JADA Continuing Education: The effects of periodontal curette handle weight and diameter on arm pain: A four-month randomized controlled trial.

Dr. Rempel is a professor of medicine, Division of Occupational and Environmental Medicine, University of California, San Francisco, 1301 S. 46th St., Building 163, Richmond, Calif. 94804.
Journal of the American Dental Association (1939) (Impact Factor: 2.01). 10/2012; 143(10):1105-13. DOI: 10.14219/jada.archive.2012.0041
Source: PubMed


/st> The design of periodontal curette handles may cause or aggravate arm pain in dental practitioners. The authors conducted a four-month randomized controlled trial to evaluate the effects of curette handle diameter and weight on arm pain among dental hygienists and dentists.
/st> One hundred ten dental hygienists and dentists who performed scaling, root planing or dental prophylaxis procedures participated in this study. The authors assessed right wrist/hand, elbow/forearm and shoulder pain levels weekly. They randomized participants to receive either a set of light (14 grams) periodontal curettes with a large diameter (11 millimeters) or a set of heavy (34 g) periodontal curettes with a narrow diameter (8 mm). The authors compared changes in mean pain scores across the study period between intervention groups by using general linear models and controlling for covariates.
/st> The improvement in pain scores across the three body regions was greater for participants who used the lighter, wider-diameter curettes. In the final adjusted model, the differences were statistically significant only for the shoulder region (P = .02).
/st> The study results show that dental instrument design has an effect on upper-extremity pain in dental practitioners. Using a lighter instrument with a wider diameter may be an easy and cost-effective intervention to reduce or prevent upper-extremity pain associated with dental hygiene procedures. Clinical implications To prevent or reduce arm pain, practitioners should consider using lightweight instruments with large diameters when performing scaling and root planing procedures.

Download full-text


Available from: David Rempel,
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Hand and ultrasonic instrumentations have been preferentially used in routine periodontics clinics. The purpose of this in-vitro study was to investigate whether experienced (EO) and less experienced operators (LO) were able to achieve greater therapeutic success during scaling with new developed tips for power-driven devices than with new developed hand instruments. Method: In an experimental study in dummy head, a sonic (AIR), an ultrasonic device (TIG) and double sharpened special curettes’ (GRA) were utilize by 12 operators (8 EO/ 4 LO) to remove biofilm. The time required for treatment was measured. Afterwards the percentage of residual biofilm and the weight loss for each tooth that was scaled was determined. Result: All operators needed 3.14±1.16min/tooth for debridement regardless of the used instrument. The sonic scaler AIR showed the highest biofilm removal (21.45±21.31%) (p<0.001) compared to the special curettes’ GRA (28.21±19.96%) and the ultrasonic device TIG (32.48±22.45%). More and less experienced operators revealed a significant difference only in the using of AIR (p=0.012). Molars in the lower jaw (46.17%) presented nearly 20% more residual biofilm after scaling related to the mean over all (27.38%). Both treatment groups removed more hard tooth structure with hand instruments (p<0.001) than with powered device systems (p=0.280) (GRA: 12.7±4.7mg; AIR 7.5±3.7mg; TIG 7.6±8.3mg). However the LO works more aggressive and showed a higher weight loss after scaling (p=0.004). Conclusion: Hand instruments showed constant results for all operators, but a high loss of tooth substance. Sonic scaler allowed a higher biofilm removal over all as well as a lower loss of dental hard tissue. Due to training, less experienced operators reached similar results in the effectiveness as experienced operators regardless of the instrument used, but with more severe side effects.
    IADR General Session and Exhibition 2014; 06/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: This discussion panel aims to identify ergonomic concerns, solutions and research needs, physical stresses, and outcomes related to clinical and surgical procedures. This session will begin with formal presentations to demonstrate current ergonomic concerns and research initiatives associated with clinical and surgical procedures to frame the panel discussion for the second part of the session. Discussion of different procedures will help to identify solutions and research needs that relate to a broad range of ergonomic problems. Questions will be collected from the attendees and speakers and organized so as to guide the panel discussion and to engage all of the speakers in the discussion to achieve the symposium aims.
    10/2014; 58(1):924-928. DOI:10.1177/1541931214581194
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Periodontal scaling might cause musculoskeletal disorders, and scaling instruments might not only have different effectiveness and efficiency but also differ in their ergonomic properties. The present study assessed ergonomic working patterns of experienced (EO) and less experienced operators (LO) when using hand and powered devices for periodontal scaling and root planning. Methods: In an experimental study using periodontally affected manikins, sonic (AIR), ultrasonic (TIG) and hand instruments (GRA) were used by 11 operators (7 EO/4 LO) during simulated supportive periodontal therapy. Using an electronic motion monitoring system, we objectively assessed the working frequency and positioning of hand, neck and head. Operators' subjective evaluation of the instruments was recorded using a questionnaire. Results: Hand instruments were used with the lowest frequency (2.57 ± 1.08 s(-1)) but greatest wrist deviation (59.57 ± 53.94°). EO used instruments more specifically than LO, and generally worked more ergonomically, with less inclination of head and neck in both the frontal and sagittal planes, especially when using hand instruments. All groups found hand instruments more tiring and difficult to use than powered instruments. Conclusion: Regardless of operators' experience, powered instruments were used more ergonomically and were subjectively preferred compared to hand instruments. Clinical relevance: The use of hand instruments has potential ergonomic disadvantages. However, with increasing experience, operators are able to recognise and mitigate possible risks.
    Clinical Oral Investigations 09/2015; DOI:10.1007/s00784-015-1605-2 · 2.35 Impact Factor
Show more