will first cause pain, then shorten your career. Find your solution now. You and your career deserve it.

Discover more about hygiene coding changes in our next issue!
The September issue of Dentaltown will feature a CE?course by hygiene educator Patti DiGangi about how gaps in the CDT code have led to delays in therapeutic care for early periodontal dental disease, and how new codes can help create change— and profit opportunities.