Prime Position

Dental professionals who ignore nagging neck pains or tingling fingers could be setting themselves up for some devastating changes in their lives, including the loss of their careers.

A pain in a dentist's neck or shoulder, for instance, could signal severe neck injuries caused by repeatedly bending over a patient or otherwise maintaining a stressful position for long periods. A dentist or an auxiliary using repeated hand movements to control instruments can also suffer lower arm and hand numbness and loss of tactile control. The pain of those injuries, coupled with the emotional pain of being forced to leave a fulfilling dental career, is a catastrophic combination. Sigmund H. Abelson, DDS, CDA's speaker of the house, fell victim to both last fall.

"I had been experiencing increasing pain in the back of my neck, predominantly when bending over a patient," Abelson said, "so I'd have to stop working frequently."

By November, the symptoms grew worse, including numbness in his left forearm and hand, and he started to lose some tactile sensitivity that caused him to begin dropping things. When that happened, he knew he had to have it checked. A neurologist confirmed through an MRI that three cervical discs were "severely degenerated." He finally had to admit that his dental career was over.

"When I was told my neck problem was not curable, I knew this wouldn't be fair to my patients," Abelson said. "In my case, it was a very traumatic thing to happen. I realized that being a dentist wasn't a job, it was an identity. It's who I am."

For Harvey J. Barish, DDS, severe shoulder pain signaled a problem, but he initially shrugged it off.

"I had no idea it was actually my neck," he said. "I thought it was some activity I had done that had strained my shoulder."

Later, an MRI found the problem; two cervical discs had degenerated. After working with the pain for two years, Barish was forced to retire in October 1993. Currently chairman of CDA's Council on Scientific Sessions, Barish said the pain of leaving dentistry was almost worse than the physical pain he suffered.

"The first year was devastating," he admitted. "I had lived with the problem for two years and finally concluded I couldn't do it any more, but I still couldn't make the break from dentistry. Finally, I learned to deal with it."

Dental auxiliaries can also suffer the consequences of working in an ergonomically challenging career. Former registered dental hygienist Tammie Bissa, like Abelson and Barish, had to give up a career she loved. Her ordeal with pain began two years before she finally had to quit work in 1993.

"I was having aching pain in my arms and hands," Bissa said. "I was having a difficult time holding instruments. When that started, I really became concerned."

Since her problem turned out to be repetitive strain injury, not carpal tunnel syndrome, surgery was not an option. Physical therapy and anti-inflammatory medications didn't work, either.

"It was very hard to deal with quitting work," Bissa said. "I was battling with myself, wondering if this was something I was going to be able to contend with, but I had to leave."

Maintaining good posture is the key to minimizing injuries. Abelson, for instance, used surgical telescopic lenses for years, causing him to bend his head downward for long periods. He discovered too late that the focal distance was set too short, requiring him to bend his neck unnaturally. An ergonomics expert advises dentists who use magnification to have the focal length adjusted to allow better posture.

"The further back the focal distance is set, the better lumbar support and spinal alignment will be," said Risa Pollack-Simon, a Certified Management Consultant in Scottsdale, Ariz.. She teaches ergonomics and OSHA compliance continuing education courses at CDA Scientific Sessions and at other major dental meetings nationwide. "To me, magnification and illumination are a key part of supporting the spine and minimizing musculoskeletal disorders."

From a liability viewpoint, Pollack-Simon said dentists or auxiliaries who qualify should carry disability insurance and check with their doctors to see if they have a problem as soon as any symptoms appear.

"Most people wait until the pain is debilitating," she says.

To help prevent debilitating injuries, Tim Caruso, MBA, a physical therapist working at the University of Illinois and at Shriners Hospital in Chicago, says his approach is to teach dentists and auxiliaries how to help themselves.

"There are exercise programs they can do throughout the day to alleviate stresses they feel," says Caruso, who also speaks on ergonomics at CDA and ADA meetings. "These can be done chairside to change position and recover a bit. The key is to balance stress with recovery. That's where success lies."

Abelson admonished dentists and auxiliaries alike to do everything they can to protect themselves so they can have a long and fulfilling career.

"Just like with masks and gloves, protect your body with proper positioning at the chair," he said. "This is using universal precautions for your musculoskeletal system."

Genes probably responsible for the sense of taste have been identified.

Researchers from a collaborative effort between the University of California at San Diego and the National Institute of Dental and Craniofacial Research write in the journal Cell that the genes that are expressed in cells specifically geared to taste.

Isolation of the possible taste receptor genes lays groundwork for manipulating the perception of taste and stimulating or blocking taste cell function. The identification also sets the stage for mapping how taste is "wired" from the mouth to the brain.

"The identity of the receptor molecules for the different sensory modalities -- like vision, smell and taste -- represents the Holy Grail of the sensory field," says UCSD professor Charles Zuker, principal co-author of the report. "These receptor molecules provide the unique specificity and selectivity of each sensory system. The color receptors in our retinas allow us to see in color, and the receptors in our nose endow us with great discrimination for smell. In the case of taste, they are what make sweet cells respond to sweet substances, bitter cells to bitter compounds, and so on."

"These two molecules have the hallmarks we expect of taste receptors," says Nicholas Ryba of NIDCR. "They may be the key to unlocking our understanding of how we detect taste, which is unclear at the moment. We must now demonstrate that functionally they can do the job."

