The Compliance Divas Podcast
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The Compliance Divas Podcast
#191 Dentistry Doesn't Have to Be a Pain
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This episode brings to light how you can prevent pain, boost productivity and extend your dental career with evidenced-based ergonomics. We interviewed Dr. Bethany Valachi of Posturedontics, an international speaker and author. Be sure to tune in and learn how you can make your job less painful.
Resources:
- Posturedontics: https://posturedontics.com/
- FDI - World Dental Federation - Posture Guidelines for Oral Health Professionals https://www.fdiworlddental.org/sites/default/files/2021-04/FDI_HSDW_ergonomics_and_posture_guidelines_eng_2021.pdf
Welcome.
SPEAKER_01I'm Leslie Cannum. I'm Mary Gavoni.
SPEAKER_00I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas. My name is Olivia Juan, and I'll be your moderator for this episode. This episode is entitled Dentistry Doesn't Have to Be a Pain. How do you feel about your job? Is it a real pain in the neck? Musculoskeletal disorders plague many dental professionals. And we are honored to have an expert with us, Bethany Valahy. I've learned so much from her over the years, and thousands upon thousands of dental professionals have been able to enjoy their jobs better with her recommendations. It's that time of year we're all thinking about improving our health. We hope you enjoy this episode. So, Bethany, tell us about you and your business posture donics. What's your background?
SPEAKER_02Well, thanks, Olivia. It's really a pleasure to be here on your podcast. My uh background is as a physical therapist, and I got involved in dentistry when I married a dentist with severe low back pain who at the age of 35 was forced to consider selling his dental practice due to that severe low back pain. So I did a lot of research trying to find someone who knew um how to treat this based on the evidence. And this was about 20, 25 years ago, and I couldn't find anyone. So that was the detour out of my um traditional physical therapy career to into dental ergonomics.
SPEAKER_00But you're also a doctor, isn't that right?
SPEAKER_02I am. I was I got my doctorate about eight years ago in physical therapy, and I actually was able to customize it to dental ergonomics. So my doctorate in physical therapy is focused on uh dentists' neck pain head magnification. So I've got a lot to say about that.
SPEAKER_00That's incredible. I know our diva, Mary Gavoni, she was a hygienist in her early life. She couldn't be with us today, but she wanted to talk to you about hygienists. And if you could, Bethany, share with us what is typical for hygienists to suffer with and any recommendations that you have to improve those muscular musculoskeletal disorders that they suffer from.
SPEAKER_02Yeah, um, I found that hygienists tend to have the highest predisposition to neck, shoulder, and hand and wrist pain. So some of the most important interventions are for hygienists, especially truly ergonomic loops. And this has been what I've seen kind of plague hygienists uh for the last 20, 25 years is non-ergonomic loops and actually manufacturers that tell their loops as ergonomic, but the declination angle on them is so poor that it actually forces them into a poor posture. So there fortunately there are some fantastic loops now available. The prismatic deflection loops that have an extreme declination angle are really going. I've seen this really uh turning around and making a it's really going to be a game changer in dentistry uh for dentists and hygienists with neck pain.
SPEAKER_00Bethany, that seems like such a simple fix. Something that could keep them in their profession longer and enjoy their career. Because I know that I've talked to hygienists over the years and some move on to do admin work or even a completely different field because of these musculoskeletal disorders. Now I know Linda had some specific questions that she wanted to reserve for you. Linda.
SPEAKER_03Thank you, Olivia. Bethany, I too am thrilled you're here because I'm not practicing as a hygienist anymore, but just to keep learning more because you know, when I we go through our offices with our clients and we see them sitting chair side and they're not sitting properly, or their neck is twisted, or their arm is way over their head, it doesn't even look right. It looks so uncomfortable. So I think what Olivia said, sometimes our the job can be a pain in the neck. It literally is a pain in the neck, or like in your husband's case, the lower back. Um, so could you talk to us about dentist um and what's what's their pain? What's their recommendation? What yeah, because I know every role in the team has to be a little different, right?
