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Caylin Levin
ENC 1102-0M12
April 12, 2015
Research Dossier: Ergonomics in Orthodontics
Introduction:
The subject of my paper is about the evidence dentists and
orthodontics have with the ergonomics in their field, and how they can
try to reduce and or prevent that about of pain. Ergonomics is the
study of peoples productivity within their field of work. There is a lot of
research out there about how dentists and orthodontics have a lot of
pain in the neck and back which could potentially decrease their
efficiency in the work place. There is a lot of research and studies done
to showing how much dentists and orthodontists suffer with their years
of work. There are many ways to relieve that pain by doing things like
taking a pain pill or going to a chiropractor, but overall these options
will only lessen the pain for a short amount of time. Im looking for the
best options to reduce the MSDs before they even happen. To do so I
will further my discussion more about the effectives of having special
ergonomic friendly furniture, how taking longer breaks would benefit
the worker enormously, and how doing things like yoga will not only
help with the physical aspect but also the mental one. I believe going
into the profession (hopefully) that this will be a very valuable topic to
have a lot of knowledge on because then I may know what type of
precautions to take.
Saying musculoskeletal pain is more frequently noted by oral
health providers than any other occupational hazard could be a
biased and other people may have different perspectives as to why
one would think oral health providers have more documented
musculoskeletal pain then any other profession. You can also look at
the difference between male and female dentists and the difference in
ages and see if the outcomes are different. Other then that there arent
different perspectives that Ive noticed when Ive doing my research
thus far. Its a fact based on evidence not opinion. The perspectives Im
looking further into are the effects of having ergonomic furniture,
taking multiple breaks throughout the workday, and to have required
exercising like yoga. With look at the chair due to the fact that dentists
and orthodontists sit in such awkward positions for such long periods of
time they need some type of chair that supports their uncomfortable
setting. These specific chairs reduce the risk of back pain because
research shows that with the support maintaining the low back curve
when sitting can reduce or prevent low back pain. It will also cut back
on the amount of neck problems because of the head rests, so having

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these items in a profession that has a record of back and neck pain
would be ideal. Normal chairs tend to have a hard surface, so when sat
upon there is an excess amount of pressure on your hips, but with
ergonomic chairs theres a seat depth that reduces the pressure on
your hips, and thats just another added indulgence. With looking into
the breaks, dentists and orthodontics have less breaks nowadays due
to the increase of patients with their busy schedules, trying to fit
everyone is a task all by itself. But if dentists and orthodontists were
able to stand up and takes short breaks after being in such awkward
positions then it would increase their productivity because it will
decrease the amount of pain. And thirdly is using yoga as a pain
reliever. Yoga isnt only a way to stay fit, but its also a healthy lifestyle
that you can only benefit from. It is built to emphasize the your
strength in the core area and when worked out properly your posture is
improved, which then leads the alleviating back, shoulder, and neck
pain. Dentists and orthodontists should partake in this exercise to try
and reduce their injuries or at least try to relive them.
The further research I would like to do is interview a dentist or
orthodontist about their experiences with my topic. I actually know a
family friend who is a dentist, so to further my evidence I can interview
her a series of questions about whether or not she has ever
experienced pain from being a dentist for said years.
My research will be relevant to anyone looking to become apart
of the dental field. It will inform future dentists and orthodontics how
the so-called risks they would be taking on when entering this field
with. This is something Ive never thought about until furthering my
research so Im pretty sure more then half of my audience will not
know anything about the ergonomics in this field.
Research Map/Calendar
One (2-3 research questions that emerge from your prior knowledge in
relation to your future profession and are grounded in your major):

Is there any form of evidence that being a dentist or

orthodontics causes injury?
If so what is it and why does it happen?
How can you prevent it from happening or decrease the pain?

Two (Make a list of 3-5 keywords and phrases for research):

Ergonomics in dentists/orthodontics
Prevention of ergonomics with dentists
Why do dentists and orthodontics have neck/back pains
Ergonomics evidence with orthodontics

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Work related musculoskeletal disorders

Three (List also your types research: Library research, internet

research, and field research):

I will be conducting mostly library (One Search/ UCF Database)

and internet (Popular sources and public opinion articles)
research; however as time progresses I am hoping to get an
interview with family orthodontist that could probably give more
insight into the thoughts behind stem cells from a personal
viewpoint.

