A dental faculty member works with dental students.

Work doesn’t have to hurt

It wasn’t until after surgery to relieve the pain and spasms in her arm that Juanita Lozano-Pineda, DDS, MPH, began to appreciate the power of ergonomics to help dentists prevent work-related musculoskeletal disorders.

“Nothing could touch my arm because it was so sensitive,” said Lozano-Pineda, associate dean for external affairs and associate professor of comprehensive dentistry in the School of Dentistry. “It was very uncomfortable, and I tried to continue to work through it but found it was very frustrating because of how it was limiting things for me.”

Lozano-Pineda had not been trained in ergonomics when she was in dental school. She didn’t realize how important it is to ensure proper posture and positioning of both the dentist and patient relative to the type of procedure being performed.

“I was unaware of what could potentially be causing the problems until I sought care for my symptoms,” she said.

Department of Occupational Therapy Associate Professor Ricky Joseph, PhD, OTR, reviews concepts with dental students during an interprofessional ergonomics activity.

Department of Occupational Therapy Associate Professor Ricky Joseph, PhD, OTR, reviews concepts with dental students during an interprofessional ergonomics activity.Ergonomics and Musculoskeletal Disorder Interprofessional Education received a Linking Interprofessional Networks for Collaboration seed grant in 2019. The project was a finalist among 18 innovation projects submitted from across the UT System at the 2021 University of Texas Kenneth I. Shine Academy of Health Science Education Conference. The project also was presented at the 2021 American Dental Educational Association Annual Session & Exhibition, the American Physical Therapy Association Education Leadership Conference and Nexus Summit 2020.

After her surgery for two herniated cervical disks, Lozano-Pineda started questioning what she could have done to avoid injury. As she researched, she learned that musculoskeletal disorders frequently derail the careers of dentists and dental hygienists, as the very nature of their work puts them at risk for a number of musculoskeletal injuries. For dentists, neck and lower back pain is a prevalent risk, as are repetitive-motion injuries for hygienists and periodontists. Static work, repetition, strained or constrained posture, vibrating instruments and improper seat and body positions contribute to cumulative damage that can lead to pain — and even early retirement.

Common musculoskeletal disorders resulting from prolonged postures include chronic lower back pain, tension neck syndrome, trapezius myalgia and rotator cuff impingement. Repetitive movements can cause disorders including carpal tunnel syndrome, ulnar neuropathy and thoracic outlet syndrome.

Lozano-Pineda wanted to help others avoid pain and career-ending injury, so in 2006, she began lecturing first-year dental students on ergonomics to let them know the risks of their future profession and how to mitigate them. That lecture has since evolved into a three-part interprofessional program that includes faculty and students from the departments of occupational therapy and physical therapy in the School of Health Professions.

An interprofessional approach

Lozano-Pineda began collaborating with Department of Occupational Therapy faculty members Associate Professor Ricky Joseph, PhD, OTR, and Associate Professor Kimatha Grice, OTD, OTR, CHT, to give students more information about how to reduce their chance of injury by creating an optimized work environment. Soon, Associate Professor Michael Geelhoed, DPT, OCS, MTC, director of clinical education in the Department of Physical Therapy, joined the project to provide the PT perspective on exercise to prevent — and rehabilitate — work-related damage.

“The way we designed it is to have the students work alongside each other so they can learn from each other,” Lozano-Pineda said. “This was all didactic material that was being taught separately to these students, and this was an opportunity for us to enhance the learning experience and have them learn from each other as the information was being applied.”

During the project’s first stage, first-year dental students receive an ergonomics lecture from Lozano-Pineda and occupational therapy faculty as they begin their first semester. That is followed by practice in the lab, where dental students practice proper patient and clinician seating and posture while receiving real-time feedback from OT faculty, students and Lozano-Pineda.

In the subsequent stages of the project, second-year occupational therapy students observe and evaluate third-year dental students as they treat patients in the clinic and provide written assessments of how they follow ergonomic principles, with notes for how they can improve. First-year dental students also meet with second-year physical therapy students, who provide evaluations of any existing issues students may have, as well as recommendations.

Responses to pre- and post-program surveys have shown that the program is making a difference for dental students, Joseph said.

“We observed there was a lot of carryover of the skills and knowledge,” he said.

infographic displaying types of musculoskeletal disorders and how to avoid them.Make the workplace fit you

Occupational therapists aim to help people function and achieve their daily goals.

“As OTs, we look at functioning and what is stopping you from doing things you want or have to do,” Joseph told first-year dental students in his portion of the lecture this summer.

Joseph emphasizes the importance of setting up a workplace that is designed for optimal physical and visual accessibility, as well as smart traffic flow. That same attention to optimized practice is necessary to make sure that the body is positioned correctly for the task at hand. But it’s not enough for dentists to adjust their seats and monitor their body positioning, Joseph tells dental students. Exercise and proper sleep are other important habits that can help reduce the risk for musculoskeletal disorders.

“Sleep-rest cycles are so important when performing physical or repetitive work,” Joseph said. “When you go to bed at night, think about how you prepare yourself to go to sleep.”

Repairing the damage

The cumulative damage of unaddressed musculoskeletal pain can lead to an injury, Lozano-Pineda said. When an injury occurs, physical therapy can repair the damage.

“PT helps you undo what has been done,” she told students in one of her summer lectures, explaining that physical therapy stretches shortened, contracted muscles and strengthens elongated, weak muscles.

Getting proper exercise and remediating damage after work is another important strategy for reducing the risk for work-related musculoskeletal disorders, Geelhoed said. He gives a guest lecture to first-year dental students on injury prevention.

“It’s primarily exercise advice to prevent neck and back pain since those are more common in dentists than in the general population,” he said.

The role of physical therapy in treating pain is reinforced during the meeting between dental students and second-year Doctor of Physical Therapy students in the PT lab. There, the DPT students perform assessments on the dental students to identify issues already occurring and can provide treatment. The activity allows PT students to share their knowledge.

“The benefits for our DPT students are huge,” Geelhoed said. “It really builds their confidence because they realize they truly know how to do this.”

Getting an early start

For second-year Doctor of Occupational Therapy student Roland Martinez, the opportunity to share best practices and to participate in the ergonomics project allowed him to delve into his future profession.

“What we are doing is pretty advanced, especially to be able to do it as a second-year student,” he said. “No one likes to be sore or in pain.”

Martinez helped evaluate dental students as they practiced ergonomic positioning during lab. Dental students in one of his groups said they found the ergonomics lecture and lab practice to be eye-opening and informative — from selecting the correct height of chairs to learning the concept of adjusting their work environment to fit them rather than fitting themselves into the existing environment.

“I didn’t know the meaning of ergonomics” before the lecture, first-year dental student Samantha Perez said after practicing her positioning under Martinez’s watchful eye. As a new dental student, Perez said she appreciated the lecture.

“We want to extend our careers as much as we can,” she said.

Before starting dental school, Elisama Navarro was a dental hygienist. She has had personal experience with the pain a career in the dental field can bring.

“I would feel it in my wrists,” Navarro said.

Joseph told dental students that it’s their responsibility to be proactive as they embark upon their careers.

“You are in charge of your health,” he said.

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