I feel pretty lucky to be here in New Zealand (NZ) for so many reasons. It’s a beautiful country, moving here in 2005 was a lifestyle choice. The country is about the size of the UK but the population just shy of 5 million, that’s less than half the number of people who live in Birmingham. Needless to say, the number of dentists here is also small with 2074 full members of the New Zealand Dental Association (NZDA) and about another 700 either retired overseas or studying. There is just one dental school here. So, while being a small in numbers can have it’s disadvantages, there are upsides too. One I’m going to discuss here is how our profession look out for one another and our Dental Association’s continuing interest in self care for dentists.
I graduated from The University of Liverpool in 2000. I don’t remember being given much in the way of self care advice. We were always aware there was a high suicide rate amongst dentists and indeed my first experience of that was the suicide of a student at dental school. We knew it was going to be stressful but we were young, ten foot tall and bulletproof. Those things wouldn’t happen to us. Likewise, the first five years following graduation in the UK I wasn’t aware of much in the way of readiness for coping mentally and physically for a 40 plus year dental career. Maybe the advice was there but I didn’t attach any importance to it because life was ticking along just fine.
So what changed? What sparked my interest and led me to look in to what information and advice was out there? Well quite selfishly, it started off all about me. It started with an injury, I managed to wrench my neck taking out a particularly stubborn lower right molar one Friday. I shrugged it off, but within days my neck and shoulder had seized up and I could hardly turn around or lift my arm up. Long story short; After months of treatment and investigations I was told I have a neck incompatible with clinical dentistry! I should look for another way to work.
I couldn’t buy that, I could work but working aggravated my injury. It wasn’t severe enough to be signed off and live of my income protection but I was told it was as good as it was going to get. Around this time I started studying to be a personal trainer and set about rehabilitating my neck and shoulder myself. It took 12 months but I did it. It made me think; without all the regular focused gym work I’d have just slipped back and forth between functioning and recurring injury, it made me wonder how many dentists were doing just that? Apparently it was only my pre-existing strength and fitness that had stopped this injury occurring earlier in my career. The physiotherapist who did my work placement said my posture and movement in the surgery was spot on it’s just that the positions we have to achieve and hold for prolonged periods weren’t any good for my injury. All I could think was that I could have been better prepared for all of this.
At this point I started to look at what information and advice was available. Look at studies into occupational injury within the dental profession, looking more to physical injury than anything else. There was relatively little to be found about musculoskeletal injuries, the main findings related to needle stick and carpal tunnel. There was a lot of information and help regarding mental health and stress management. The NZDA and Dental Council of New Zealand (DCNZ) produced their first edition of Self Care for Dentists in 2001 and then a revised version in 2013. The revised edition did have a couple of paragraphs on Musculoskeletal Discomfort and reads as follows:
“The first paper on dentist’s physical well-being appeared in the journal, Dental Cosmos, nearly 140 years ago (Allen, 1875). Lehto, Helenius and Atlanta, (1991) showed that psychological distress, work-related stress and musculoskeletal symptoms were strongly correlated. Contemporary reports show that very high percentages of dentists experience back or neck pain at some time during their careers. The largest study involved 1253 US dentists, where over 60% reported some musculoskeletal discomfort (MSD) during the previous year (Sugars, Miller, Williams, Fishburne & Strickland, 1987). Palliser (2005) reported a 2001 postal survey of 413 NZ dentists, showing that more than 90% of respondents experienced musculoskeletal discomfort during the previous year. These were particularly in the lower back, neck and shoulders; and 35% of sufferers had needed to restrict their normal activities.
Although aware of many of the do’s and don’ts regarding posture and exercise, apparently few dentists apply their knowledge preventively. They put up with symptoms thinking them to be unavoidable or part of the job. That is not right. You can take care of your physical self at work. One very clear message can be taken from the studies. Dentists are suffering far to much. Action is needed because if you are fit, and the more exercise you do, the less likely you are to develop musculoskeletal problems”
So the warning’s there but not really the solution, exercise is part of it but more specific advice is needed. It’s a great starting point though, these publications were a great step by our professional bodies. I’m delighted to see they have been recently followed up with a survey, study and subsequent wellness workshops being rolled out. I’m going to one next month and can’t wait. As to the physical side of it all, well stay tuned, I’m working on that for you. In the mean time, maybe stop, think about where you’re at. Are you taking care of yourself?
P.S If you want to discuss this or similar issues with a closed group of dentists and allied health professionals then head over to my facebook group Fang Farriers. I look forward to hearing from you.
Jones & Annan, 2013. Self Care For Dentists, New Zealand Dental Association, Auckland.
Annan & Dixon, 2001. Self Care For Dentists, New Zealand Dental Association, Auckland.