Introduction

In addition to the risk associated with his profession, the dental surgeon seems to be exposed to the scourge represented by musculoskeletal disorders (MSDs).

objectives

Identify the risk factors for MSDs in active military dental surgeons and specify the work situations that may contribute to their appearance in order to propose appropriate ergonomic corrective measures for their prevention.

Method

Semi-quantitative study, conducted at the military polyclinic of dental surgery of Greater Tunis, by observation of the biomechanical constraints during 3 different dental acts. The analysis and interpretation of the results were carried out by the ERGOROM software.

Results

Dental extraction, endodontic treatment and treatment of dental caries were studied. The restrictive postures, the repetitiveness, the contractions in isometry of the shoulders and the bad position of work emerged as risk factors of MSDs common to all dentists. The neck flexed more than 40 degrees or extended 95% to 63% of working time. The shoulder was in permanent contraction during 72% to 40% of working time, with a low variability suggesting an isometric contraction of the shoulders. The elbows were flexed 91% to 56% of working time with low flexion / extension variability. The preferred position of the wrists in our study was hyper-extension or hyper-flexion on 64% to 42% of working time and ulnar or radial deflection on 35% to 14% of working time. The digital isometric grip of Serenity Scottsdale Dentist instruments was spread over almost the entire working time range in the 3 acts observed.

Conclusion

The results thus obtained led us to propose to the Commandant appropriate corrective ergonomic measures likely to improve working conditions and prevent the occurrence of MSDs.

Process of health promotion at work on the laundries of meal trays CHU de Montpellier

MSDs are the leading cause of occupational disease recognized in France and their number is growing. INRS estimates that work stoppages related to MSDs represent 8.4 million lost workdays.

MSDs have become a major issue in the prevention of occupational risks and diseases and are, more broadly, a public health problem.

The collective catering sector is particularly concerned by MSDs because the carrying of heavy loads, the repetitiveness of gestures, bad postures, precarious work contracts … are usual. In fact, according to the INRS, 6% of work-related accidents are related to MSDs in this sector, compared with 4% for all other business sectors in France in 2016.

At the CHU Montpellier, the reasons for accidents related to lifting and handling represented more than 24% of the TAs at the end of November 2016.

We were alerted by the increase in work stoppages on the laundries of the meal trays of the Central Food Production Unit (UCPA).

The observation of the real work, the analysis of the exposure sheets, the HR and health indicators and the setting up of a nurse consultation, allowed us to objectify a problem related to the physical activity of the agents of the laundromat of the meal trays of the UCPA.

We were able to make a diagnosis of nursing related to a risk of appearance or worsening of MSDs.

It is therefore necessary to prevent or moderate their onset among these employees by acting upstream in primary prevention.

To this end, we will implement an action plan to promote workplace health, adapted to the risks of MSDs of laundromats. This action plan will have the dual advantage of increasing employees’ well-being at work but also reducing the costs of absenteeism.

Technical, organizational and human solutions will be developed and highlighted. The occupational health nurse will be the pilot.

In this context, she will carry out an educational campaign with laundry workers to encourage them to take care of their health at work by training.

This action will not be completed when all the laundry agents are trained. It goes well beyond. It will have to be followed, evaluated, readjusted. It is also possible that it can grow in scale and be of interest to all current and future UCPA agents.

The involvement of all remains necessary, that of the agents, that of the SST, that of the supervision of the UCPA and that of the management of the University Hospital of Montpellier.

Study of gestural and postural constraints at the position of dental surgeon