Regulations
Ergonomics and the Dental Office: An Overview and Consideration of Regulatory Influences
Sandy Laderas, RDAEF, CDA, MA, and Alan L. Felsenfeld, MA, DDS
Copyright 2002 Journal of the California Dental Association.
 |
Nearly 2 million workers suffer from musculoskeletal disorders each year. These problems are caused by repetitive, awkward, or stressful motions. Dental health care workers are susceptible to these types of injuries. This article will discuss state and federal programs to control job-related injuries and relate the regulations to dental practice.
|
Each year, according to estimates from the Bureau of Labor Statistics, nearly 2 million workers suffer from work-related conditions known as musculoskeletal disorders. These problems are caused by repetitive, awkward, or stressful motions.1 Prime examples of these injuries include carpal tunnel syndrome, tendonitis, and neck or back problems. While dental health care workers represent only a small part of the total workforce, they are susceptible to these types of injuries as a consequence of occupational stresses placed on their bodies. This article will discuss state and federal programs to control job-related injuries and relate the regulations to dental practice.
California Regulations
Title 8 of the California Code of Regulations was amended in 1997 to include Section 5110 on repetitive motion injuries. The objective of these amendments was to reduce disorders for workers whose jobs involve repetitive motion, force, awkward postures, contact stress, and vibration. While these regulations were controversial when introduced, they are in effect and represent California law.
This law provides a definition that is applicable to any job, process, or application where a repetitive motion injury has occurred to more than one employee. Additionally, the following criteria need to be present:
* The injuries were caused predominantly by a work-related incident.
* The injured employees were performing the same type of job.
* The injuries were diagnosed objectively by a physician.
* The injuries were reported to the employer within the previous 12 months but not before the date of enactment of the regulation.2
When the above criteria for repetitive motion injuries are identified, the employer is required to develop a program designed to minimize these injuries. This program must include a worksite evaluation for repetitive motion injury exposures and a plan to correct worksites that represent a risk for employee injury. This plan might include redesigning or refitting workstations as well as protecting employees through job reclassifications or responsibilities.
Additionally, employers are responsible for providing training of employees regarding repetitive motion injuries. This training must include:
* A description of the employer program;
* Identification of exposures in the workplace that have resulted in repetitive motion injuries;
* The symptoms and consequences of repetitive motion injuries;
* The importance of reporting the symptoms to the employer; and
* Methods used by the employer to minimize repetitive motion injuries in the workplace.
Subsequent to the enactment of this regulation, the California Department of Industrial Relations, Division of Labor Statistics and Research, stated that job-related nonfatal injury/illness rates in 1999 decreased from previous years. A record low of 6.3 workers injured out of every 100 was obtained, while employment increased 3 percent. This represented a decrease from 6.7 per 100 workers in 1998. The decrease was attributed to the California Occupational Safety and Health Administration inspection program focus on agriculture and construction, the highest areas of injury in the past. Of the nonfatal occupational illnesses reported, 56 percent were disorders associated with repeated trauma.3 The effects on dentistry appear to be minimal.
Federal Legislation
At the federal level, OSHA published ergonomic standards that were to be effective Jan. 16, 2001, and implemented no later than Oct. 14, 2001. The original ergonomic standard was written to require employers to adopt the principle of ergonomics -- fitting the job to the worker through adjusting a workstation, rotating between jobs, or using mechanical assistance.4 These standards required employers to inform all employees regarding musculoskeletal disorders in the workplace. The information was to include signs and symptoms, the importance of reporting injuries, risks of the job for musculoskeletal disorders, and a description of the OSHA ergonomics program standard.5 Congress, recognizing that there was much uncertainty as to the compliance requirements of the regulations, forced its withdrawal in March 2001. However, the Bush administration held public hearings during the summer of 2001 as to whether and how to provide regulation for work-related repetitive motion injuries. It is the intention of federal OSHA to base new regulations on injury prevention, sound science, incentives, program flexibility, cost feasibility, and program clarity.
