The Effects of Dental Hygiene Instrument Handles on Muscle Activity Production.

Purpose The objective of this study was to compare the effects of ten commercially available instrument handle designs' mass and diameter on forearm muscle activity during a simulated periodontal scaling experience.Methods A convenience sample of 25 registered dental hygienists were recruited for this IRB-approved study. Ten commercially available instruments were categorized into four groups based on their masses and diameters: large diameter/light mass, small diameter/light mass, large diameter/heavy mass, and small diameter/heavy mass. Participants were randomized to four instruments with one from each group. Participants scaled with each instrument in a simulated oral environment while muscle activity was collected using surface electromyography. Muscle activity was compared among the four instrument group types.Results Muscle activity of the flexor digitorum superficialis was not significantly influenced by instrument mass (p=0.60) or diameter (p=0.15). Flexor pollicis longus muscle activity was not significantly influenced by instrument mass (p=0.81); diameter had a significant effect (p=0.001) with smaller diameter instruments producing more muscle activity. For the extensor digitorum communis and extensor carpi radialis brevis, instrument mass did not significantly affect muscle activity (p=0.64, p=0.43), while diameter narrowly failed to reach significance for both muscles (p=0.08, p=0.08); muscle activity for both muscles increased with smaller diameter instruments.Conclusion Results from this study indicate instrument diameter is more influential than mass on muscle activity generation; small diameter instruments increased muscle activity generation when compared to large diameter instruments. Future research in real-world settings is needed to determine the clinical impact of these findings.

Color-Blind Racial Attitudes in Entry-Level Dental Hygiene Students in Virginia.

Purpose Subscribing to color-blind racial attitudes may contribute to inequities in the delivery of oral care and affect treatment of diverse patients. The purpose of this study was to survey all entry-level dental hygiene students in one state to determine color-blind racial attitudes.Methods After IRB approval, a convenience sample of 220 dental hygiene students in all entry-level programs in Virginia were invited to participate in this cross-sectional study. The Color-Blind Racial Attitudes Scale (CoBRAS), an effective, validated measuring instrument, was used to quantify unawareness of contemporary racist ideals. Three subscales (Racial Privilege, Institutional Discrimination, and Blatant Racial Issues) were also measured by the survey. Descriptive statistics, separate one-way between-subjects ANOVA, and independent samples t-tests were used to analyze the data.Results One hundred and sixty (n=160) dental hygiene students completed the survey. Independent samples t-tests revealed statistically significant differences when comparing year in program and program type. Participants in their second year of dental hygiene education had significantly lower overall CoBRAS scores compared to those in their first year of education (M=50.76, M=59.13, respectively; p=0.004). Participants enrolled in a baccalaureate dental hygiene (B.S.) program had significantly lower overall CoBRAS scores compared to those enrolled in an associate (A.S.) program (M=50.53, M=59.54, respectively; p=0.002).Conclusion Participants possessed moderate levels of color-blindness suggesting a need for more awareness and training early in dental hygiene education to increase delivery of culturally competent oral healthcare.

The effects of dental hygiene instrument handles on muscle activity production.

OBJECTIVE: The objective of this study was to compare the effects of 10 commercially available instrument handle designs' mass and diameter on forearm muscle activity during a simulated periodontal scaling experience. METHODS: A convenience sample of 25 registered dental hygienists was recruited for this IRB-approved study. Ten commercially available instruments were categorized into four groups based on their masses and diameters: large diameter/light mass, small diameter/light mass, large diameter/heavy mass and small diameter/heavy mass. Participants were randomized to four instruments, one from each group. Participants scaled with each instrument in a simulated oral environment while muscle activity was collected using surface electromyography. Muscle activity was compared among the four instrument group types. RESULTS: Muscle activity of the flexor digitorum superficialis was not significantly influenced by instrument mass (p = 0.60) or diameter (p = 0.15). Flexor pollicis longus muscle activity was not significantly influenced by instrument mass (p = 0.81); diameter had a significant effect (p = 0.001), with smaller diameter instruments producing more muscle activity. For the extensor digitorum communis and extensor carpi radialis brevis, instrument mass did not significantly affect muscle activity (p = 0.64, p = 0.43), while diameter narrowly failed to reach significance for both muscles (p = 0.08, p = 0.08); muscle activity for both muscles increased with smaller diameter instruments. CONCLUSION: Results from this study indicate instrument diameter is more influential than mass on muscle activity generation; small diameter instruments increased muscle activity generation when compared to large diameter instruments. Future research in real-world settings is needed to determine the clinical impact of these findings.

