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March 24, 2009 | Modern Hygienist
Illuminated options Have you ever tried getting dressed in the dark? Generally, you can feel and fumble your way around to getting it nearly right. When you add a little light, you may have to re-button your blouse or straighten your trousers to complete the process. Have you ever tried performing dental procedures in the dark? In dentistry, you are not afforded the same flexibility to “feel your way around” the oral cavity as you are in getting dressed in the dark—not so good for business. While it is true that kinesthetic and tactile senses are vital components to dentistry, vision is critical. How well do you visualize the oral cavity? If you are like most dentists and hygienists, direct visualization is how you see; you twist and turn, lean and bend in order to see your target. Over time, this approach is not without consequences. Generally, it is at the expense of good balanced posture, effective teamwork and fatigue – both visual and muscular. These shortcomings have long been accepted as just part of dental practice. At the end of the day, what part of your body is most fatigued? Your head, neck, shoulders, back? How about your eyes? The eye must focus and refocus thousands of times a day. Researchers have found that the average person blinks 12 to 20 times per minute at rest. This average is affected by the task at hand. It has been found that the visual tasking—that is, work difficulty, complexity, and cognitive overload—lowers the frequency of blinking. And there appears to be an inverse relation between the difficulty of the task and the blink frequency.
Within the dental operatory, there are an extraordinary number of visual tasks occurring. And while lighting plays a significant role, there are relatively few guidelines to follow when it comes to work and ambient light ratios. In Dr. Harold Kilpatrick’s book, Work Simplification in Dental Practice (WB Saunders 1974), he states that the suggested ratio between operating light and the working light should not be more than 4:1. These ratios were based on information from the Society of Illuminating Engineers. While this work is becoming outdated, and there has not been a lot of good scientific research into “correct” lighting ratios, one observation from that original text still rings true. In the book, it is reported that working with less than adequate lighting involves unnecessary expenditure of nervous energy on the part of the dental practitioner, which can slow up his/her work, and result in extreme fatigue, nervous exhaustion and possibly eye impairment which can be career threatening. So what is the right answer? The answer is: it depends. What if we were able to solve these problems? Where would you like to start? How about improved illumination of the oral cavity? Traditional dentistry has utilized an external light source. The trouble has always been to get the right amount of light from the external source into the oral cavity using a hand mirror. In today’s operatory, it is now possible to bring light directly into the oral cavity. The advantages are clear: now you can see! Now what if we could improve upon adding light to the oral cavity by adding improved or increased magnification? Being able to better visualize what you have just illuminated brings you the best of both worlds. Once again, a number of options exist. Starting simply, there are a number of loupes and scopes with light sources attached that are available. They move where you move and point where you look. Within the larger dental community, opinions on the options vary. Some practitioners wouldn’t practice without them while others feel encumbered by the harness and the weight of the headset. If we take a step into higher technology, there are a number of oral cameras with light sources. They have the advantage of providing an illuminated image on an LCD screen. In general, these cameras provide a quantum improvement in one’s seated posture and positioning and diminish the stress on the eye; clinicians report improved comfort and less overall fatigue at the end of the day. On the down side, some clinicians report problems with depth perception and clarity. For sure, there is concern about depth perception, some others report concerns about how the image is displayed and the amount of time required to master the equipment. Some of the latest technologies bring magnification and illumination into the oral cavity. There are at least two devices that bring an LED light source into the oral cavity along with a camera. The oral cavity is illuminated and the image is magnified and displayed on an LCD screen in the operatory. Newer technology has improved the clarity and depth perception while allowing the images to be inverted on the screen to mimic the hand mirror. Pretty slick! Generally, these instruments are expensive initially, but the long-term payoff can be priceless! As with all high price purchases, it is important to try it before you buy it. Ask your vendor for a demonstration and an adequate amount of time to get a good feel for the equipment.
So if you are interested in decreasing the amount of stress in your day, there are some questions that you might want to answer. What type of overhead lighting do you have—direct, recessed, reflected? How about indirect lighting in your office? What are the colors of the walls, floors and cabinetry? Is there an outside window with natural light? Do you have shades, blinds or reflective film to filter the light? Is there glare in the office? What about your patient light sources? Are they the same in each operatory? What is the intensity of the light sources? Do you wear loupes, scopes or glasses to work? All of these factors come into play when considering lighting in the operatory. There may be better or worse but there is no one right answer and when it comes to you, the answer is…it depends. However, some of the new technologies are worth a closer look! Timothy Caruso, PT, MBA, MS, Cert. MDT, is a practicing Physical Therapist with 25 years of experience in healthcare. Mr. Caruso assumed the manager’s position at the Oak Park Physical Therapy Clinic in 1987 where he became interested in musculoskeletal pain within the dental profession after noticing a signifi cant number dental professionals in his clinic who were unable to work.
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