SPEAKER_02Yeah. Uh so dentist, uh, I the most frequent complaint is the neck and the back. And um, with dentists, just as in oral health care, waiting until the painful episode is not a good idea. As every dentist knows, uh we don't want to be waiting until the patient has pain, until we recommend, oh, you should be flossing, brushing, have regular checkups and that. So just as in oral health care, we want to um be preemptive and take some preventive action before the painful episode. And this is what is so hard for dentists to hear because uh very often in times they're coming out of dental school thinking they're pretty invincible, right? It'll they the mindset it will never happen to me. Well, guess what? It does. So with dentists, um, the most important uh concepts here for uh wellness and intervention are to really look at the research of your sources. Um uh just as with anything you want to make sure it's research-based. And uh for instance, would you be taking recommendations for exercise from a personal trainer with a high school education versus a doctor of physical therapy, right? So um look for the education and uh and the credentials. Um, some exercises are actually contraindicated for dentists that aren't a problem for the rest of the population, but for dental professionals, due to their their unique muscle imbalances, it will throw them right into a vicious pain cycle. Uh, the other thing that I'd say is very important for dentists is that they become familiar with the specific um headrests on their patient chairs because the flat versus double articulating headrests are very different in positioning the patient for treating the upper arch. It can make the difference between the doctor practically having to stand on his head when he was looking at the occlusal of number three versus sitting upright with comfortable posture. So um I have a whole one-hour CE course just on that patient positioning um concept. So and what clock position for different quadrants of the mouth and all of that. Very important.
SPEAKER_03So, Bethany, that's good information. And I have a couple follow-up, but I'm gonna kind of summarize what you just said. So it's important that the dentist and maybe everybody on the team take preventive action to watch how you're sitting and be careful of posture. Because if you find yourself starting to go home and you're a little bit tired, a little bit achy, maybe that's beginning signs that you're not in the best posture. And to be sure that you use credentialed professionals and look for dental-specific exercises that are fit for us and not to do something that's gonna perhaps um aggravate whatever's going on, right? And I so appreciate you talking about the patient position. That's another important aspect. But could you make a couple of comments about the loops? You mentioned a type of loop a minute ago. Uh, could we go back to that? Could you re-mention it again and just talk about do you do you think there's more opportunity for us as a profession to be healthier ergonomically and musculoskeletally because of the types of loops that you're recommending? Um and how to evaluate your loops.
SPEAKER_02Yes, that's a great point, Linda. Thank you for going back to that because we really didn't get to talk much about it. So these new loops are called prismatic deflection loops. And if you can imagine like looking into a periscope, right, on a submarine, you're looking straight ahead and the vision is going up. This is the absolute exact reverse. So you're looking straight into the loops and they're looking down into the oral cavity, not at a 90-degree angle, obviously, like a periscope, but of much more extreme than traditional through the lens or flip-up loops. So the most of these flip-up, or sorry, most of these prismatic deflection loops now that have this extreme declination angle are mounted into the carrier lens. So they're not, you know, flip up and movable and that. And that is the type you want uh for the prismatic deflection loops. And how to evaluate these quality is very important. So there are uh some manufacturers that make a little higher quality, lighter weight, wide range of magnification. I would say um on the upper end would be and al medical. Um they make a prismatic deflection loop that goes clear up to from three to 10x. Um they're the lightest weight in my um in my experience. I've evaluated six of these. Um I always evaluate the products that I talk about. And uh and then um Lumident, another good one. Um and yeah, so there's quite a few out there right now. Some of them I've evaluated, some not. And uh I what I don't like that I've seen are uh some of these new prismatic deflection loops that are in a flip-up design because it really makes no sense. The whole purpose of flip-ups is to increase the declination angle and so you can sit up straighter, but with this angle, you're already sitting up straight. So it's just adds another thing that can go out of alignment, I guess, or out of focus. So um, I would just make sure that these prismatic deflection loops mount it directly into the carrier lens. And you're right, Linda, this can be a real game changer today in um in the practice. There is one ergonomic consideration though, with these prismatic deflection loops, and that is because the uh downward view is so steep that imagine you're in the 12 o'clock position and looking at the lower arch. Now you might have to tilt your head slightly backward, right? To view uh that lower arch. And so this is uh so for that reason, my positioning recommendations are very slightly um altered with these loops. The when working on the lower arch, the patient should be a little more reclined than the semi-supine position. Does that make sense? So for the lower arch, normally we put the patient in semi-supine, but with these prismatic deflection loops, we want them a little more toward the supine position so you're not having to tip your head back with the lower arch.
