Proverbs Shine Light on Ergonomics

Sometimes old proverbs say it best, especially when discussing ergonomic issues.

For example, "An ounce of prevention is worth a pound of cure."

At least that’s what Labor Secretary Elaine Chao is advocating, although not exactly in those proverbial words. In the first major announcement by the Bush administration since Clinton-era ergonomic standards were struck down in March, Chao outlined the principles that will guide the formulation of new ergonomic rules. There is no timeline for when new federal standards will emerge. However, first on Chao’s list of principles is prevention.

"The Department of Labor’s goal will be to prevent ergonomic injuries rather than rely on command-and-control enforcement," Chao says. "The workforce and economy require a new approach to safety based on cooperation and prevention rather than the antiquated, adversarial approach of years past."

For California dentists, a little Yiddish wisdom is handy here: "A wise man hears one word and understands two."

Those two words would be "prevention now," even though OSHA rules are not currently requiring it. When the federal ergonomic rules were repealed earlier this year, dental offices in California were bound to comply only with less-stringent state standards, which basically focus on ergonomic issues after they have become a problem, i.e., when a repetitive motion injury has occurred to more than one employee with similar work duties in a 12-month period.

As the saying goes, "a stitch in time saves nine."

A little attention to ergonomic issues now could help prevent worker’s compensation costs and loss of employee work time in the future. According to the Bureau of Labor Statistics, there were 582,300 musculoskeletal disorders that resulted in employees missing time from work in 1999, the most recent year for which statistics are available. Such disorders are caused by the cumulative trauma of repetitive tasks.

Zenith, a workers’ compensation insurance provider for CDA members, reports that one-third of all claims are hand, wrist, or upper extremity cumulative trauma injuries. Cumulative trauma in upper extremities accounts for half of workers’ compensation costs, according to Dave Strong, MPH, CIH, of Zenith’s safety and health department.

As the old English proverb says, "protect the goose that lays the golden eggs."

In a labor market where hygienists and assistants are difficult to find, a little protective action in the form of ergonomics can go a long way. Ergonomics basically means the study of people, the objects they use, and the environment in which they function. Experts in the field have looked closely at tasks related to dentistry and developed suggested preventive strategies. The following measures come from Gayle Macdonald, RDH, PhD, who has been studying ergonomic issues for the past 15 years in relation to her teaching duties at the University of Southern California School of Dentistry.

* Provide adequate workspace and unobstructed access to both sides of the patient.

* If possible, rotate employees from one job to another. This is sometimes impossible in a dental office, but if it can be done, it could reduce the possibility of musculoskeletal disorders from developing. Dentists may also want to consider how many days per week employees are working.

* Provide adjustable furniture that will minimize leaning, twisting, and reaching and will allow employees, as much as possible, to keep their bodies in a neutral position.

* Maintain a straight back and keep the weight of the head on top of the spinal column when working. Proper use of a mouth mirror may be helpful as will looking through the lower half of the visionary field.

* Use neutral hand and body postures whenever possible.

* Use sharp, lightweight instruments with large-diameter handles whenever possible to reduce required force and number of repetitions.

* Use properly fitted gloves. Injuries may be exacerbated by the use of ambidextrous gloves or wearing gloves that are too small. Wearing an ambidextrous glove forces the hand to work against an unnatural position.

* Alternate tasks so that employees are not doing all the heavy work (i.e., quadrant presurgical scaling appointments) in a row.

* Allow time for brief breaks between patients.

Other preventive measures include providing education about symptoms of musculoskeletal disorders such as tingling, pain, or burning sensations; decreased sensation to touch; numbness; weakness; cramping; and stiffness. Most musculoskeletal disorders are correctable if treated early.

As the French would say, "It is not enough to run, one must start on time."

Online Resources for Ergonomic Information

A list of OSHA employer responsibilities:
http://www.osha.gov/as/opa/worker/employer-responsibility.html

Ergonomic standards and solutions for specific industries:
http://www.osha-slc.gov/SLTC/ergonomics/index.html

Statements from the Bush administration concerning ergonomics:
http://www.osha-slc.gov/ergonomics-standard/index.html

For more proverbial wisdom:
http://www.corsinet.com/braincandy/proverb.html

Second-Hand Smoke May Cause Caries in Children

Children whose parents smoke are more likely to develop dental caries, according to a study from the University of Rochester’s Strong Children’s Research Center.