Pinch force generation during scaling by dental professionals: A systematic review.

OBJECTIVE: The objective of this review was to examine the impact of instrument designs on pinch force generation during scaling by dental professionals. METHODS: Three databases were utilized from September 2019 to November 2021 in addition to hand-searching specific journals and reference lists. Research articles that examined pinch force generation in dental professionals during scaling with manual instruments only were included. Bias was assessed in the individual articles. RESULTS: Six research articles were included with sample populations that varied from 12 to 24 participants. Four articles evaluated instrument designs in relation to pinch force generation during scaling by dental professionals. Two articles evaluated the clinicians' experience levels and the impact on pinch force generation. Results of three articles revealed instruments with large diameters and low weights produced the least amount of pinch force (p < 0.05). Additionally, two articles found instruments with a round, tapered shape produced less pinch force and instrument handles made of silicone produced higher pinch strength post-scaling (p < 0.05). One study indicated instrument designs associated with modified scaling techniques may reduce thumb and index finger pinch force (p < 0.05). CONCLUSION: The findings from this review indicate weak evidence for instrument choices to reduce pinch force during scaling. Dental professionals should consider lightweight and large diameter instruments for manual scaling. Clinicians may also want to consider round, tapered handles and instrument designs with modified scaling techniques. This systematic review further identified the need for clinical research studies with rigorous research designs that examine the ergonomic impacts of instrument designs.

Color-Blind Racial Attitudes in Practicing Dental Hygienists.

Purpose: Individuals who subscribe to a color-blind racial ideology may not be aware of differences or differential treatment based on race which may be related to racial inequality in the delivery of oral health care. The purpose of this study was to determine color-blind racial attitudes in a convenience sample of clinical dental hygienists.Methods: A convenience sample of practicing dental hygienists recruited through social media via snowball sampling was invited to participate in this cross-sectional survey study. The Color-Blind Racial Attitudes Scale (CoBRAS), a valid and reliable measuring instrument, was used to determine unawareness of racial attitudes and stereotyping. Three subscales (Racial Privilege, Institutional Discrimination, and Blatant Racial Issues) were measured by the survey. Descriptive statistics and separate one-way between-subjects ANOVA were used to analyze the data.Results: Two-hundred and thirty-three (n = 233) dental hygienists in clinical practice completed the survey. ANOVA revealed statistically significant differences in overall CoBRAS scores when comparing age groups and ethnicities. Participants aged 18-29 had significantly lower overall CoBRAS scores compared to participants aged 60 and over (x = 49.41, x = 59.17, respectively; p = .019). African American participants scored significantly lower on overall CoBRAS scores compared only to those in the Other ethnicity category (x = 42.27, x = 62.08, respectively; p = .029).Conclusion: Participants possessed moderate levels of color-blindness, suggesting unawareness of racism and a need to understand the implications of racism as a means of promoting equity and improve oral health care delivery. Findings emphasize a need for more research examining color-blind ideology and how it affects oral health care delivery to diverse patient populations.

Attitudes of Virginia Dental Hygienists Toward Dental Therapists.