SPEAKER_03Well, that is so fascinating. I'm not practicing anymore, so I'm just trying to envision what I'm seeing from my clinicians that I work with. And I think I have a client who's using the prismatic deflection, although now I know what to ask them when I tell him in. So I was in one day and I was walking down the hallway. And you know, you're just passing an operator as divas do when we're going and we do a mock inspection. So we're not in that room with the patient, but I saw him sitting up very, very erect and his head was looking straight ahead. But I saw his hands in the patient's mouth and almost did a double take like, wait a minute, what's going on here? Because he's his head is his eyes should be looking like at the delicate, but his hands are moving in the mouth. And then I realized secondarily it was the loops because it just took me by surprise.
SPEAKER_02Right.
SPEAKER_03So that's fascinating to learn all this. Thank you so much for sharing. We're glad you're here. Back to you, Olivia.
SPEAKER_00That's great information, Bethany. It seems like this should be taught year one at dental schools so that they can learn this early on. And definitely for our dentists and hygienists that are following the podcast, it would be such a good opportunity to have a consultation with you. So if they're in the market of looking at loops and fighting neck and back pain or shoulder pain, that they can select the right type of loop that would relieve some of these problems. Now, I know Leslie was a dental assistant years ago as I was, and she's anxious to discuss more information that would be relevant to dental assistants.
SPEAKER_01Yeah, Bethany, you know, in California, we have a category of dental assistant. We have registered dental assistant who is able to perform many duties on their own, and then the uh a registered dental assistant in expanded functions. Um now, when I say on their own, I mean that they're the sole provider of the patient in the chair at the time, and the doctors are supervising their uh patient's care. But uh there are many of them, RDAs and RDA in expanded function, EFs, um, they are asking more and more about loops. Some of them have loops already and have found an extreme uh change in their ability to be able to make temporary crowns and do the things that are expanded functions much better than they had before. And I wanted to talk to you about the individuals who are wearing loops, that they should be looking at the same considerations you mentioned for dentists and for hygienists. And then also because they're sitting at a little bit different position, not at the 12 o'clock position, many times we hear about dental assistants who are experiencing pain from having to bend over and contort themselves to be able to not only have uh better access to the patient's mouth, a better view, but be able to be out of the dentist's way enough so that uh treatment can be performed. Can you tell us a little bit about what your recommendations are for assistants?
SPEAKER_02Yes. Um Leslie, the assistants definitely have a whole different uh dynamic in the operatory when they're practicing chairside with the dentist than the rest of the team. So therefore, they're prone to you know different uh musculoskeletal problems. The one of the biggest problems with that uh assistants face is getting close to the oral cavity, because as we know, the patient is 90% of the time being positioned for the doctor, right? Not for their best view, not the assistant. So getting that close proximity is really paramount. And one way that the assistant can, two ways that the assistant can increase the uh proximity. One is to sit with the thighs sloping slightly angled down, which is going to improve their proximity to the oral cavity. They can do this with a saddle style seat on the assisting stool that will get them closer. They're also not having to reach as far to the oral cavity. And the second way is standing. So we know that the assistant of all the team members is most highly prone to low back pain. So the and of the entire team who has the least ability to freely move around the patient in reposition is the assistant, right? So they are most highly prone to low back pain, they can move the least, so therefore, the assistant should be standing for 50% of their treatment time. A lot of people are gonna be shocked when they hear this, but um this is easy, usually easy to do for a medium to short assistant working with a medium to tall height dentist. Now, obviously, it's an ergonomic nightmare for a tall assistant with a short doctor, but rarely does that happen. But something to consider for future interviews, right? So now, when the assistant is working alone, the uh ergonomic considerations are really very similar to the dentist and hygienist, and they should be seriously thinking about um loops, and the cost of the loops is somewhat of a consideration. Um so um you know, because usually the uh expanded functions, they're not what percentage of the time, Leslie, would you say that in California there that they are practicing uh solo versus assisting the doctor?
SPEAKER_01Well, you know, I'll tell you, as much the doctors would like them to do that as much as possible, particularly in some of the fields like orthodontics, where the assistants are are primarily the only one with the patient, and the orthodontists will buzz through periodically. So it's hard to say from practice to practice, from specialty to specialty, but I know our listeners are are certainly in tune to how much time they are working solo with a patient versus assisting. And uh I I love that suggestion of of standing 50% of the time. So I have another question to piggybacks on standing as soon as you finish your thought regarding this part.