Shortly before this issue was to be printed, the Department of Labor released a statement saying that "in the wake of the Sept. 11, 2001, event, the Department will temporarily postpone the announcement of a plan of action on ergonomics." Additional announcements were scheduled for the fall.6
The Dental Office
What is the relationship of ergonomics to dental offices? The concept of ergonomics in dentistry is not of recent onset. In the late 1950s, Eccles and Powell wrote one of the first journal articles pertaining to dental ergonomics.7 By the 1960s, Kilpatrick and others began to identify postural and procedural rules for sit-down dentistry.7 Ergonomic education in the dental schools from the 1970s to the present included such concepts and practices as performance logic, four-handed dentistry, human factors engineering, and dento-ergonomics. Considering that most dental care is provided while the team is seated, seated postures play a key part to spinal balance. In a recent article, it is noted that dentists have "experienced less varicosities of the legs, but more breakdowns of the upper back and extremities."8
Improved technology has had a significant impact on the way dentistry is practiced today. However, technological advances in dentistry may have a deleterious effect on providers relative to musculoskeletal disorders. Even the physical placement or location of equipment and use patterns can affect the way dental professionals work.
The risk of having a musculoskeletal injury or work-related disorder may be high in dental practice. Sit-down dentistry is not without potential harm to the dentist or the staff if equipment or other constraints create postural problems. Dental school curricula may not be able to spend a significant amount of time in the teaching of ergonomically correct work habits.
The Proactive Approach
The California Dental Association has learned that a proactive approach to internal evaluation may minimize exogenous regulation in the dental office. Consideration should be given to performing an ergonomic assessment of one’s dental practice. If there have been complaints from the staff or if the dentist or staff is feeling the stress and strain of practice more intensely than in the past, there may be potential for repetitive motion disorders. In an effort to prevent musculoskeletal disorders, it may be wise for the dentist to meet with his or her staff or add a discussion to the office meeting agenda. The dentist should consider asking questions such as these developed by Cal/OSHA:
* Have there been musculoskeletal injuries or complaints in the practice?
* Has the scheduling, pace, organization or work activity changed?
* Have staffing levels decreased?
* Have new job tasks or equipment created any operating inefficiencies?
* Is there an effective procedure for problem evaluation and correction?
* Is any additional training needed? 9
Conclusion
At present in California, dental office ergonomic regulation is based on practices that have a history of repetitive motion injuries. Federal OSHA standards, while not in effect at this time, potentially will be slightly more stringent in the proposed approach mandating all offices to develop plans to protect employees. It is only rational that dental providers would like to minimize injuries to their employees and themselves from repetitive motion injuries. It makes sense that all dental practices should consider the ergonomic implications of their offices.
The dentist should determine his or her needs for employee and self-protection and develop a plan of action. He or she should perform an annual review to keep the plan current. Careful preparation and prevention of repetitive motion injuries can save significant amounts of lost time as a result of employee absenteeism. Likewise, it can save the dentist from injuries that could jeopardize his or her career.
Authors
Sandy Laderas, RDAEF, CDA, MA, is the supervisor of the Dental Auxiliary Utilization Program and coordinator of infection control at the University of California at Los Angeles School of Dentistry
Alan L. Felsenfeld, MA, DDS, is an adjunct professor of oral and maxillofacial surgery at the UCLA School of Dentistry and chairman of the Council on Dental Research and Developments for the California Dental Association
References
1. Los Angeles Times, Senate overturns ergonomic rules on worker safety. LA Times, March 7, 2001, A1-A2.
2. California Code of Regulations, Title 8, Sec 5110. Repetitive Motion Injuries
3. California Occupational Safety and Health Administration,, Injuries at record low in California. Cal/OSHA news release, Jan 9, 2001.
4. Occupational Safety and Health Administration, US Department of Labor, OSHA Regulations (Standards – 29 CFR) Summary of the OSHA Ergonomics Program Standard (Non-Mandatory). 1910.900 App B, 2001.
5. Organization for Safety and Asepsis, OSHA Ergonomics Standard. OSAP Monthly Focus No 2, 2001
6. Occupational Safety and Health Administration, national news release. US Department of Labor, Office of Public Affairs, Sept 21, 2001.
7. Murphy DC, Ergonomics and dentistry. NY State Dent J 30-34, 1997.
8. Rucker LM., Technology meets ergonomics in the dental clinic: new toys for old games? J Am Coll Dent 67:26-8, 2000.
9. California Occupational Safety and Health Administration, Back disorders and injuries. Cal/OSHA Pamphlet. July 26, 1999.
To request a printed copy of this article, please contact/Sandy Laderas, RDAEF, CDA, MA, UCLA School of Dentistry, Center for the Health Sciences, Room 53-038, Los Angeles, CA 90095-1668.
