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Nerve conduction and sensorineural function in dental hygienists using high fFrequency ultrasound handpieces.

Authors
Cherniack-M; Brammer-AJ; Nilsson-T; Lundstrom-R; Meyer-JD; Morse-T; Neely-G; Peterson-D; Toppila-E; Warren-N; Atwood-Sanders-M; Michalak-Trucotte-C; Abbas-U; Bruneau-H; Croteau-M; Fu-RW
Source
Am J Ind Med 2006 May; 49(5):313-326
NIOSHTIC No.
20043171
Abstract
Background: Oscillatory vibration from industrial power tools poses a well-recognized risk of peripheral nerve injury. There have been reports of elevated vibrotactile perception thresholds (VPT) among dentists, dental technicians, and dental hygienists, using rotary devices and ultrasonics. Elevated VPTs are an indicator of small fiber nerve or mechanoreceptor injury, but the high frequencies associated with dental instruments are presumed by the ISO to exceed physiological response upper thresholds. This study examines nerve conduction and sensorineural deficits in dental hygienists. Methods: A cross-sectional study of 94 experienced dental hygienists was conducted to assess peripheral nerve function and clinical signs and symptoms. Specialized testing included measurement of VPTs for three different categories of mechanoreceptors, sensory nerve conduction tests with fractionated digit and palmar segments, and measurement of calibrated pinch force with force sensitive resistors (FSRs) during a simulated procedure. Results: Chronic hand paresthesias were described by 44.7% of experienced dental hygienists. Sensory nerve conduction velocity (SNCV) across the wrist-palm segment of the median nerve. VPTs were particularly elevated at the FAII mechanoreceptor among experienced dental hygienists. Compared to participants without carpal tunnel syndrome (CTS), as defined by study criteria, 14 experienced hygienists with diagnosed CTS had almost twice the average weekly use of vibratory instruments -8.3 hr versus 4.5 hr, and had SNCV deficits along the digit -47.11 m/sec (+8.70) versus 42.57 m/sec (+8.25), and across the wrist -44.04 m/sec (+7.15) versus 41.36 m/sec (+9.27). There was a distinct subset of dental hygienists (27%) with a combination of low calibrated pinch force in simulations, subjective loss of strength and elevated VPTs, especially in the FAII mechanoreceptor population -110.82 db (+8.57) versus 104.84 db (+6.80) in the rest of the cohort. This subset also had a higher prevalence of paresthesias (67% vs. 39%) and greater cumulative vibration exposure (OR?=?1.206 [CI 1.005-1.448]), than other hygienists. Conclusions: The high levels of paresthesias observed among dental hygienists appear to be attributable to several pathophysiological mechanisms, including, sensory nerve demyelination at the carpal tunnel and intrinsic to the digits, and dysfunction of fingertip mechanoreceptors. A distinct sub-population appears to exhibit a high level of accumulated abnormality.
Keywords
Vibration; Vibration-effects; Vibration-exposure; Power-tools; Peripheral-nervous-system; Nerve-damage; Nerves; Nerve-function; Dentists; Injuries; Hand-tools; Hand-injuries; Psychological-effects; Psychology; Musculoskeletal-system; Musculoskeletal-system-disorders; Humans; Men; Women; Workers; Force; Statistical-analysis; Carpal-tunnel-syndrome; Author Keywords: vibrotactile threshold; sensory nerve conduction velocity; ultrasonics; dental hygienists
Contact
M. Cherniack, Director, ErgonomicsTechnology Center, University of Connecticut Health Center, 263 Farmington Avenue-MC6210, Farmington, Connecticut 06030-6210
CODEN
AJIMD8
Publication Date
20060501
Document Type
Journal Article
Email Address
cherniack@nso.uchc.edu
Funding Type
Cooperative Agreement
Fiscal Year
2006
NTIS Accession No.
NTIS Price
Identifying No.
Cooperative-Agreement-Number-U01-OH-007312
Issue of Publication
5
ISSN
0271-3586
Source Name
American Journal of Industrial Medicine
State
CT
Performing Organization
University of Connecticut Schools of Medicine
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