We are writing regarding Dr. David Rempel and colleagues’ August JADA article, "The Effects of Periodontal Instrument Handle Design on Hand Muscle Load and Pinch Force" (
JADA 2006;137[8]: 1123–30
).
We agree that ergonomic instrument design research is needed in dentistry and value this contribution. However, we were disappointed with the misperceptions promulgated by the authors about the frequency of musculoskeletal disorders (MSDs) in dentistry. In addition, this article missed including an accurate presentation of current knowledge in the field, which is essential for credible and objective science.
The authors cited only a few studies on the frequency of dental MSDs, most of which were based on symptom and survey data that inaccurately characterize the issue. As shown in earlier studies, and noted by Anton and colleagues,1 using self-reported symptoms alone grossly inflates estimates of MSD prevalence. Critical studies using objective current diagnostic standards based on electrodiagnostic nerve or muscle conduction testing were not included.
The authors also ignored existing studies that had been conducted in dentistry using these standard diagnostic techniques. In a collaborative study with the American Dental Association, we reported a 3 percent prevalence of carpal tunnel syndrome (CTS)—a commonly reported MSD—in dentists, based on clinical and electrodiagnostic measures.2 This level is similar to that reported in dental hygienists, dental students and the general population using similar electrodiagnostic methods.3,4
Sadly, by reporting inflated estimates of CTS and MSDs, the authors may be diverting appropriate attention from the higher prevalence (13 percent) of upper-extremity tendonitis in dental hygienists, which likely is related to awkward postures.3
Better instrument design should be developed to mitigate problems associated with forceful pinching and hand pain. Here also, these authors failed to note other work5 regarding the ergonomic impact of dental hygiene mirror diameter and weight, which would have added collaborative value to the discussion.
In select professions, poor ergonomic practices have been linked to MSDs, which can be painful and affect workers’ quality of life. However, poor presentation of current knowledge about MSDs confuses dental professionals and encourages them to be motivated by fear, rather than fact.
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