An Assessment of the Postural Risks in Dentistry and of the Potential for Passive Exoskeletons to Mitigate Musculoskeletal Risks among Dental Professionals

Abstract

Dental health professionals—comprising Dentists, dental Hygienists, and dental Assistants—are exposed to prolonged non-neutral static postures that partially account for them experiencing a relatively high prevalence of musculoskeletal disorders (MSDs). For example, approximately 70% of Dentists report experiencing symptoms of MSDs over the previous year, with the most affected regions being the neck, shoulders, and back. However, there have been no reported efforts to objectively record postural exposures throughout a work-shift, in a real-world environment, among American dental health professionals, or to directly compare risks between clinical roles. Exoskeletons (EXOs), though, could be of benefit, as this technology can reduce physical load at target body segments, such as the low back or shoulders. EXOs effectively reduce muscle activation in static holding tasks and have demonstrated potential benefits for some simulated healthcare procedures. However, the applicability of EXOs to dentistry is currently unclear, and their use over prolonged periods, such as a full work-shift, has not commonly been evaluated. The purpose of this dissertation was to assess the postural exposures of Dentists, dental Assistants, and dental Hygienists, and to test the effectiveness and acceptance of EXOs among these workers. Specifically, the first study surveyed dental clinical staff on their chronic pain and fatigue, aspects of their workplace that might influence pain, and their impressions of multiple kinds of EXOs. Major results from this study were that back-support EXOs may receive acceptance in dentistry, and that workers experiencing pain would be more open to trying an EXO. Study two used occupational motion capture via inertial measurement units to quantify the differences in exposures between clinical roles. There were clear differences in exposure characteristics between roles and the usage of loupes. Hygienists had least severe postures but the greatest discomfort, potentially due to low exposure variability/high routinization of their job. Further, use of standard loupes was associated with more extreme postures. Participants in a follow up from Study two used an EXO to assess acceptability across dental clinical workers in real-world working scenarios. Minor reductions in lower back discomfort were reported over one dental shift. Participants performed less trunk flexion during EXO use and compensated with greater neck and arm flexions. Overall impressions of the EXO were positive; all participants agreed that EXOs have a place in dentistry due to prevalent back pain, however concern about sizing the device for a wider array of body types was noted. Overall, results of this dissertation indicate that EXOs could be a valuable intervention in dentistry, especially for Hygienists, who modified their work exposures the least during use. EXOs may need to be combined with newer ergo loupes, though, to effectively mitigate both back and neck risk, and concerns regarding sanitizing the device need to be addressed. In conclusion, dentistry has a wider array of exposures than just static bending, and interventions should consider the unique risks of each clinical role to successfully reduce WMSD risk.