Four: Have any issues similar to my issue concerned other researchers

in the recent past? If so, when and where?
There are ergonomics in probably every field out there like
nurses being on their feet all day can prevent them from
preforming to their best potential because there have swollen
feet, or firefighters being in contact with a lot of smoke can
hurt their immune system, and athletes as well probably have
it the worst. No pain no gain right?
Five: Include a table with major deadlines (from the syllabus) and
events, such as weddings, trips, spring break, conferences, athletic
events, concerts, etc., that guides your research times. Cover the time
from today till publication of e-portfolio to help you plan and manage
your time:

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Annotated Bibliography
Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal
disorders in dentists. BMC Musculoskelet Disord. 2004;5:16.
The aim of this study was to investigate the relations between
physical, psychosocial, and individual characteristics and different
endpoints of musculoskeletal complaints of low back, neck, shoulders
and hand/wrist (Alexopoulos, Stathi, & Charizani).
This will help with providing a comparison between the physical and
psychosocial complaints that dentists may have.
Alexopoulos EC is the main author of this article and is in the
Department of Public Health, School of Medicine, University of Patras,
Greece. He is an author of many article dealing with back pain, health
care, musculoskeletal disorders and occupational injuries.
Baheti, Mayuresh J., Dr., and Nandlal G. Toshniwal, Dr. "Ergonomics: A
Pain Free Dentistry for Professionals." Orthodontics (2014): 5461. Your Guide on the Path of Dentistry. Web. 2 Mar. 2015.
One of the most prevalent types of work-related injuries are
musculoskeletal disorders. Work-related musculoskeletal disorders
(WRMDs) result in persistent pain, loss of functional capacity and work
disability, but initial diagnosis is difficult because they are mainly
based on complaints of pain and symptoms. An ounce of prevention is
better than pounds of cure Thats what dental health care workers
spend their day telling their patients, but it also applies to working
conditions that can cause pain in the neck, shoulder and hand to a
dentist. Dentists and dental students often assume awkward physical
positions while providing treatment to (a) get a better view of the
intraoral cavity; (b) provide a more comfortable position for the
patient; and/or (c) operate equipment and reach for instruments and
supplies. This update reviews various causes, signs, symptoms of
musculoskeletal disorder and their preventive measures and various
exercises to work with comfort, efficiency and ease (Baheti &
Nandlal).
This will be beneficial to me in my paper because it gives three reasons
as to why and how the dentist is receiving this pain and also gives
ways to prevent it.
"Ergonomics ... How Does Dentistry Fit You?" DentistryIQ. The Dentistry
Network, Web. 02 Mar. 2015.

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Dentists are at high risk for musculoskeletal disorders due to the
nature of their work. Musculoskeletal pain is more frequently noted by
oral health providers than any other occupational hazard, including
communicable diseases and other physical and emotional disorders. A
survey published in the Journal of the California Dental Association in
February 20021 found that 61 percent of dentists surveyed said they
had experienced work-related neck pain during the year; 51 percent
reported lower-back problems; 44 percent said they had shoulder pain;
43 percent had upper-back pain; 38 percent reported hand pain; 30
percent mentioned mid-back pain; 14 percent indicated arm pain; and
10 percent reported leg pain. Dentists lose millions of dollars a year
because they have to cancel patient appointments or can't work due to
musculoskeletal pain (Ergonomics ... How Does Dentistry Fit You?).
This will be beneficial to me because it includes statistics and with that
I can provide a chart, which will include a visual in my research paper.
Saying musculoskeletal pain is more frequently noted by oral health
providers than any other occupational hazard could be a biased and
other people may have different perspectives as to why one would
think oral health providers have more documented musculoskeletal
pain then any other profession is a little biased in my opinion.
Finkbeiner, Betty L., and Michael Muscari. "Let Ergonomics and True
Four-handed Dentistry Help You." Let Ergonomics and True Fourhanded Dentistry Help You. The Dentistry Network, Web. 02 Mar.
2015.
The next time you are uncomfortable after a days work, consider
remodeling or building a new office, or when visiting a convention floor
seeking new equipment, ask yourself how wise you are about the
ergonomics of the dental equipment you are considering!(Muscari &
Finkbeiner)
This article will allow for alternative ideas to place equipment in order
to avoide some of the musculoskeletal pain a dentist/orthodontics one
may receive.
Kumar, Dodda K., Neelima Rathan, Sreevalli Mohan, Mohammadi
Begum, Bhanu Prasad, and Eswar Prasad. "Exercise Prescriptions
to Prevent Musculoskeletal Disorders in Dentists." Journal of
Clinical and Diagnostic Research (2014): 13-16. NCBI. Web. 2
Mar. 2015.
Since the number of dental patients is increasing day by day dentists
are forced to spend longer times in dental chairs. This is increasing the

