ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Performing a Variety of Tasks May Help Dentists Maintain Hand Strength Throughout Their Careers
Clinical Question How does doing a variety of different procedures affect pinch grip strength in a practitioner’s dominant hand?
Clinical Bottom Line Dentists performing higher variation in work tasks have higher pinch grip strength.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23601435Ding/2013295 Female dentists in the age group of 45-63 years.Cross- Sectional study
Key results“Dentists with low variation of work task history had an increased risk of low pinch grip strength in the right hand (OR 2.3, 95% CI 1.2-4.3), but not in the left (1.13, 0.62-2.08), compared to dentists with high task variation.” Symptomatic osteoarthritis was seen mostly in the first three fingers and wrist of the right hand as compared to the left hand (right vs. left: 10.9% vs. 8.2%, P<0.001). The first three fingers aid the pinch grip for use of instruments during procedures, thus the occurrence of symptomatic OA in that specific location.
#2) 16567556Solovieva/2006291 Female dentists in the age group of 45 to 63 years.Cross- Sectional study
Key results“Dentists with a history of low task variation had a greater prevalence of OA in the thumb, index, and middle fingers compared with dentists with high variation (OR 2.22; 95%CI 1.04-4.91)” In a comparison between general dentists and specialists, all types of OA were more prevalent amongst specializing dentists. This study shows that OA in the thumb, index, and middle finger joints is related to the history of pattern of work tasks. Overall, the time specialists’ spent on restorative/endodontic treatment decreases from the age of 25-34 years to the age of 45-54 years, whilst time for orthodontics increased, accordingly.
Evidence Search variation[All Fields] AND ("work"[MeSH Terms] OR "work"[All Fields]) AND tasks[All Fields] AND pinch[All Fields] AND ("hand strength"[MeSH Terms] OR ("hand"[All Fields] AND "strength"[All Fields]) OR "hand strength"[All Fields] OR "grip"[All Fields])
Comments on
The Evidence
The first study consisted of a cluster analysis in which 295 female subjects were enrolled, and three clusters were distinguished. The clusters that emerged were: low (most work time in restoration treatment/endodontics), moderate (about 50% in the former and 50% in prosthodontics/periodontics/surgery), and high (variable tasks including administrative duties). The instrument used to measure pinch grip strength of the pulp of the thumb and the pulp of the index and middle fingers, is called the Martin Vigorimeter. This is also called the “tripod pinch grip strength.” Also, factors such as BMI, osteoarthritis, hand size, and hand-loading leisure time activity were adjusted in the results. Questionnaires were used to record handloading leisure time activities and joint pains. Glove size was used as a proxy for hand size. Hand radiographs were taken to observe signs of symptomatic osteoarthritis. BMI was calculated based on measured weight and self-reported height. The potential confounders, i.e. BMI, hand size, hand loading leisure time activity, symptomatic osteoarthritis, and age were variables which were controlled in the analysis. Subjects were asked to recall their work history in periods of 10-years and to give an average of work hours per week and the amount of average time spent on each different procedure. The second study is similar to the first study. It involved 291 female dentists and also formed three clusters: cluster 1 (high variation - mixture of tasks performed), cluster 2 (moderate - 50% of time on restorative and endodontics and 50% of time on prosthodontics, periodontics, and surgical procedures), cluster 3 (low - restorative and endodontic treatment mostly). A detailed questionnaire was used to gain information, including occupational exposure, daily manual activities, leisure activities, family history of Heberden’s nodes and smoking. BMI was also calculated and controlled as a potential confounder along with the previously collected information via the questionnaire. Both studies have a potential recall bias because the participants were asked to recall procedures over a lengthy period of time. The accuracy of properly recollecting performed procedures may be altered. Moreover, the noted history of Heberden’s nodes in the second study is a helpful marker of generalized OA. The two studies used females only as subjects, thus the chance of varied findings in male subjects can not be disregarded. Perspective: Overall, I have found these studies to be conducted thoroughly with the evaluation of specific related factors. However, no conclusions can be drawn as to the cause-and-effect relationship between task variety and pinch grip strength; all findings during these studies were limited to correlations. I believe that a different type of study, i.e. cohort study of general dentists and specialists, including both male and females, should be carried out to examine the effects of task variety on pinch grip strength over time.
Applicability According to this study, dentists can benefit with the knowledge that including variation in their work can help in preventing loss of pinch grip strength. Furthermore, specialists can also use this information to modify or broaden their level of skill by including different procedures requiring more precision and grip from other specialties to decrease the chance of developing symptomatic OA, as well as to prevent the risk of low pinch grip strength. Moreover, gaining insight on such a topic may help dentists to enhance their careers and continue with their profession for a longer period of time.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Dentists; Pinch grip strength; Symptomatic hand osteoarthritis
ID# 2906
Date of submission: 07/09/2015spacer
E-mail khushbusmalhotra@gmail.com
Author Khushbu Malhotra
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author John D. Rugh, PhD & Kelly C. Lemke, DDS
Faculty mentor/Co-author e-mail rugh@uthscsa.edu, LemkeK@uthscsa.edu
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