Purpose: The state of Virginia faces a reported dental health professional shortage affecting approximately half of its residents.The purpose of this study was to assess the opinions and attitudes of dental hygienists in Virginia toward a mid-level dental provider model, dental therapists (DTs), and to determine whether current education level and years of practice affected opinions regarding the education requirements for DTs.Methods: A 22-item questionnaire was distributed online to a convenience sample of Virginia dental hygienists (n=910). Items assessed attitudes of participants toward the DT using a seven-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). Participants were asked to provide demographic information and to respond to open-ended questions regarding potential advantages and/or disadvantages to DTs. Independent samples t-tests and chi-square analyses were used to analyze the data.Results: A response rate of 22% was obtained (n=200). Most respondents agreed a DT was needed in Virginia (M=5.78, p<0.001) and supported the concept that dental therapy could be a solution to the problem of access to care issues in Virginia (M=5.97, p<0.001). While most respondents agreed it was important for Virginia to adopt legislation for a dental therapy model (M=5.89, p<0.001), most disagreed that DTs' practice should be restricted to acknowledged underserved areas in the state (M=3.19, p<0.001). No significant association was found between years of practice and opinions toward education requirements for DTs; however, a significant association was found between current education level and opinions toward education requirements for DTs (Fisher's Exact Test=34.17, df=9, p=.000, Cramer's V=.28).Conclusion: Results revealed Virginia dental hygienists had overwhelmingly positive attitudes toward DTs. Research with a larger sample could provide more insight into opinions of the Virginia dental hygienist population regarding this mid-level oral health care provider.

The Effects of the Traditional Scaling Technique Versus a Modified Scaling Technique on Muscle Activity and Pinch Force Generation: A pilot study.

Purpose: Dental hygienists perform precision instrumentation tasks repetitively throughout the workday, placing them at increased risk for developing a musculoskeletal disorder. The purpose of this pilot study was to determine differences in muscle activity and pinch force generation between the traditional scaling technique and a modified scaling technique.Methods: A convenience sample of dental hygienists (n=12) acted as their own controls in this counterbalance-designed pilot study. Muscle activity and pinch forces were assessed while participants performed traditional and modified scaling techniques with designated instruments on artificial calculus applied to the lower left quadrant of a typodont, for a period of five minutes. Surface electromyography was used to measure muscle activity; sensors attached to the instrument handle measured pinch forces. Participants were surveyed regarding the instruments used and scaling technique preferences at the conclusion of the session. Parametric and non-parametric tests were used to analyze the data. Descriptive statistics were used to analyze the exit survey.Results: The modified scaling technique required less muscle activity than the traditional technique while scaling, however results were not significant (p>0.05). The traditional scaling technique required greater overall pinch force during scaling (p=.00). Pairwise comparisons revealed significant differences between pinch force generation in the thumb for the two scaling techniques (Z = -2.401, p= 0.016) and in the index finger (Z = -2.223, p= 0.026). The traditional scaling technique generated more pinch force (thumb x=7.25±4.99, index finger x=2.86±2.14) when compared to the modified scaling technique (thumb x=4.52±2.32, index finger x=1.65±1.28). Participants had a slightly higher preference for the instrument utilized for the modified scaling technique in terms of balance, maneuverability, overall comfort and the associated scaling technique as compared to the instrument utilized for the traditional scaling technique.Conclusion: Use of a modified scaling technique may reduce muscle activity and pinch force generation as compared to the traditional lateral pressure scaling technique during instrumentation. Future research on ergonomic scaling techniques is needed to determine their efficacy and impact on musculoskeletal disorders.

The effects of static seated and standing positions on posture in dental hygiene students: a pilot study.

