Endodontists Need Ergo Too!

By Katrina Klein, CEAS, RDH, CPT

Oftentimes, the dental world sits with green eyes blazing on the endodontist specialty. I mean, why wouldn’t they? No class 2’s, no hygiene checks, no body pain – wait just a minute … That’s absolutely not true, and the grass isn’t actually greener on the endo lawn. This Certified Ergonomic Assessment Specialist and ergo coach is here to clarify and offer solutions!

First, let’s unmuddy the water. Endodontists have body pain too! Sixty-one percent complain of pain in the lower back and neck. (1) In fact, one study discovered that endodontists complain of more pain than other specialties by 88%. (2) From fused necks to arthritic backs, endodontists definitely need ergo too!

What are the real solutions? Like dentistry, solving body pain isn’t a one trick pony. We can’t just buy a microscope and thing that’s going to save the day. It’s a HUGE help, but there are drawbacks from full time use of a microscope for every single piece of treatment performed. Before we dive down that rabbit hole, we need to understand WHY we get pain.

Risk factors for injury from the OSHA website are as follows: Awkward Posture, Force, Contact Stress, Vibration and Repetition. Managing exposure to these risk factors can be the difference between a career ending in disability or not.

Let’s talk solutions. Since literally everything we do is awkward, we have to start by altering the way we practice to avoid injury. The use of a microscope keeps the neck flexion at a minimum (chin up looking directly ahead) is highly recommended, but forward head posture (ears in front of the body instead of over the shoulders from a side view) can become a problem as the scope is often placed well in front of the operator. The solution: make sure the patient is at the TOP of the headrest while using a microscope and ergonomic (deflective) loupes for the restorative portion of the procedure, administering anesthetic or when the microscope isn’t practical.

Static posture is also a big part of awkward posture. Sitting in one spot with muscles contracted for prolonged periods of time can wreak havoc on the body. Humans are meant to move! Solution: stand for shorter segments of procedures or for exams. This allows the body to micro shift so that muscles aren’t in a constant state of contraction and compressing joints/ligaments and fascia. (3) It also relieves the back from leaning forward.

A saddle stool is another great piece of equipment that helps with back pain. (4) The operator sits up high so that the knees are well below the hips allowing the operator to get in closer and avoid leaning forward. One key factor in purchasing a saddle is the ability to adjust the seat pan to individual anatomy for ideal fit.

Ergonomic training is another highly impactful way to reduce injuries for dental clinicians. Until deflection loupes entered the equation, ergonomic training was THE most effective means of preventing workplace injury. (5) One on one in person time with a dental ergonomics specialist with patients in the chair provides real time feedback of actual experiences and guidance on individual operator positioning, patient positioning and ergonomic strategies to be employed during practice. It’s the ergonomic things we were supposed to practice during school that were often neglected to learn our craft.

Force is another major player for endodontists. The repetitive pressure applied to a twisting file to dive into a canal is a musculoskeletal disorder waiting to happen. Since that part of the procedure is vital, the operator must adapt their body to reduce that potential. Start by pivoting so that the elbow remains down at the side of the body. This may require moving clock positions to marry the hip on the filing hand to the patient shoulder.

One last factor worth mentioning is body preparation. Dentistry – regardless of specialty – is physically intense. It requires muscular integrity to maintain neutral posture. It also demands that we release chronically tight muscles like the chest, shoulders, back and hip flexors as well as modify our ergonomic strategies and equipment to reduce pain (6).  Many dental professionals schedule routine yoga or massage therapy appointments to get a release of these muscles while others stretch for themselves daily rather than let the muscle tightness accumulate to a point of discomfort. There is a difference between releasing tight muscles and developing adequate musculature for postural support. Stretching doesn’t build muscle. Resistance training is how muscle is built. Dental clinicians that routinely exercise in this way find a significant reduction in pain and prevent unnecessary injury. (7)

Ergonomics is about protecting the worker from workplace injury. It takes some consistent small mindful strategies, some quality equipment and body preparation to make that happen. Instead of doing the same thing we’ve been doing and hoping for different results, try just one suggestion here and see what happens!

1. Zarra T, Lambrianidis T. Musculoskeletal disorders amongst Greek endodontists: a national questionnaire survey. Int Endod J. 2014 Aug;47(8):791-801. doi: 10.1111/iej.12219. Epub 2014 Jan 11. PMID: 24283200.
2. Kumar M, Pai KM, Vineetha R. Occupation-related musculoskeletal disorders among dental professionals. Med Pharm Rep. 2020 Oct;93(4):405-409. doi: 10.15386/mpr-1581. Epub 2020 Oct 25. PMID: 33225267; PMCID: PMC7664727.
3. Pejcić N, Jovicić MĐ, Miljković N, Popović DB, Petrović V. Posture in dentists: Sitting vs. standing positions during dentistry work–An EMG study. Srp Arh Celok Lek. 2016 Mar-Apr;144(3-4):181-7. PMID: 27483563.
4. Labbafinejad, Y., Ghasemi, M. S., Bagherzadeh, A., Aazami, H., Eslami-Farsani, M., & Dehghan, N. (2017). Saddle seat reduces musculoskeletal discomfort in microsurgery surgeons. International Journal of Occupational Safety and Ergonomics, 25(4), 545–550. https://doi.org/10.1080/10803548.2017.1389463
5. Lietz J, Ulusoy N, Nienhaus A. Prevention of Musculoskeletal Diseases and Pain among Dental Professionals through Ergonomic Interventions: A Systematic Literature Review. Int J Environ Res Public Health. 2020 May 16;17(10):3482. doi: 10.3390/ijerph17103482. PMID: 32429439; PMCID: PMC7277669.
6. Shariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther. 2018 Mar-Apr;22(2):144-153. doi: 10.1016/j.bjpt.2017.09.003. Epub 2017 Sep 6. PMID: 28939263; PMCID: PMC5883995.
7. Holzgreve F, Fraeulin L, Maurer-Grubinger C, Betz W, Erbe C, Weis T, Janssen K, Schulte L, de Boer A, Nienhaus A, Groneberg DA, Ohlendorf D. Effects of Resistance Training as a Behavioural Preventive Measure on Musculoskeletal Complaints, Maximum Strength and Ergonomic Risk in Dentists and Dental Assistants. Sensors (Basel). 2022 Oct 21;22(20):8069. doi: 10.3390/s22208069. PMID: 36298418; PMCID: PMC9609802.

Katrina Klein RDH, CEAS, CPT has been a practicing registered dental hygienist since 2007. She is the founder of ErgoFitLife and can be reached at ergofitlife.com/.