Impact of Enhanced Visualization Techniques and/or Microsurgery on Ergonomics

An advantage of magnification use during the delivery of dental care is the reduction in practitioner malposition resulting in poor ergonomic form and subsequent potential injury. Work-related musculoskeletal disorders are common among dentists due to the repetitive, forceful or prolonged exertions of the hands and prolonged awkward postures.⁷⁸ In fact, it has been reported that nearly 30% of dentists who retire early do so due to musculoskeletal disorders that make practicing difficult and/or uncomfortable.⁷⁹ Proper positioning and ergonomics in dentistry is critical to the efficient and effective delivery of dental care as well as the maintenance of high levels of clinical skill throughout the working life of the dental healthcare professional. Practitioner posture is considered critical to avoiding many work-related musculoskeletal injuries for dentists and the following recommendations on ideal posture have been made:⁸⁰

• Always try to maintain an erect posture

• Use an adjustable chair with lumbar, thoracic and arm support

• Work with hands location close to the body, not extended

• Minimize excessive wrist movements

• Avoid excessive finger movements

• Alternate work positions between sitting and standing

• Adjust the height of the practitioner’s chair and the patient's chair to a comfortable level

• Consider horizontal patient positioning

• Check the placement of the adjustable light

Given these recommendations, the use of magnification may be critical in helping dental healthcare professionals achieve optimal ergonomic posture.⁸¹ In a survey deployed to dental healthcare providers, the use of magnification was reported to improve practitioner comfort in 89% of cases.⁸² The use of loupes by dentists and dental hygienists have been associated with improved posture and a more neutral body position when fitted properly.^81,83-85 Both the dental endoscope and dental microscope require the practitioner to focus in front of them. The endoscope provides visualization on the external screen and the fixed eyepieces of the operating microscope necessitate an erect, forward positioning. Furthermore, it should be noted that unlike loupes, which generally have converging optics, the optics of a microscope are parallel, which can reduce the need for eye accommodation and decrease eye strain over time and decrease ocular fatigue.⁴⁵