Background: Musculoskeletal disorders (MSDs) are highly prevalent among dental hygiene professionals. The purpose of this pilot study was to evaluate and compare seated and standing postures during simulated dental hygiene practice to determine ergonomic risks associated with each posture. Methods: A convenience sample of 35 female second-year dental hygiene students with no history of musculoskeletal disorders was enrolled in this IRB-approved study. In 2 separate sessions, 1 seated and 1 standing, participants instrumented 1 quadrant of the mouth in a simulated oral environment. Two images per session, per participant, were taken to evaluate biomechanical demands of each posture using the Rapid Upper Limb Assessment (RULA) tool. The same 4 calibrated researchers scored all images independently and mean scores for each posture were analysed. Results: Thirty-four students completed the study. Results revealed statistically significant (p = 0.001) differences in mean RULA scores between seated (M = 3.91, SD = 0.77) and standing (M = 4.50, SD = 1.00) postures, although these differences may not be clinically relevant. Discussion: When postures were independently assessed, seated postures were more acceptable on average compared to standing postures, yet both were in the unacceptable range. Lack of training in standing postures may have impacted the results. Conclusion: Results support the need for additional ergonomic training in dental hygiene curricula. Less than ideal posture when seated or standing could increase MSD risk. Future research should examine biomechanical loads of seated and standing postures, as well as the combination of these postures, for more insight into their ergonomic benefits and associated MSD risks.

Contexte: Les troubles musculosquelettiques (TMS) sont très répandus parmi les professionnels de l'hygiène dentaire. Cette étude pilote visait à évaluer et à comparer les postures assise et debout dans le cadre de simulations de la pratique de l'hygiène dentaire afin de définir les risques sur le plan de l'ergonomie liés à chacune de ces postures. Méthodes: Dans le cadre de cette étude approuvée par un comité d'examen institutionnel, on a examiné un échantillon de commodité réunissant 35 étudiantes en hygiène dentaire de 2e année sans antécédents de troubles musculosquelettiques. À l'occasion de 2 séances distinctes, une effectuée en position assise et une effectuée en position debout, les participantes ont travaillé sur un quadrant de la bouche dans un environnement oral simulé. On a pris 2 images par séance et par participante pour évaluer les exigences biomécaniques de chacune des postures à l'aide de l'outil d'évaluation rapide des membres supérieurs (RULA). Les 4 mêmes chercheurs calibrés ont attribué une note à toutes les images de façon indépendante. On a ensuite analysé la moyenne de ces notes pour chacune des postures. Résultats: Trente-quatre étudiantes ont participé à l'étude jusqu'à son terme. Les résultats ont révélé des différences statistiquement significatives (p = 0,001) dans les moyennes des notes de l'outil RULA entre les postures assise (M = 3,91, ET = 0,77) et debout (M = 4,50, ET = 1,00). Toutefois, ces différences pourraient ne pas être pertinentes sur le plan clinique. Discussion: Dans le cadre de l'évaluation indépendante des postures, en moyenne, la position assise était plus acceptable que la position debout. Cependant, les 2 postures se trouvaient dans la fourchette de valeurs inacceptables. Il est possible que le manque de formation en position debout ait une incidence sur les résultats. Conclusion: Les résultats confirment la nécessité d'une formation supplémentaire sur l'ergonomie dans les programmes d'hygiène dentaire. Une posture non idéale en position assise ou debout pourrait entraîner une hausse du risque de TMS. À l'avenir, des études devraient examiner les charges biomécaniques des postures assise et debout, ainsi que la combinaison de ces postures, afin de renforcer la compréhension de leurs avantages ergonomiques et des risques de TMS connexes.

The Additive Effects of Cell Phone Use and Dental Hygiene Practice on Finger Muscle Strength: A Pilot Study.

Purpose: The purpose of this study was to determine strength of muscles involved with instrumentation (scaling) by dental hygienists and the additive effects of cellular (mobile) phone usage, as indicated by measurements of muscular force generation.Methods: A convenience sample of licensed dental hygienists currently in clinical practice (n=16) and an equal number of individuals not currently using devices/tools repetitively for work (n=16), agreed to participate in this pilot study. All participants completed a modified cell phone usage questionnaire to determine their use pattern and frequency. Upon completion of the questionnaire, participants' force production in six muscle groups was measured using a hand-held dynamometer. Descriptive statistics were used to analyze the data.Results: A total of 16 licensed dental hygienists (n=16) and 16 participants with no history of using tools/devices repetitively for work (n=16), comprised the experimental and control groups, repectively. The control group generated greater muscle force than the experimental group for the abductor pollicis longus (p=0.045). Significant differences were identified when comparing the low mobile phone users in the experimental group to the control group for the flexor pollicis brevis (p=0.031), abductor pollicis longus (p=0.031), and flexor digitorum (p=0.006), with the control group demonstrating higher muscle force. Years in clinical practice and mobile phone use was shown to have a significant effect on muscular force generation for the flexor pollicis brevis (F=3.645, df=3, p=0.020) and flexor digitorum (F=3.560, df=3, p=0.022); subjects who practiced dental hygiene the longest produced the least amount of muscle force.Conclusion: Results from this pilot study indicate there are no significant additive effects of cell phone use and dental hygiene practice on finger muscles used for instrumentation. However, results indicate that dental hygiene practice demonstrated significant effects on muscular strength as compared to individuals who do not use tools/devices repetitively for work. The small sample size may have impacted results and the study should be repeated with a larger sample.