Forty-seven percent of the children involved in the study had caries in deciduous teeth, and 26 percent had caries in permanent teeth. Second-hand smoke was most associated with caries in deciduous teeth, likely because children who have not entered school are more dependent on their parents, spending more time with them and increasing their exposure if the parents smoke.

"This study should serve as a sobering wake-up call to parents who still don’t see the danger in smoking around their children," says pediatrician Andrew Aligne, MD, the study’s lead author and an assistant professor of general pediatrics at the University of Rochester. "This study indicates that second-hand smoke accounts for a significant proportion of cavities in children."

The well-established association of caries with low socioeconomic status has not yet been explained, but Aligne theorized that second-hand smoke might be a risk factor. Young children who are poor are still particularly vulnerable to caries despite the overall decrease in the entire population during the past few decades.

Aligne and his colleagues analyzed data from the third National Health and Nutritional Examination Survey, which provided a nationally representative sample of 3,873 children.

"This relationship between cavities and second-hand smoking persisted after we controlled for many variables, including age, sex, race, region, dentist’s visits, nutritional status, and blood lead levels," Aligne says. There was also a dose-response effect: The higher the exposure to smoke, the more carious lesions the children had.

The children in the study had dental examinations and a blood test measuring their cotinine levels. An objective, quantitative marker of tobacco-smoke exposure, cotinine can reveal whether someone is a smoker or is often subjected to second-hand
smoke. When people are exposed to tobacco smoke, they absorb nicotine into the body. In order to excrete the nicotine, the body turns it into cotinine.

Aligne suggests that dentist use the findings to bolster their anti-tobacco efforts with patients.

"If a child has a cavity, the dentist should explain to parents that smoking may be the cause," Aligne adds.

Click with Care: Problems Abound on Web Health Pages

Finding answers to important health questions using Internet search engines and simple search terms is difficult at best. And while the information consumers do find on Web sites is generally accurate, it is usually incomplete and hard for many readers to understand, according to a report in the May 23 issue of the Journal of the American Medical Association.

Recent surveys indicate that almost 100 million Americans go online in search of health information; 70 percent of them say that what they find influences treatment decisions.

The study, commissioned by the California HealthCare Foundation, is the most comprehensive evaluation to date of the quality, accessibility, and readability of the data in a vast, rapidly expanding e-health universe that numbers millions of Web pages and thousands of sites. The study’s research focused on information about four medical conditions: breast cancer, childhood asthma, depression, and obesity.

"We know that the Internet is revolutionizing the availability of health information for consumers. The study suggests that there are lots of good things going on, and also lots of room for improvement," says Mark D. Smith, MD, MBA, president and CEO of the California HealthCare Foundation.

The study found that answers to important health questions are often incomplete. Working with nationally recognized clinical experts and patient advocates, the researchers established the basic elements of what consumers should know about each of the four conditions studied and compared those with the information on 25 Web sites.

Among the findings:

* On average, about one-third of those clinical elements were not covered at all by the sites.

* Although the accuracy of information presented was fairly high, many of the sites contained contradictory information.

* The research showed that consumers may encounter a lot of irrelevant information when using search engines and simple search terms.

Advice for Patients Surfing the Web

* They should allow ample time to search for answers to their questions.

* They should be aware that a single site will probably not provide a comprehensive picture of what they need to know about a condition. As many as four to six sites must often be visited.

* They should discuss information they find on the Internet with their health care providers before they use it to make a treatment decision.

Oral, Tongue Cancer Rates Rise Among Young Americans

A new research study asserts that even though the overall incidence of head and neck cancers has remained stable, young Americans are being diagnosed with higher rates of oral and tongue cancer.

The study, Head and Neck Cancer Incidence Trends in Young Americans, 1973-1997, With a Special Analysis for Tongue Cancer, was presented at the 2001 spring meeting of the American Head and Neck Society.

The goal of the research was to update and confirm the changes in incidence of young adult oral tongue cancer, as well as other head and neck cancers, using a large cancer surveillance database in the United States. Data for the analysis were obtained from the Surveillance, Epidemiology, and End Results Program Public-Use CD-ROM (1973-1997), released April 2000.