With the new information, scientists could one day be able to manipulate taste receptors, thereby conceivably "eliminating" bitter and sour tastes from important products, such as children's medicine.

Aussies Turn To Prevention

Dentistry in Australia is shifting from restorative and prosthodontic toward diagnostic and preventive, according to a study published in the Australian Dental Journal.

While the number of children and young adults is remaining fairly constant in Australia, the number of middle-aged and older adults is increasing. Those demographic changes, along with a decrease in edentulism, are leading to changing dental service patterns.

More services are being provided per visit, with the emphasis moving away from restorative and prosthodontic services, and more patients are receiving diagnostic, preventive, endodontic, and crown and bridge services, according to the study.

Violence Toward Women
Found in Dental Survey

Twelve percent of women surveyed during a study of patients at University of California, San Francisco, School of Dentistry dental clinics had visited their dentist seeking care for a problem that was a direct result of a violent incident. Nineteen percent had injuries in the head and neck region as a result of partner abuse.

UCSF researchers conducted the study to determine the prevalence of domestic violence in a female dental population and possible behaviors that may increase a woman's risk of falling victim to domestic violence.

All female patients who presented during a number of randomly selected clinic sessions were asked to participate. Sixty-eight percent completed the questionnaire.

Researchers found no association between domestic violence and marital status, level of education, utilization of dental services, or risk of alcohol abuse. However, subjects at risk for drug abuse were 2.5 times more likely to have experienced partner violence in the preceding year. Other findings:

* Thirty-seven percent of the respondents had experienced partner violence in the preceding year.

* Sixty-nine percent reported having experienced partner violence during their lifetime.

* Ten percent had experienced severe violence -- such as being choked, punched, or hit with an object -- in the preceding year.

* At least 25 percent had been seriously hurt by a partner during their lifetime.

Getting the Big Brush-Off

A "brush-off" involving 1,367 people has set a record for simultaneous tooth brushing.

The Arizona event was sponsored by the Healthy Smiles Partnership as a kick-off for its "Life's a Lot More Fun With Teeth" oral health awareness campaign aimed at Arizona children.

The event was April 19 at a school in Phoenix. Arranged in a toothbrush formation while simultaneously brushing their teeth for 3 minutes, 3 seconds, 1,367 participants (mostly elementary school students) broke the 1998 record set in Massachusetts by 1,180 participants.

In February, 996 children simultaneously brushed during an event sponsored by the San Diego Dental Health Coalition to mark Children's Dental Health Month.

Containing Costs -- and Charity Work

Competitive market pressures may hold down the amount of charity work performed by physicians, according to articles in the Journal of the American Medical Association.

Peter J. Cunningham, PhD, of the Center for Studying Health System Change in Washington, D.C., and colleagues studied the results of a 1996-1997 national survey of 10,881 physicians from 60 communities about the number of hours of charity care they provided in the month before being interviewed.

Charity care was defined as free care or care provided at reduced costs because of the financial need of the patient.

Physicians with more revenue derived from managed care provided less charity care than physicians with less revenue from managed care. In addition, physicians who practice in areas with high managed care penetration tended to provide less charity care.

The researchers found that while 77.3 percent of the physicians interviewed provided an average of 10.3 hours of charity care per week, physicians who derived at least 85 percent of their practice revenue from managed care plans were considerably less likely to provide charity care and tend to spend fewer hours providing charity care than physicians with little involvement in managed care plans.

More charity care occurred in smaller practice settings (solo practices and two-physician practices).

"Charity care provision tends to be greater in solo practices or small groups where physicians own all or part of their practice," the authors write. "It is possible that physicians in larger group practices provide less charity care because the larger and more formal structures of these settings intentionally or unintentionally result in greater organizational barriers. In addition, 'employed' physicians may have less autonomy and discretion in treating medically indigent patients."

The articles appeared in the March 24/31 JAMA.

Honors

David W. Chambers, PhD, MBA, and Kenneth Fat, DDS, each have been awarded the Medallion of Distinction University of the Pacific School of Dentistry. Chambers is the school's associate dean for academic affairs.

John C. Greene, DMD, MPH, has been awarded the UCSF Medal. Dr. Greene is dean emeritus of the UCSF School of Dentistry.

Upcoming Meetings 1999

Sept. 1-4 Surfaces in Biomaterials 99, Scottsdale, Ariz., (612) 512-9103
Sept. 2-4 Academy of Surgical Research Annual Meeting, Scottsdale, Ariz., (612) 545-1919
Sept. 16-18 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470
Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans, (317) 290-2613
Sept. 25-29 American Academy of Periodontology Annual Meeting, San Antonio, Texas, www.perio.org
Oct. 28-Nov. 1 FDI Annual World Dental Congress, Mexico City, +44 171 935 7852

2000

April 6-8 Dentistry 2000 -- British Dental Association Annual Conference and British Dental Trade Association Dental Showcase Exhibition, Birmingham, England, 01934 844408
April 13-16 CDA Scientific Session, Anaheim, Calif. (916) 443-3382, Ext. 4470
Sept. 17-20 American Academy of Periodontology Annual Meeting, Honolulu, www.perio.org
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.