Carpal Tunnel Syndrome: An Occupational Health Risk For Dental Hygienists

Abstract
Carpal tunnel syndrome (CTS) is an extremely painful, expensive, and potentially disabling disorder that affects workers in occupations that perform highly repetitive hand intensive activities. The incidence of CTS symptoms among dental hygienists is high despite awareness of carpal tunnel syndrome risks and ergonomically improved dental instrumentation.

By: Lynn A. Henderson, RN, BSN

Problem
The repetitious hand and wrist movements of dental hygienists daily work activities place them at extremely high risk for CTS.

Implications & Recommendations for Occupational Health Nurses

Dental Hygienists must take preventive ergonomic measures to protect their most valuable asset, their hands. Help them keep their hands healthy and prevent injury by: Identifying existing medical predispositions, causes, and exacerbating activities Ergonomic interventions include: Lighter weight, larger diameter, padded instruments Interchanging tools continuously during repetitious activities Ergonomic work station design Seat & Mirror Positioning Frequent hand rest breaks Adequate Lighting The UCLA/RAND CTS quality measures non-operative treatment recommendations include: Minimize forceful and repetitious activities Do not use laser therapy, muscle relaxants, opioids, diuretics, and non-steroidal anti-inflammatory drugs (NSAIDS) 6 weeks of wearing a neutral positioned splint Do not exceed 4 steroid injections Research needed in these areas: Practical Work Restrictive Activities Exacerbation activities with exposure times Return to work interventions

Literature Review
Dental professionals have a high prevalence of CTS due to the repetitive nature of their work. Studies reported musculoskeletal complaints as early as dental hygiene school (Hayes, Cockrell & Smith, 2009). CTS is more prevalent in females versus men (Dale A. et al., 2013; Giersiepen & Spallek, 2011). Predisposing factors for CTS include diabetes mellitus, hypothyroidism, obesity, rheumatoid arthritis, amyloidosis, acromegaly, tenosynovitis, pregnancy, as well as gender (Palmer, K., 2011; Yazdanpanah, P. et al., 2012). Ergonomic dental instruments should be lighter weight, have a larger diameter, be padded, and be continuously alternated while working (Simmer-Beck & Branson, 2010). The UCLA/RAND Prevention Research Center developed 78 quality measures focused on the evaluation and management of CTS with attention to occupational factors. They used clinical guidelines from The American College of Occupational and Environmental Medicine (ACOEM), literature reviews, and recommendations from clinical specialists to develop the measures (Nuckols, T. et al., 2011).

Background & Epidemiology

The overall prevalence of musculoskeletal disorders (MSD) in dental professionals is between 64% and 93%. The incidence of musculoskeletal problems in dental hygienists was reported at 93% with 44.2% reporting specific carpal tunnel symptoms. Three out of every 10,000 full time workers are affected by CTS. Women are 3 to 10 times more likely than men to develop CTS. Approximately 98% of US dental hygienists are female, a contributing factor for CTS development. CTS had a reported 28 median days

away from work for 2011, the highest

number of median days over all other types of MSD.

Definition of Terms
Carpal Tunnel Syndrome (CTS) is a common illness caused by compression of the median nerve within the carpal tunnel. Symptoms include numbness, tingling, burning, pain, and weakness. Occupational risk factors include repetitive hand and wrist activities, forceful gripping, and hand-arm vibrations.

References
Hayes, M.J., Cockrell, D., Smith, D.R. (2009). A systematic review of musculoskeletal disorders among dental professionals. Int J Dent Hygiene, 7, 159-165. doi:10.1111/j.1601-5037.2009.00395.x Nuckols, T., Griffin, A., Asch, S., Benner, D., Bruce, E., Cassidy, M., Chang, W., Harness, N., Hiatt, L., Jablecki, C., Jerome, J., Sandin, K., Shaw, R., Weng, H., Gibbons, M. (2011). RAND/UCLA Quality-of-Care Measures for Carpal Tunnel Syndrome. Retrieved from http://www.rand.org/pubs/technical_reports/TR809.html Palmer, K. (2011). Carpal tunnel syndrome: The role of occupational factors. Best Pract Res Clin Rheumatol. 25(1), 15-29. doi: 10.1016/j.berh.2011.01.014 Simmer-Beck, M., & Branson, B. G. (2010). An evidence-based review of ergonomic features of dental hygiene instruments. Work, 35(4), 477-485. doi: 10.3233/WOR-2010-0984 Yazdanpanah, P., Aramesh, S., Mousavizadeh, A., Ghaffari, P., Khosravi, Z., Khademi, A. (2012). Prevalence and severity of carpal tunnel syndrome in women. Iranian J Publ Health, 41(2), 105-110. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23113142

American Dental Hygienists Association. (2009). ADHA fact sheet. Retrieved from http://www.adha.org/...docs/72210_Oral_Health_Fast_Facts_&_Stats.pdf Bureau of Labor Statistics, U.S. Department of Labor. (2011). Nonfatal occupational injuries and illnesses requiring days away from work, 2011. Retrieved from http://www.bls.gov/news.release/osh2.nr0.htm Bureau of Labor Statistics, U.S. Department of Labor. (2012). Occupational safety and health definitions. Retrieved from http://www.bls.gov/iif/oshdef.htm Dale, A.M., Harris-Adamson, C., Rempel, D., Gerr, F., Hegmann, K., Silverstein, B., Burt, S., Garg, A., Kapellusch, J., Merlino, L., Thiese, M., Eisen, E.A., Evanoff, B. (2013). Prevalence and incidence of carpal tunnel syndrome in US working populations: Pooled analysis of six prospective studies. Scandinavian Journal of Work Environment & Health, 39(5) , 495-505. doi:10.5271/sjweh.3351 Giersiepen, K., Spallek, M. (2011). Carpal tunnel syndrome as an occupational disease. Deutsches Arzteblatt International, 108(14), 238-242. doi: 10.3238/arztebl.2011.0238