Caitlin Parsons is a registered dental hygienist. 

Caitlin Parsons, RDH

Becoming a Dental Athlete: Promoting Wellness for Long-Term Career Success. Image courtesy of Chinnapong/stock.adobe.com 


Dentistry is a demanding profession that can take a toll on the body, with up to 96% of dental professionals experiencing pain during their careers.¹ One of the most common health issues faced by dental professionals is musculoskeletal disorders (MSDs), which can lead to acute and chronic pain, and even disability.² MSDs affect the musculoskeletal system, including bones, muscles, tendons, ligaments, and joints, causing discomfort and impairing movement. According to OSHA, factors such as awkward positioning, contact stress, repetition, vibration, and force/grip can increase the likelihood of MSDs, therefore making dental professionals particularly vulnerable to these injuries.³

While it is impossible to eliminate all risk factors, steps can be taken to minimize their impact. Consider dental professionals as "dental athletes.” Katrina Klein, RDH, personal trainer, ergonomics specialist, and founder of ErgoFit Life, who coined this term says that just as professional athletes must prepare themselves for game day, dental professionals must do the same. By adopting a holistic, individualized approach to wellness, dental professionals can reduce the risk of injury, while creating the foundation for a long-lasting, healthy career.

The first step towards becoming a dental athlete is the preparation for game day. Most dental professionals practice in a seated, and oftentimes awkward position. The human body wasn’t designed to sit for extended periods of time. In fact, sitting for long periods of time is linked with numerous health concerns, including back pain, diabetes, and heart disease.⁴ Sitting forces the body into a dangerous position for the spine and the supporting muscles. It forces certain musclesof the body to overcompensate, while others become underutilized–in both instances, the muscles can become weak over time, and lead to an imbalance in the musculoskeletal system.

One way dental professionals can prepare for work is by focusing on rebalancing the body from sitting and awkward positioning. This can be achieved through a variety of methods such as yoga therapy, strength training, stretches, Pilates, or traditional yoga. Practicing these activities can help to create stabilization throughout the muscles and joints while also stretching and releasing tension from tight, overworked muscles. Yoga has been shown to help reduce back pain.⁵ Regularly incorporating practices that help the body stay strong and mobile reduces the risk of injury and pain and sets the stage for a long-lasting career.

In addition to preparing the body for work, there are also small actions that dental professionals can take while in the office to minimize the risk of injury. Incorporating chairside stretching into the workday is a simple way to reduce tension, improve circulation, and help the body stay in balance. Clinicians can easily weave in micro-stretch breaks between patients, during lunch, or even reading chart notes. This small action done regularly creates massive results long term.

Practitioners can also focus on their posture throughout the day, making small adjustments to their body positioning regularly. When we maintain a neutral posture, in and out of the office, we set ourselves up for better ergonomics and reduce the risk of MSDs.⁶ An ideal seated posture involves aligning the head, ears, shoulders, torso, spine, hips, and legs. Ideally, the shoulders are relaxed, elbows in towards the sides of the body, and the hips are higher than the knees. Practitioners can adjust their posture throughout the day, even during their morning commute, while seeing patients, or waiting in line at Starbucks. By focusing on postural alignment, the foundation for better ergonomics is achieved.

The goal of ergonomics is to prevent soft tissue injuries and musculoskeletal disorders caused by sudden or sustained exposure to force, vibration, repetitive motion, and awkward posture.³ There are many ways to improve ergonomics, including proper practitioner and patient positioning, effective and efficient use of workspace, and accessibility to equipment, as well as the tools and equipment we use. All of these can either add to or reduce strain on the body. Our goal with ergonomics is to make the body work less while being more productive and efficient. In the dental office, ergonomics is extremely multi-faceted. Continuing to practice proper ergonomics is one of the core components of becoming a dental athlete.

Another important aspect of wellness for dental professionals is stress management. Stress is a common issue in dentistry, and the effects of stress can contribute to a host of health issues.⁷ Practicing stress management techniques such as meditation, deep breathing exercises, and yoga can help dental professionals manage stress and reduce the risk of injury.

Finally, dental professionals should prioritize self-care and rest. Taking time for self-care activities such as yoga, hot baths, massage, acupuncture, or chiropractic care can help to reduce tension and prevent injury. Additionally, getting enough rest is crucial for overall health and wellness.⁸ Rest allows the body to repair and rejuvenate, and getting enough sleep may help to reduce the risk of injury and improve overall well-being.

Becoming a dental athlete requires a multi-faceted approach that is unique to each individual. Dental professionals must understand that prioritizing their mental and physical well-being is non-negotiable. By focusing on rebalancing the body, incorporating chairside stretching, maintaining good posture, managing stress, and prioritizing self-care and rest, dental professionals can reduce the risk of injury and pain, and create a foundation for a long-lasting career in dentistry. By adopting a holistic approach such as this, dental professionals can become their best selves both in and out of the office.

