Cumulative Trauma Syndrome
MANAGING CUMULATIVE TRAUMA SYNDROME
Dental hygiene occupational risk factors.
Part 1-Repetitiveness:
Risk ChecklistPreventive strategies
  • Are you scheduling more than two consecutive root planing appointments?
  • Are you scheduling more than two consecutive difficult patients?
  • Do you use ultrasonic or sonic scalers infrequently or not at all?
  • Are you repeating the same hand motions or position for prolonged periods?
  • Allow sufficient time to treat the needs of the patient.
  • Regulate the total number and scheduling of patients requiring hand-intensive motions.
  • Alternate debridement and root planing within the same appointment.
  • Vary hand-intensive activities by interspersing procedures such as radiographs, home care instructions, and selective polishing with debridement and root planing.
  • Use very sharp instruments.
  • Shorten the patient's recall interval.
  • Maximize use of ultrasonic scalers
Part 2- Force
Risk ChecklistPreventive strategies
  • Are you using a constant, pinching grasp during both exploring and working strokes?
  • Are your instrument handles smooth?
  • Use minimum pressure in instrument grasp
  • Increase pressure with grasp only when deposits are engaged or in the early stages of root planning.
  • Use instruments of adequate weight
  • Select instruments handles that are serrated or textured
  • Use sharp instruments
Part 3 - Force - Posture
Risk ChecklistPreventive strategies
  • Operator Posture
    • Are your shoulders elevated and/or one higher than the other?
    • Are your wrists flexed of extended during sealing?
  • Operator/patient position
    • Are your elbows elevated more than 30?
    • Is your back bent and is your head unsupported by your spine?
  • Relax shoulders; keep them even and parallel to the floor.
  • Resist elevating elbows above 30.
  • Avoid prolonged ulnar deviation.
  • Reduce wrist flexion and extension; keep wrist in a neutral position with the hand/arm straight (patient height will help control this).
  • Use full-arm strokes rather than wrist of finger action.
Part 4- Mechanical Stresses
Risk ChecklistPreventive strategies
  • What is the diameter of your instruments?
  • Are instrument handles hexagonal?
  • Are hand piece cords short or curly?
  • Are hand pieces unbalanced?
  • Are your gloves ill-fitting?
  • Choose larger diameter, round instrument handles.
  • Use contra angled instruments in anterior treatment to help maintain neutral wrist position.
  • Avoid heavy, unbalanced hand pieces.
  • Select contra angled rather than right-angled prophy angles.
  • Avoid short and curled cords or retractable cords that pull on the wrists.
  • Wear properly fitted gloves.
Part 5- Temperature
Risk ChecklistPreventive strategies
  • Is the operatory cold?
  • Is there a cold air vent directed towards the employees?
  • Are instruments cold when being used?
  • Are hands being washed with cold water?
  • Avoid cold drafts and cold air exhaust.
  • Work in warm rooms, wear warm clothing.
  • Use warm water to wash hands.
  • Exercise hand for muscle warm-up and to relax muscles between patients.

This completes a 5 part series on Cumulative Trauma Syndrome, and managing the dental hygiene occupational risk factor for this exposure. The Series covered the following topics:

Lost time from injuries contributes to office inefficiencies. Although it may not be practical to eliminate all potential risk exposures, it is logical to identify as many risk factors as possible, then modify behavior and implement preventative strategies to reduce loss potential.

If you need any of the information from past articles concerning these risk factors and preventative strategies, please contact our office.