Color-Blind Racial Attitudes in Dental Hygiene Students: A pilot study.

Purpose: Color-blind racial attitudes and biases have been linked to racial prejudice which may potentially affect dental hygiene care to diverse patients. The purpose of this pilot study was to determine the color-blind racial attitudes of dental hygiene students.Methods: A 20-item, Color-Blind Racial Attitudes Scale (CoBRAS) electronic survey was sent to a convenience sample of 41 first-year and 30 second-year dental hygiene students (n=71) in a dental hygiene program in Virginia. The CoBRAS instrument measures contemporary racial attitudes and stereotyping in three subcategories: Unawareness of Racial Privilege, Institutional Discrimination, and Blatant Racial Issues. CoBRAS scores range from 20-120, with higher scores indicating elevated levels of denial of racism. Descriptive statistics were used to analyze the data.Results: Of the 71 students invited to participate, 70 completed the survey (n=70) for a 98.6% response rate. The majority of respondents were White females (70%, 98% respectively), aged 18-29 (90%). Results indicated an overall average CoBRAS score of 64.89. No statistically significant findings were identified between the two groups in regards to overall scores (p>0.05).Conclusion: A majority of the participants in this pilot study possessed moderate levels of color-blind racial attitudes, suggesting rejection of the concept of racism. Color-blind racial attitudes and biases have been linked to a lack of awareness of White privilege. Further education in this area may foster improved interactions with diverse patient populations.

Effects of Instrument Handle Design on Dental Hygienists' Forearm Muscle Activity During Scaling.

Purpose: The purpose of this study was to determine the effects of 4 different commercially available instrument handle designs (A. 16 grams and 12.7 mm diameter, B. 23 grams and 11.1 mm diameter, C. 21 grams and 7.9 mm diameter and D. 18 grams and 6.35 mm diameter) on the muscle activity of four forearm muscles during a simulated scaling experience.Methods: A convenience sample of 27 (n=27) dental hygienists used a Columbia 13/14 curet with four different instrument handles to scale artificial calculus from typodont teeth. Each participant's muscle activity was measured using surface electromyography (sEMG).Results: Similar muscle activity was generated when scaling with instruments at 16, 18, and 21 grams with varying diameter handles. Instrument B generated significantly more muscle activity when compared to each of the other instrument handle designs (p=0.001, p=0.002, p=0.039). The lower left quadrant displayed significantly less muscle activity during scaling than the upper and lower right quadrants (p=0.026, p=0.000), although no significant interaction effect was found with instruments within quadrants. Most participants (62.96%) preferred instrument A, which was rated more comfortable based on weight when compared to the other instruments tested.Conclusions: Instrument handle design has an effect on forearm muscle activity when scaling in a simulated environment. The heaviest instrument with a relatively large diameter (B 11.1 mm and 23 g) generated significantly more overall mean muscle activity compared to the other three instruments. Similar amounts of muscle activity were produced by instruments weighing between 16 and 21 g. Participants' instrument preferences were more affected by handle diameter than weight. Results support the need for further research to determine the impact of these findings on muscle load related to risk of musculoskeletal disorders in a real-world setting.