Lietz J, Kozak A, Nienhaus A. Prevalence and occupational risk factors of musculoskeletal diseases and pain among dental professionals in Western countries: A systematic literature review and meta-analysis. 

. 2018;13(12):e0208628. doi:10.1371/journal.pone.0208628

Kumar M, Pai KM, Vineetha R. Occupation-related musculoskeletal disorders among dental professionals. 

. 2020;93(4):405-409. doi:10.15386/mpr-1581

Occupational Safety and Health Administration. Ergonomics. Accessed at https://www.osha.gov/ on January 10,2021.

Harvard Healthy Publishing. The Dangers of Sitting. May, 23, 2019. Accessed February 20, 2023. https://www.health.harvard.edu/pain/the-dangers-of-sitting

Seguin-Fowler R, Graham M, Ward J, Eldridge G, Sriram U, Fine D. Feasibility of a yoga intervention to decrease pain in older women: a randomized controlled pilot study. 

. 2020;20(1):400. Published 2020 Oct 12. doi:10.1186/s12877-020-01818-y

Cramer H, Mehling WE, Saha FJ, Dobos G, Lauche R. Postural awareness and its relation to pain: validation of an innovative instrument measuring awareness of body posture in patients with chronic pain. 

. 2018;19(1):109. Published 2018 Apr 6. doi:10.1186/s12891-018-2031-9

Ahmad AH, Zakaria R. Pain in Times of Stress. 

Articles

With how physically demanding dentistry can be, it is important to take good care of yourself for long-term success and happiness. 

Becoming a Dental Athlete: Promoting Wellness for Long-Term Career Success

How Stress and Mental Health Plays a Role in Physical Well-Being for Dental Professionals. Photo courtesy of Mikhaylovskiy/stock.adobe.com. 

Dentistry is known to be one of the most stressful professions in health care. According to a survey conducted by RDH E-Village, more than half of dental hygienists feel stressed by their job on a daily or weekly basis.

 This survey suggests that the common causes of higher stress levels for dental professionals are musculoskeletal discomfort, personal strain, ambiguity in the office, and emotional exertion. Musculoskeletal disorders, also known as MSDs, are extremely common among dental professionals. Studies show that up to 97.9% of dental professionals experience physical pain from musculoskeletal disorders.

 In an industry known for high stress and work-related pain, the question we must ask is: are they connected?

Some contributors to musculoskeletal disorders among dental professionals are awkward working posture, movement repetition, on-going vibration, and long-durations sitting. Many dental professionals complain that the pain eases when they’re not working and then it returns during work hours. There is a strong correlation between stress and pain. Moving forward in this article, I’ll examine the connection between the these.

Let’s start by talking about stress. Stress is our body's response to pressure; it is a feeling of emotional or physical tension. Stress can stem from a specific thought, situation, or event. It often occurs when we feel frustrated, angry, nervous, or lacking control. In addition, stress can come from the food we eat, the exercise we partake in or lack thereof, our lifestyle, relationships, and more. In small doses stress is a good thing. However, stress can become highly problematic when it’s ongoing and the body isn’t able to go through the full stress response and return to homeostasis.

There are many ways to address stress and improve our physical and mental wellbeing. One simple practice is to focus on your breathing. Our breath and the way we breathe have a direct correlation to our nervous system. When you feel stress coming on or lingering after an event, simply become aware of your breathing patterns. Often, the breath will be shallow and fast. Focus on slowing down the breath, and the exhale in particular. Exhalation is connected to our parasympathetic nervous system. Take 10 breaths and focus on long, slow, steady exhalations.

Another practice for reducing stress is called Box Breathing. Box Breath is a breathing practice that focuses on creating balance in the breath. To practice Box Breathing, start by inhaling for a count of 4, pause at the top for a count of 4, exhale for 4 counts, and pause at the bottom for 4 counts. You can adjust the counts as needed. Try this cycle of breathing for 8-10 rounds or until you feel more relaxed.

Another practice to help reduce stress is a body scan. A body scan is a simple way of becoming more aware of your body, and in turn, becoming more present. This one is taught in many mindfulness and yogic practices. Start at your head and work your way to your feet–or vice versa. Simply notice and relax each area as you go.

The last practice to help reduce stress and optimize our resilience to stress is therapeutic yoga. With gentle and mindful movements of the body linked with a steady breathing pattern, you create balance in the nervous system, reduce muscle tension, and become more present. With this, stress levels reduce, and the muscles relax.

How we cope with stress is extremely important. Everyone deals with stress differently and it depends on several things including early life events, genetics, and our personality. To understand stress and the relationship between our mental and physical well-being, we must look at the nervous system. The nervous system has 2 main divisions; the first is the autonomic nervous system. The autonomic nervous system is a branch of the peripheral division which encompasses 2 individual systems, both of which have unique functions: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).

