title: Comparison of muscle activity associated with structural differences in dental hygiene mirrors.
abstract: OBJECTIVE
  Ergonomic studies suggest that the commonly used pinch grasp, held in a static position, is a contributing factor for dental Hygienists' development of work-related musculoskeletal disorders (WMSDs) such as carpal tunnel syndrome (CTS), Trigger Thumb, de Quervain's stenosing tenosynovitis, and carpometacarpal (CMC) osteoarthritis. The pinch grasp is commonly used by the dental hygienist while holding the dental mirror in the non-dominant hand. In response to this concern, manufacturers are redesigning dental mirror handles. The value of these re-designed products is based solely on anecdotal evidence. To date, minimal research has been done to examine the non-dominant mirror hand. The purpose of this study was to objectively evaluate dental mirror handle design using surface electromyography (sEMG) to compare muscle activity associated with grasping the mirror.
  
  
  METHODS
  This randomized controlled clinical trial utilized a two-by-two repeated measures statistical design. Data was collected on a convenience sample of 19 (N=19) healthy dental hygiene students in their last year of study. Data collection was divided into two phases to maintain a balanced study. The independent variables in phase I were diameter and weight. The independent variables in phase II were weight and padding. Muscle activity was measured while grasping various dental hygiene mirrors in 30-second increments using sEMG. Following data collection subjects designated which mirror felt most and least comfortable to compare subjective data with objective data.
  
  
  RESULTS
  Three statistically significant results occurred. In phase II, padding (p=.01) demonstrated the largest reduction of muscle activity in the flexor pollicis brevis, by decreasing mean muscle activity by 3.7 microv. The interaction of diameter and weight (p=.01) in phase I reduced the mean muscle activity in the extensor digitorum by .8 microV and weight (p=.02) in phase II decreased the muscle activity in the extensor digitorum by .62 microV. Self-reports of comfort reported by the subjects in this study were not consistent with the measurements of muscle activity using sEMG.
  
  
  CONCLUSIONS
  Ergonomic adaptations to dental hygiene mirror handles were associated with increases and decreases in muscle activity. The clinical impact of this is amplified as force is exerted. Furthermore, it may be possible to reduce WMSDs for dental hygienists by using instrument designs during the workday. Self-reports of comfort by the subjects in this study did not calibrate with the measurements of muscle activity using sEMG. Additional research is needed to further isolate the external variables of the study and to determine what actual reduction in muscle activity is significant for maintaining musculoskeletal health.
authors.affiliation: Division of Dental Hygiene, University of Missouri-Kansas City, USA. simmerbeckm@umkc.edu
authors.forename: Melanie
authors.initials: M
authors.lastname: Simmer-Beck
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Bray
authors.forename: Bonnie
authors.initials: B
authors.lastname: Branson
authors.forename: Alan
authors.initials: A
authors.lastname: Glaros
authors.forename: Jeff
authors.initials: J
authors.lastname: Weeks
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D012090:Cumulative Trauma Disorders / Q000209:etiology / Q000517:prevention & control*; D003756:Dental Hygienists; D003762:Dental Instruments / Q000009:adverse effects; D003777:Dental Prophylaxis / Q000295:instrumentation*; D004576:Electromyography; D004867:Equipment Design; D006804:Ergonomics; D005260:Female; D018737:Hand Strength; D006801:Humans; D018482:Muscle, Skeletal / Q000503:physiopathology; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control*