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prevalence of musculoskeletal disorders in dentists. This article reviews
the mechanisms causing musculoskeletal disorders among dentists
and also covers the exercises that can be done to prevent them.
Exercises that increase the fitness of a dentist are divided into aerobic
exercises concentrating on total body fitness, stretching exercises
that concentrate on the muscles that tend to tighten in prolonged
dental postures and strengthening exercises that concentrate on the
muscles that are opposite to the tight muscles. These exercises are
made simple and of minimal intensity so that a dentist can practice
them independently(Kumar, Neelima, Sreevalli, Begum, Prasad, &
Prasad).
This talks about how dentists are being required to work longer hours
which increases the amount of musculoskeletal disorders, so this
article gives ideas for exercising that will increase fitness.
Mostamand, J., H. Lotfi, and N. Safi. "Ergonomics: Evaluating the Head
Posture of Dentists with No Neck Pain." Journal of Bodywork &
Movement Therapies (2013): 430-33. ScienceDirect. Web. 2 Mar.
2015.
Dentistry is one of the professions that requires a high degree of
concentration during the treatment of patients. There are many
predisposing factors, affecting dentists when working on the patient's
teeth, including neck flexion, arm abduction and inflexible postural
positions, which may put them at the risk of developing
musculoskeletal disorders related to the neck. Although dentists with
long records of service show different levels of pain and discomfort in
their necks, there is no evidence regarding whether younger dentists
report neck pain before the onset of an abnormal condition in this
region, including forward head posture (FHP). Discovering any
alteration in the head posture of dentists might confirm one of the
reasons for neck pain in this population(Mostamand, Lotfi, & Safi).
This talks about the concentration and results of being so still and
concentrated in such awkward situations as a dentist, which have an
effect on their neck, arms, and posture.
Nutalapati, Rajasekhar, Rajasekhar Gaddipati, Harini Chitta, Mallika
Pinninti, and Ramanarayana Boyapati. "Ergonomics in Dentistry
and the Prevention of Musculoskeletal Disorders in Dentists." The
Internet Journal of Occupational Health Volume 1 Number 1.
Internet Scientific Publications. Web. 02 Mar. 2015.
Recently, Ergonomics has become a popular term. The term has
been used with most professions, but increasingly in the dental

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profession. It is a discipline that studies workers and their relationship
to their occupational environment. This includes many different
concepts such as how dentists position themselves and their patients,
how they utilize equipment, how work areas are designed and how all
of these impact the health of dentists. Good working ergonomics is
essential so that work capability, efficiency and high clinical level of
treatment can be maintained throughout the working life of dental
professionals. The scope of ergonomics in dentistry is
large(Nutalapati, Rajasekhar, Harini, & Mallika).
This helps with the definition of ergonomics and how it is increasing in
the dental world and why.
Rajasekhar Nutalapati is a senior lecturer, apart of the department of
periodontics, with mamata Dental College. Rajasekhar Gaddipatiis a
professor and head, department of Oral and Maxillofacial surgery, with
Mamata Dental College, Harini Chitta is a consultant dental surgeon.
Mallika Pinninti is also a consultant dental surgeon. And finally
Ramanarayana Boyapati is a post graduate trainee, apart of the
department of periodontics, with Sibar Institute of Dental Sciences.
Rafeemanesh, Ehsan, Zahra Jafari, Farzad Omidi Kashani, and Farzaneh
Rahimpour. "A Study on Job Postures and Musculoskeletal
Illnesses in Dentists." International Journal of Occupational
Medicine and Environmental Health 26.4 (2013): 615-20. Versita.
Web. 2 Mar. 2015.
Objectives: Musculoskeletal disorders (MSDs) compose a large part of
occupational diseases in dental professionals, prevention of which is
dependent on assessment and improvement of job postures by means
of ergonomic interventions. This study was aimed at evaluation of
ergonomic conditions of the profession of dentists and also at
assessing the relationship between MSDs and conditions of work.
Materials and Methods: This cross-sectional study was performed
among 65 dentists using the method of Rapid Entire Body Assessment
(REBA). The prevalence of MSDs was obtained by the use of the Nordic
Musculoskeletal Questionnaire (NMQ). Results: In this investigation, the
prevalence of MSDs for different body parts was: 75.9% for the neck,
58.6% for the shoulders, 56.9% for the upper back, 48.3% for the lower
back and 44.8% for the wrist. Job analysis by the use of REBA showed
that 89.6% of limbs in group A and 79.3% of limbs in group B had a
score > 4. Only neck and lower back pains have significant relationship
with the risk levels obtained using the REBA method. Conclusions: It
can be concluded that work postures of dentists need to be improved.
In addition to education, work station design, rest period during work

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and regular physical activities should be taken into
account(Rafeemanesh, Zahra, Farzad, & Farzaneh).
This article also gives statistics, which could be very useful, and I could
compare it to the previous article and talk about the similarities and
differences.
W