These 2 systems work together throughout every day. When stress occurs, the SNS activates what is commonly known as the “fight or flight” response. When the stress response is triggered, our body produces stress hormones that allow us respond to dangerous situations quickly. This is the main function of the sympathetic nervous system. When this response is activated, the body shifts its energy and resources towards fighting off a threat, such as a medical emergency in the dental office. The SNS signals the release of specific hormones, and from there, a host of actions occur within the body including increased heart rate, blood vessel dilation, and digestive disruptions. The SNS response happens suddenly to prepare the body to respond to an emergency. This is known as acute stress.

Stress and the stress response can be extremely useful in certain situations. Working in clinical dentistry, it allows us to activate quickly as needed to help an anxious patient or a medical emergency. Once the crisis has passed, ideally the body returns to an unstressed state. The recovery from the stress response is facilitated by the parasympathetic nervous system, the second system within the autonomic nervous system. When the stressor passes and the PNS is prompted, our hormones go back to normal quickly, shifting the body into the “rest and digest” state. When our body is able to respond to stress and swiftly return to homeostasis, no long-term effects arise.

While stress can occur as a result of heavy traffic on the way to work, a rude comment from a co-worker or patient, or equipment not functioning properly, it can add up throughout the day, leading to chronic stress. We live in a busy society, constantly inundated with information from the news and social media which can cause a compounding effect whether we realize it or not. In addition, as dental professionals, we are receiving information all the time–feedback from our patients, messages from our team, our own thoughts and analytical processing, and so on. If we don’t find ways to manage our stress and our response to stress, we will remain in a state of constant arousal, leading to long-term health effects.

When we remain in a constant state of sympathetic arousal, many symptoms can occur including feelings of anxiousness, frustration, and irritability. Some may notice themselves snapping at co-workers or friends, being unable to make clear decisions, or having difficulty sleeping. Other symptoms include low energy, fatigue, digestive problems, headaches, shallow breathing, and aches & pain in the body. There are clear signs that long-term stress is directly correlated to our physical well-being.

Chronic stress occurs when the body experiences stressors with such high intensity and frequency that the autonomic nervous system cannot activate the relaxation response regularly. This leads to a continuous trigger of physical reactions in the body and affects every system in the body–directly or indirectly. Our bodies are designed to handle acute stress–such as the random medical emergency in the office–not a state of constant stress. To evaluate the correlation between stress and physical pain, we can look at how an overactive nervous system affects the entire body.

We know that stress affects all systems of the body including the musculoskeletal system. When our body experiences stress, our muscles become tense and breathing becomes shallow. Ideally under stress, the muscles tighten all at once, and once the stressor passes, the muscles relax. However, what happens when the trigger passes but we continue to feel stressed, as a result, the muscles remain tense.

Muscle tension is our body’s intelligent way of protecting itself against harm or threat, however, if we’re living in a state of chronic stress, it becomes difficult for our muscles to relax. When muscles are tight for long periods of time, other reactions in the body may be triggered, and may lead to pain. For an example, chronic muscle tension in the head, neck, and shoulders often leads to headaches for people.

Constant muscle tension can lead to many adverse effects including reduced blood flow and circulation, both of which are necessary for our body to heal. With an overproduction of cortisol released during chronic stress, inflammation in the body increases, leading to pain and fatigue. In addition, once you experience pain, it’s common for people to start worrying about that pain. In the study 

The Pain Catastrophizing Scale: Development and validation

, they explain that, “Pain-related fear of movement can lead to hypervigilance, muscular reactivity, and avoidance.”

 Often time, we avoid exercise or movement thinking that it will lead to more pain. When in reality, our muscles need movement! When they are not being used, they become weak and lead to further discomfort.

Our body is interconnected and complex. When we experience stress, mentally, emotionally, or physically, it creates a ripple effect in the rest of our body. So, when we are experiencing chronic stress, it takes a toll on our entire system. While it’s important to reduce physical pain, which can lead to stress, it’s necessary to address stress itself.

Pain and stress are designed to alert the body on a short-term basis. The body is designed to deal with them for a short time. When the body is stuck in “fight or flight” mode for extended periods of time, this overworks the body and causes problems. We can minimize stress and pain by building better resilience to stress, minimizing stressors, and actively managing stress levels day-to-day.

Hartley M. Career satisfaction survey: Coping with stress | dentistry IQ. dentistryiq.com. April 8, 2015. Accessed September 22, 2022. https://www.dentistryiq.com/dental-hygiene/salaries/article/16350568/career-satisfaction-survey-coping-with-stress

Ohlendorf D, Naser A, Haas Y, et al. Prevalence of Musculoskeletal Disorders among Dentists and Dental Students in Germany. 

. 2020;17(23):8740. Published 2020 Nov 24. doi:10.3390/ijerph17238740

Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. 

(4), 524–532. doi:10.1037/1040-3590.7.4.524

Stress takes a physical toll on the body, which can and will make your job as a dental professional more difficult. We look at what stress does to the nervous system. 