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

M. Cherniack, A. J. Brammer, T. Nilsson, R. Lundstrom, J. D. Meyer, T. Morse, G. Neely, D. Peterson, E. Toppila, N. Warren, M. Atwood-Sanders, C. Michalak-Turcotte, U. Abbas, H. Bruneau, M. Croteau, Rongwei (Rochelle) Fu

Research output: Contribution to journalArticle

28 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)313-326
Number of pages14
JournalAmerican Journal of Industrial Medicine
Volume49
Issue number5
DOIs
StatePublished - May 2006
Externally publishedYes

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Dental Hygienists
Neural Conduction
Mechanoreceptors
Paresthesia
Wrist
Carpal Tunnel Syndrome
Vibration
Dental Instruments
Dental Technicians
Peripheral Nerve Injuries
Median Nerve
Demyelinating Diseases
Dentists
Peripheral Nerves
Nerve Fibers
Ultrasonics
Population
Signs and Symptoms
Hand
Cross-Sectional Studies

Keywords

  • Dental hygienists
  • Sensory nerve conduction velocity
  • Ultrasonics
  • Vibrotactile threshold

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Nerve conduction and sensorineural function in dental hygienists using high frequency ultrasound handpieces. / Cherniack, M.; Brammer, A. J.; Nilsson, T.; Lundstrom, R.; Meyer, J. D.; Morse, T.; Neely, G.; Peterson, D.; Toppila, E.; Warren, N.; Atwood-Sanders, M.; Michalak-Turcotte, C.; Abbas, U.; Bruneau, H.; Croteau, M.; Fu, Rongwei (Rochelle).

In: American Journal of Industrial Medicine, Vol. 49, No. 5, 05.2006, p. 313-326.

Research output: Contribution to journalArticle

Cherniack, M, Brammer, AJ, Nilsson, T, Lundstrom, R, Meyer, JD, Morse, T, Neely, G, Peterson, D, Toppila, E, Warren, N, Atwood-Sanders, M, Michalak-Turcotte, C, Abbas, U, Bruneau, H, Croteau, M & Fu, RR 2006, 'Nerve conduction and sensorineural function in dental hygienists using high frequency ultrasound handpieces', American Journal of Industrial Medicine, vol. 49, no. 5, pp. 313-326. https://doi.org/10.1002/ajim.20288
Cherniack, M. ; Brammer, A. J. ; Nilsson, T. ; Lundstrom, R. ; Meyer, J. D. ; Morse, T. ; Neely, G. ; Peterson, D. ; Toppila, E. ; Warren, N. ; Atwood-Sanders, M. ; Michalak-Turcotte, C. ; Abbas, U. ; Bruneau, H. ; Croteau, M. ; Fu, Rongwei (Rochelle). / Nerve conduction and sensorineural function in dental hygienists using high frequency ultrasound handpieces. In: American Journal of Industrial Medicine. 2006 ; Vol. 49, No. 5. pp. 313-326.
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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.",
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AU - Cherniack, M.

AU - Brammer, A. J.

AU - Nilsson, T.

AU - Lundstrom, R.

AU - Meyer, J. D.

AU - Morse, T.

AU - Neely, G.

AU - Peterson, D.

AU - Toppila, E.

AU - Warren, N.

AU - Atwood-Sanders, M.

AU - Michalak-Turcotte, C.

AU - Abbas, U.

AU - Bruneau, H.

AU - Croteau, M.

AU - Fu, Rongwei (Rochelle)

PY - 2006/5

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N2 - 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.

AB - 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.

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