Strive-the Student View
May - June, 2006 edition

Enhancing the Vision of Your Career: Students' Perspective on Magnification

 
By Maria Burreci-Diana and Krystle Brown

When we first started the dental hygiene program at the University of Medicine and Dentistry of New Jersey-The School of Health Related Professions (UMDNJ-SHRP), our instructor and mentor Professor Janet Jaccarino said to us, "Always be an advocate of change, you do not want to remain static, for this profession is always changing." Those were some of the great words of advice we eagerly accepted from our professors when we entered into this program.

At the beginning of our journey, during our didactic studies, we learned about ergonomics and the risks of work-related musculoskeletal disorders and how important it is to maintain certain techniques and postural positions to help the practitioner engage in a long and prosperous career in dental hygiene (Figure 1).1

Once we began to actually treat patients, our concentration seemed to be focused on everything but our posture. The combined stresses of assessing our patients, gathering data, using our instruments effectively, providing the prophylaxis and paying close attention to time management while being graded on the entire process unfortunately left little time or energy to devote to assuming the optimal working postures. We wanted to examine the oral cavity in the most meticulous manner, which consequently had us bending, crouching and squinting. Our professors reminded us of the importance of proper position, proper instrument grasps, and firm finger rests and mirror usage. These suggestions enhance not only patient treatment, but also the longevity of a career in dental hygiene, as well as reducing the risks of operator fatigue.

We started to notice that some of our professors were wearing magnification loupes to oversee our work. We began to think about what they could see versus what we could see (Figure 2). Were magnification loupes something the student dental hygienist could benefit from?

Various companies that specialize in the marketing of magnification loupes visited our class. Some of them offered a free trial period along with a significant student discount, so we decided to take advantage of the opportunity. After all, we wanted to take our mentor's advice and be advocates of change to provide the best care possible to our patients and to protect our own health as well.

During the presentation, we were made aware of various options available to dental hygiene students. Fundamentally, there are two different types of magnification loupes: through-the-lens (TTL) and flip-up.4 Through-the-lens loupes have the magnification barrels mounted directly to the lens of the glasses. The advantages of this type of magnification loupes include the following.

• TTL typically weigh less than the flip-up.
• TTL provide a wider field of view (the field of view is the magnified area that is viewed while looking through your loupes) since the magnification barrels are mounted closer to the eye.5
• the loupes are made to be custom fit, therefore there is no need to adjust the angle of declination (the angle from your eyes to the patient's mouth). This allows you to assume your best neutral working position while never having to waste time trying to adjust the declination angle.4

The disadvantages of TTL are that

• it costs more than the flip-up loupes.3
• if you choose to have your prescription put into the lens of the glasses, and your prescription changes, the loupes need to be sent to the manufacturer to be modified. This may involve a considerable cost, and you may not be able to use your loupes for several days or even weeks.4
• when working with patients, you may need to look up through the lens of the glasses in order to speak with them.
• The second type of magnification loupes we tried were flip-ups. Flip-up loupes have the magnification barrels suspended over the glasses by a pivoting arm attached to the nosepiece of the glasses. The advantages of the flip-up magnification optics include
• a significantly lower cost than TTL loupes.
• they can be used during extraoral examination, while doing paperwork and during patient interaction with the flip-up feature.
• they can be shared within the dental team because they are not customized to a specific person.2 Unlike the TTL, the angle of declination can be adjusted to accommodate each user.3
• if the loupes are intended for use by one person, a prescription can be incorporated into the lens of the glasses and changed at any optical store.4
• This is an advantage because the attachment containing the magnification barrels can be removed and the wearer does not need to be without the use of their loupes for very long.
• The disadvantages of flip-up magnification optics include that
• the angle of declination can be adjusted incorrectly, causing eyestrain and musculoskeletal strain on the neck and back.
• they typically weigh more than the TTL, which may cause additional stress on the muscles of the neck and back.
• they have a narrower field of view than the TTL because they are mounted further away from the eyes.4

For dental hygiene students, there are two main advantages of purchasing loupes. One is the professional discount companies may offer to students. The other is that the learning curve for using loupes as a student may not be as steep as it is for the practicing professional who must learn to adapt to the new device on the job under time constraints, and who may have already made a habit of poor posture.

One of the biggest misconceptions about loupes is that prolonged use of magnification can impair one's vision. According to the article, "Demystifying Magnification," written by Cathy G. Richardson, RDH, MBA, research shows that "rather than adding strain and stress to the eyes, magnification serves to enhance detail and reduce strain. The ciliary muscle surrounding the eye must continually constrict and expand to accommodate distance and clarity. Incorporating magnification reduces the strain that this eye muscle experiences."3 Therefore, it is advantageous to integrate magnification as part of your daily practice due to its beneficial impact. We believe it is possible to become dependent on magnification loupes; however, we do not view this as a hindrance because it helps to enhance our clinical abilities and promote our physical well being while practicing. Figure 3 provides two more examples of the difference between what a practitioner visualizes with and without using loupes.

We have had the opportunity of working with and without magnification and are in our third semester of dental hygiene. In our opinion, the use of loupes greatly enhances our ability to provide optimal oral health care for our patients. Our faculty continuously compliments us on our posture and position, whereas before purchasing the magnification loupes, we were exhibiting improper positioning techniques (e.g., "hygiene hunch") which, if continued, would have resulted in negative effects on our musculoskeletal systems.

The use of magnification loupes is becoming a standard of care for many dental hygienists around the country. Many dental hygiene schools are also incorporating them into their curriculum as a requirement to ensure proper ergonomics and clinical techniques. Magnification loupes give the dental hygiene student better visualization of the oral cavity, a clearer view of the instrument's working end to help in correcting adaptation, an advantage in reading probe depths, enhanced ability to interpret radiographs, the ability to use superior techniques in instrument sharpening, and improved posture.

Based on personal experiences, we both agree that magnification loupes are an invaluable tool that is the future for our new profession. Not only do we benefit from the use of loupes, but our patients are also well served. For all of these important advantages, dental hygiene students should continue to research and explore the option of loupes in order to become a more productive, efficient and marketable dental professional.

References

1. Barbieri S. Ergonomic injury: alternative methods of prevention and treatment. Contemporary Oral Hyg 2006; January: 20-3.

2. Daniels AH. Visual acuity-surgical loupes: which one to choose? J Practical Hyg 2005; April: 27-8.

3. Richardson CG. Demystifying magnification. Contemporary Oral Hyg 2005; August: 5, 17-21.

4. Richardson CG, Wiest TA. Focus on your future: effective use of magnification in dental hygiene. Contemporary Oral Hyg 2004; September 20-3.

5. Osuna T. Improving visualization and ergonomics for the hygienist. J Practical Hyg 2005; September: 25-6.

Maria Burreci-Diana is on the Dean's list and in her third semester of the dental hygiene program at the University of Medicine and Dentistry of New Jersey, School of Health Related Professions. She has been a CDA, RDA for 10 years. She resides in Manalapan, N.J. with her husband and two sons. In addition to school and family, she is the president of her dental hygiene class and a member and an alternate delegate for the Student American Dental Hygienists' Association (SADHA). She can be reached at dianama@umdnj.edu.

Krystle Brown is a third-semester dental hygiene student at the University of Medicine and Dentistry of New Jersey, School of Health Related Professions. She lives in Staten Island, N.Y., where she graduated in 2002 from Tottenville High School with the Dental Office Careers Award. She has received the honor of being on the National Dean's list for two years for college excellence. She is an active member of SADHA, and the vice president of her dental hygiene class. She can be reached at brownk5@umdnj.edu.