Ehsan Rafeemanesh is in occupational medicine, a faculty of

medicine, with Mashhad University of Medical Sciences, in Mashhad,
Iran. Zahra Jafari is in Occupational Medicine Department, a faculty of
medicine, Pardis, Park square, Mashhad, Iran. Farzad Omidi Kashani is
in the Occupational & Environmental Health Department, TorghabeShandiz Health Center, Mashhad University of Medical Sciences,
Mashhad, Iran. And finally Farzaneh Rahimpour Orthopedic, Faculty of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

W
Ratzon NZ, Yaros T, Mizlik A, et al. Musculoskeletal symptoms among
dentists in relation to work posture. Work. 2000;15:153-158.
Dentists who work in the sitting position have more severe low back
pain than do those who alternate between sitting and standing despite
the fact that those who sat at least 80% of the time worked less hours
and had less of a workload during their working hours. This suggests
that altering position should be recommended to dentists. An
intervention study, however, is needed to demonstrate that changing
posture will decrease the prevalence of low back pain in
dentists(Ratzon, Yaros, & Mizlik).
This talks about how moving around and changing positions ever so
often from sitting to standing can be extremely beneficial.
Rundcrantz BL, Johnsson B, Moritz U. Cervical pain and discomfort
among dentists. Epidemiological, clinical and therapeutic
aspects. Part 1. A survey of pain and discomfort. Swed Dent J.
1990;14:71-80.
The aim of the investigation was to study the frequency of pain, ache
and discomfort in the musculoskeletal system among dentists, above
all concerning headache, cervical and shoulder pain and further, to find
possible correlations between these symptoms and various working
positions and different working actions. A questionnaire was answered
by 359 dentists (90.8%). Of those who answered the questionnaire
72% had pain and discomfort from either the neck, shoulders or
headaches. Only 60 dentists had no pain or discomfort. Concerning the
male dentists, the investigation revealed that younger dentists had

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pain and discomfort in the neck, shoulders and headaches to a greater
extent than the older dentists. Younger female dentists had a
significantly higher frequency of pain and discomfort in the neck and
headaches than older colleagues. The results showed that dentist who
positioned the patient carefully so that a direct view gained had a
significantly lower frequency of headaches. Of the 359 dentists 55%
mostly used the mirror to facilitate a direct view. From the answers it
was clear that those dentists who did not have discomfort in the upper
locomotor system used the mirror more often than those who did suffer
discomfort(Rundcrantz & Johnsson).
This mentions a questionnaire surveyed by dentists talking about
whether or not the have discomfort is the joints most commonly seen.
It compares males to females and ages.
Sachan, Avesh, Karuna Singh, Sujit Panda, and Vinaykumar Verma.
"Ergonomics, Posture and Exercises - Painfree, Prolong
Orthodontic Career." Journal of Orthodontic Research 1.3 (2013):
89. Web. 2 Mar. 2015.
Orthodontists are exposed to several occupational hazards. Back and
neck pain arising due to improper posture is very common in this
community. The nature of work entails abnormal flexion of the lumber
spine and subsequent loading on the inter-vertebral disks or extra
tension in the spinous ligaments causing musculoskeletal disorders.
Neck and shoulder, lower back, hand and wrist are the most commonly
involved regions. Obtain an accurate diagnosis from a qualified
healthcare provider. Early intervention is the key. Treatment may range
from pain relief medications and rest to surgery and ergonomic
interventions at work place and home. The current paper discusses
etiology of musculoskeletal disorders (MSD) preventive measures,
which can be incorporated to ensure a trouble free professional
career. (Sachan, Singh, Sujit,, & Verma).
This just talks about the different pains and musculoskeletal disorders
most commonly see in dentists because of their improper postured for
a long period of time.
Avesh Sachan, Vinay Kumar Verma, Sujit Panda, Karuna Singh are all
apart of the Department of Orthodontics, Rama Dental College,
Hospital and Research centre, Kanpur, Uttar Pradesh, India
Valachi, Bethany. "Ergonomic Positioning: A Few Degrees Add Years to
Your Career." Ergonomic Positioning: A Few Degrees Add Years to
Your Career. Dentistry Today, 10 Sept. 2010. Web. 01 Mar. 2015.
With tight patient schedules, emergencies, and production goals to

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consider, it is easy to overlook proper patient positioning. However,
taking the time to position the patient, dentist, assistant, and
equipment properly can not only have positive ramifications for the
operators posture, comfort, and career longevityit can also lead to
better treatment and increased productivity(Valachi).
This talks about the different ways to receive more comfort and have a
longer lasting career with less pain.
Valachi was originally a physical therapist, but when she married a
dentist with back pain she became full time dental ergonomic speaker
and is the founder and CEO of Posturedontics, which is a company that
provides information on dental ergonomic education and evaluates
dental products