Being a dental hygienist is hard work. In our profession we are constantly compromising proper posture to see into the oral cavity. In dental hygiene school we are taught how to properly position ourselves using the clock concept. This concept has been around for many years, it is not a new age idea. When we graduate from hygiene school unfortunately, we begin to neglect correct spinal alignment.


Years of using improper alignment takes its toll on the neck, back and shoulders, hands, wrist and even your eyesight; trust me, I’ve been there! There are many facets and adverse consequences to this. Your eyes represent a complex part of your nervous system. When you have good posture the communication your brain sends via the spine comes fast and interrupted. In fact, the brain cannot make a definite connection to the object it is viewing without correct alignment. This is seen in the prevalent maladjustment, can decrease blood flow, and impulse connection to the eyes that we as clinicians face on a daily basis. Let’s also remember that we do not normally place our patients in a position that is comfortable for them or what we think may be comfortable for them. When, In fact we just do not take the time to adjust the headrest to support the patient’s neck. Taking that extra minute to adjust the headrest will in turn help your instrumentation and vision into the oral cavity. Once the head is properly positioned the clock concept should be incorporated to your practice.


Oh, but wait now there is the inevitable variable the saliva ejector…  Now ask yourself how do you practice your craft? Do you have the patient hold your saliva ejector or do you fish hook off the side of the patient’s’ mouth? Or do you hold the saliva ejector in one hand and follow it around while using the ultrasonic scaler? Do you leave your patient in a slight up right position and have them face towards you? In this blog I want to give you valuable information on each of those types of modalities. I would like to inspire you to think about your essential health which will ultimately lead to longevity in your career. Below I will list these modalities and explain to you why they cause shoulder, neck and back pain.


Holding the saliva ejector in one hand while following along with the ultrasonic scaler.

             If this is the way you practice think about what that is actually doing to your shoulders and neck. Are your arms in a neutral position? The clinicians working distance should be where the patient and clinicians elbow level and oral cavity should be 15 to 22 inches from the clinician’s eyes.  Now if you are holding the saliva ejector in your hand there is no possible way to be in the neutral working position. This means you are using a motion that is unnatural and this will inevitably cause repetitive motion disorders. If you are using the High volume suction the same way as the saliva ejector it is the same problem. No matter which suction you use holding it with your non dominant hand while working there is no possible way to prevent you from being out of the neutral position.


The fish hook off the side of the patient’s’ mouth method.

            If you use this method of draping the suction off the side of the patient’s mouth you know how grueling that is when a patient has larger cheeks. However, it does allow you to at least be in a neutral clinician position. Unfortunately, it is not a desirable solution for patient comfort.  A lot of times we clinicians have to move the suction around placing us again in an unnatural position for ideal ergonomics.


Having the patient sit in a semi upright position and having them facing towards you.

Having your patient in a semi upright position and having them turn their head towards you to control the water flow is another way that places the clinician out of the neutral position. When you are using your non-dominant hand your arm is forced to lift high over the patients head making the elbows at a 90 degree angle. This position causes the majority of our shoulder, neck and head pain.


Having the patient hold the suction in place.

This is an easy solution to free up the clinicians non-dominant hand. However, this is a burden for the patient and their dental experience. I understand that most patients don’t mind but there are some that do. You also know as a clinician that they usually get in our way because they do not know where to place the suction. I have had several friends tell me that they are paying for a service and why do they have to hold our own suction?  My standard reply to them is point well noted.


In any case we clinicians are always compromising our ergonomic practice. This in turn causes us to suffer from musculoskeletal disorders from improper repetitive motion disorder.  We must practice mindful, ergonomics to prevent body injury.