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ADA Wellness Survey reveals dentists’ ergonomic issues

January 12, 2018

By David Burger

Does your neck hurt? Your back?

You’re not alone.

The ADA Council on Dental Practice’s Dental Wellness Advisory Committee conducted a 2015 survey to study the well-being of dentists.

Poor ergonomics emerged as a major issue.

Two-thirds of the respondents reported that they suffered from neck pain and nearly half of them said that it was either moderate or severe in its intensity. A similar percentage reported low back pain and again, half of those surveyed said that it ranged from moderate to severe.

Three members of the committee who were selected for their ergonomics expertise — Timothy J. Caruso, Tamara James and Robert Werner, M.D. — prepared a report in late 2017 that addressed musculoskeletal problems and their causes based on the survey’s findings.

Mr. Caruso is a physical therapist who has served on the committee for over a decade; Ms. James is director of ergonomics at Duke University’s Occupational and Environmental Safety Office; and Dr. Werner is former Chief of the Physical Medicine & Rehabilitation at the Ann Arbor VA Medical Center.

“The practice of dentistry involves risk factors such as strained postures, repetitive motion and sustained muscular contractions, not to mention confined spaces,” said Dr. Douglas Wolff, chair of the committee. "When dentists went from standing up to sitting down, many of these problems were thought to be eliminated, but there continues to be a significant number of physical complaints associated with practicing dentistry. Good ergonomics should be a cornerstone of today’s modern dental practice in order to keep the clinician comfortable, efficient, effective and healthy.”

Aches can arise from a number of issues, the authors of the report said, including:

  • The practitioners’ seated posture if the patient chair does not allow them to easily access the oral cavity. 
  • Bending, twisting and assuming awkward positions when treating the patient.
  • Poor intraoral lighting that leads to perching on the edge of the operator stool and peeking into the oral cavity.
  • An operator stool that will not adjust up and down and has an unstable seat, requiring the dentist to sit askew on the seat in order to maintain a balanced sitting position.
  • Instruments that are not properly sharpened that require more exertion in order to be effective.

To address the pain, the authors recommended:

  • Seeing a primary care physician, with possibly a referral to a physical therapist.
  • Massage, exercise, acupuncture and chiropractors might offer relief.
  • A treatment called the McKenzie Approach, which can help mitigate back and neck pain. The approach is performed by specially-trained physicians who are well-versed in the care of back and neck pain. To find a clinician who performs this procedure, visit

The authors also stress research when purchasing loupes. The magnification level, working length, field of view and the angle of declination must all be determined in order to maintain good head and neck posture, they said. Ideally, the authors maintain, dentists should have their loupes properly fitted by a trained optical specialist, with the fitting done in their own dental operatory with a volunteer in the chair. Poor-fitting loupes can cause the practitioners to drop their head in order to achieve proper focus and declination angle to see the oral cavity, leading to poor posture along with neck, shoulder and neck pain.

Stopping pain before it starts is always best, the authors said. Dentists should focus on how they work, how they hold instruments and how neck and back posture could be contributing to their aches. One way to do this is to have a staff member photograph or video a dentist’s procedures to get a better understanding of what may be contributing to the pain.

The authors also recommend looking at the layout and design of the operatory. In the case of the patient chair, having a chair that is too thick or too wide can impede a practitioner’s access to the oral cavity.

For more information, the 2015 ADA Wellness Survey can be found at the ADA’s Center for Professional Success.