The SEER program registered 63,409 head and neck cancer (oral and pharynx) patients from 1973 to 1997. Of these, 3,339 patients were less than 40 years old. From the 1973-1984 period to the 1985-1997 period, the overall incidence of head and neck cancer was stable.

In regard to the number of cases and observed incidence rates, researchers noted a slight decrease in 1985-1997 in ages 40 and older. In contrast, however, the number of patients with head and neck cancer increased among young Americans less than 40 years old. The increase seemed to be mainly caused by tongue cancer.

The increase in tongue cancer in individuals born after 1938 and its association with improved survival suggest the emergence of a distinct disease process independent of tobacco and alcohol use. This disease process is apparent in white, but not black, populations and is of uncertain cause.

Many reports suggest that head and neck cancer, particularly oral tongue cancer, is increasing among young adults internationally.

Factors that may account for oral cancer in the young adults remain unknown. Suspected causes include smokeless tobacco, various forms of drug abuse, virus, as well as host susceptibility factors. However no clear evidence exists to support the significance of any single determinant, including the role of tobacco.

Tea Fights Cavities, Reduces Plaque

A group of researchers from the University of Illinois College of Dentistry believe that black tea and its components benefit oral health by interfering with bacteria that cause dental caries and periodontal disease.

"In recent years, many symposia and publications have focused on the health effects of green teas. Earlier studies by Japanese scientists have suggested that consumption of green tea lead to reduction of dental cavities in humans," says Dr. Christina Wu, the principle investigator of the study. "However less attention has been focused on black tea, the more popular drink in the Western countries; and worldwide 80 percent of the tea consumed is black tea."

The study was presented at the American Society of Microbiology General Meeting.

Wu and her colleagues found that compounds in black tea were capable of killing or suppressing growth and acid production of caries-causing bacteria in dental plaque. Black tea also affects the bacterial enzyme glucosyltranferase, which is responsible for converting sugars into the material that plaque uses to adhere to teeth. In addition, certain plaque bacteria, upon exposure to black tea, lost their ability to form the clumpy aggregates with other bacteria in plaque, thereby reducing the total mass of the dental plaque.

One of Wu’s study found that when volunteers rinsed with black tea for 30 seconds five times at three-minute intervals, plaque bacteria stopped growing and producing acid. This research supports an earlier Swedish study that found rinsing the mouth with black tea significantly reduced plaque build-up.

"It is our belief of these researchers that the intake of black tea can be significant to improve oral health of the general public," Wu says. "If sequenced properly between meals and normal oral hygiene, a reduction in dental caries may be possible. Drinking tea may have added oral health benefits by controlling through ‘prevention’ the most prevalent diseases of mankind, mainly caries and periodontal disease."

Reunion Classes Donate $2 Million to UOP

University of the Pacific School of Dentistry alumni celebrating reunions recently gave UOP $2 million.

During the alumni association’s recognition luncheon earlier this year, representatives from the reunion classes of 1951, 1956, 1966, 1976, 1991, and 1996 presented class gifts. The largest gift, $1,320,000, came from the Class of 1966.

The 10-year reunion class also reached a milestone with its $400,000 gift to the dental school. It is the largest gift given by a 10-year reunion class in the history of the UOP School of Dentistry.

Honors

David M. Perry, DDS, was recently elected president of the California Society of Pediatric Dentists. Perry is also the pediatric dentistry representative to CDA’s Interdisciplinary Affairs Committee.

Upcoming Meetings

2001

July 19-21 Forensic Dentistry 2001: A Symposium With Workshops, Chicago, (312) 440-2895

Aug. 17-18 Southern California Chapter of the Crown Council 3rd Annual Meeting, Los Angeles, (818) 998-1851

Sept. 6-9 American Academy of Pain Management 12th Annual Clinical Meeting, Arlington, Va., (209) 533-9744, www.aapainmanage.org

Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

Sept. 27-Oct. 1 FDI World Dental Congress, + 44 207 935 7852, www.fdi.org.uk

Sept. 30-Oct. 3 Pacific Coast Society of Orthodontists Annual Session, Honolulu, (800) 445-8667

Oct. 6-10 American Academy of Periodontology 87th Annual Meeting, Philadelphia, (312) 573-3210

Oct. 13-17 ADA Annual Session, Kansas City, (312) 440-2500.

Nov. 4-10 U.S. Dental Tennis Association Annual Meeting, Palm Desert, Calif., (800) 445-2524

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.