SPEAKER_02Right. So I guess in summary, I would just say that um the assistants who are uh working solo uh should definitely be considering dental loops. And uh as part and you know, if they need to invest in those, consider them as investing in your career, you know, in its longevity.
SPEAKER_01So yeah, absolutely. And uh of course, being able to be a better provider is gonna increase productivity for the rest of the practice and yeah. Now the question of standing. So do you have any do's or don'ts on recommendations for shoes for dental assistants who are gonna maybe convert to standing 50% of the time?
SPEAKER_02That's a great question, Leslie. And I don't really have any brands except they need to have good art support. So yeah, I don't really have any brand recommendations, but there are a lot of good ones. A lot of um assistants that I have talked to, they go to the nursing websites because we know nurses are on their feet all the time, and um just look at what nurses would wear, and that's a pretty good uh a pretty good direction to be looking for for good shoes for standing. Thank you for that.
SPEAKER_00Great information. You know, I was thinking, Bethany, when you're talking about dental assistance and loops, especially if the dental office does not provide the loops or pay for that expense. In my head, I was thinking it's probably still less expensive than reaching your annual deductible for your health insurance plan. And paying for MRIs and paying for costly x-rays and going to the doctor and going to PT. So it's probably well worth the cost, as you said, making an investment in themselves and their career. Because really, I think dentist dental assistance in dentistry now more than ever is really a profession that we may have not been considered as such 20, 25 years ago. But Bethany, describe how you can assist dental practices. At what level do you serve them?
SPEAKER_02So I provide virtual consultations. So since 2020, since the COVID pandemic, I used to go into offices and do in-office consultations, and team members would fill out a medical form where they're having pain, how they're practicing, what equipment they're using, how they're positioning it. And then they would um, and then I would arrange for equipment to come in and all of this. And since COVID, I've been doing virtual consultations and I've been getting equally effective outcomes. And so uh this is a process where team members will sign up for a virtual consultation. Uh, we'll pick a date, it's a one-hour virtual consultation ahead of time. They fill out a medical information form that has specific information about their dental equipment, their physical um uh pain, where if they have any. And then they also take some very specific photos ahead of time from certain angles. And then they actually have a camera, whether it's on a uh a laptop or a phone in the operatory the day of the one-hour practicum. And uh then I put all of this information together and I develop a customized ergonomic recommendations report based on that particular person and their physical traits and their challenges in the operatory and their existing equipment and so on. So, and then we have a follow-up about uh two or three months after that.
SPEAKER_00That's incredible. So, this virtual consultation can lead to a truly customized experience. So I I love that. Um, what about your website? You had mentioned before we got on the show about information that people can access.
SPEAKER_02Right. So my education, I've I've got dental, ergonomic, and wellness education, 10 hours worth of lecture material, of education and lecture material. And so what I've done is taking taken all 10 hours of um lecture material and made one hour CE courses out of them. I'm an AGD PACE provider, so they get uh CE credits for all of them, and I have them for every uh category you can imagine. I've got one for dental stools and low back pain, um neck pain and dental loops, um, positioning for the patient and the operator, stress in dentistry, um, how to self-treat myofascial pain and uh chronic pain, uh chair side stretching and home exercise. And I just finished an uh hour and a half dental assistant ergonomics course that is brand new on the website, and also new on the website is a one-hour front office ergonomic CE course. So um I'm almost done. I just have one more um CE course to record, and I will have all of my lecture material on my website available for purchase.
SPEAKER_00So there's something really for everyone. So I encourage listeners to look at your site. We will have the site on the show notes. And I believe Linda wanted to add something.
SPEAKER_03Olivia, I'd like to circle back with Bethany on uh hygienist. Um Bethany, I think you mentioned something in the very beginning about hygienist being at high risk for the hand wrist pain. Could you go back? And I I'm liking it to myself. Of course, I've been out of clinical practice for a while as a consultant, but for friends of mine that stayed longer, they really a lot of them had carpal tunnel surgery in the hand or bilateral carpal tunnel. Was that because of the hand scaling? What where do you where do you think do you think ultrasonics has made a difference for hygienists as a profession? Tell me, tell me your thoughts, please.
SPEAKER_02Yeah, so thanks for asking that, Linda, because actually the the one course that I am um just in the process of finishing up is the hand and wrist pain one for um in dentistry. And that is very, very heavily geared toward the dental hygienist, because we do see a lot of carpal tunnel type symptoms in hygiene. We also I've seen a lot of misdiagnosed carpal tunnel syndrome because very oftentimes the um there are five syndromes that mimic carpal tunnel but have an entirely different etiology. They need to be um assessed by a um certified hand therapist. So uh your your general, your um your primary health, your primary um practitioner, right? Your doctor, your medical doctor is very, very diversely trained. And because they have so much to learn, they don't learn a lot of the skills to finely differentiate um certain hand syndromes from other hand syndromes. So it's very easy to uh look at a set of syndrome or a set of symptoms and say, yep, looks like carpal tunnel. Well, there's a lot of other syndromes that can mimic carpal tunnel. So here is my biggest um gold nugget of information for those people with hand and wrist pain is that you need to insist on an appointment with a certified hand therapist. Okay, don't take the your primary care practitioner's um word for you know going to a surgeon because what's gonna happen then? Right? You're gonna have surgery. So make sure these certified hand therapists have over 3,000 hours of specialized education in differential diagnosis of all of these uh hand and arm and wrist pain uh syndromes. And they are by far the best qualified to give an accurate conservative diagnosis because this is what we really want to do is um have the most conservative intervention first, right, before you get cut on, right? Because that's pretty non-reversible. So um a certified hand therapist is a very, very valuable um resource in the hygienist profession.
SPEAKER_03Wow, that's amazing. I had no idea of the background of a certified hand therapist. And when you when you think about that, it makes me wonder how many hygienists over the years have been misdiagnosed and gone through carpal tunnel syndrome, maybe to either have it recur or whatever, because that wasn't the problem to begin with. So Bethany, not only did I learn that, but I've learned the importance of evaluating the loops properly now with the techniques you shared. Seating, which is important. I I never would have thought about a saddle seat for our assistant because I'm not a dental assistant. And so many times over, you know, you see just the typical dental assisting chair with the armrest where they can kind of lean over. And we know the leaning posture is probably not ergonomically correct either, straining their lower back, and then the patient position. So, so important. Thank you for being here and sharing that.
SPEAKER_02So I just wanted to add to that, Linda, with regard to the dental assistant saddle stool, is assistants should be looking for a very narrow saddle. So for seated biomechanical reasons that I won't go into, a wide saddle seat is a really bad idea for an assistant. Not a problem for a dentist, hygienist, but for assistants, should not be spreading the legs that wide because there's always a twisting, slight twisting component to the seated dental assistant. BQE ergonomics is a great resource for um dental assistants who want a good, truly ergonomic stool, as is uh crown seating.
SPEAKER_03Very good. Thank you for those great tips. Thanks again. Back to you, Olivia.
SPEAKER_00Yeah, these are such great tips for our listeners. And before we close this episode, I would love for you just to briefly share uh a little bit about your uh National Mounted Police. I think that might be of interest to our listeners as well.
SPEAKER_02So I was lucky enough to get a former police horse. So I'm an equestrian and I got uh Murphy, who was a Portland police horse, and we did dressage, we're competing in musical freestyle, which is the funnest thing I've ever done. And uh just recently we joined the our local Washington County Sheriff's Posse, and so now he's kind of back into the the law thing again, and uh we are uh patrolling uh fairs and doing parades. Uh, we just did a wildfire rescue, and that was a very exciting. Um so yeah, very, very fun. Um, of course, everybody wants a safe, safe horse, right? So this is about as safe a horse as you can get, is a police horse. So I've I figure I got very, very lucky. And uh once in a lifetime you get a horse like this. So I feel very blessed.
SPEAKER_00Well, how fun that you can enjoy them on the weekends. I think this has been uh a great episode, full of content that everyone on the dental team can use. And we hope that people will come back and re-listen to this episode. As the compliance divas, we bring clarity and simplicity to compliance by navigating a regulatory compliance to keep you on course. Please submit any questions to support at thecompliancedevas.com. And also please check the show notes for the resources, especially some of the resources that Dr. Valahy mentioned during the episode. We'll see you next week.