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Dentistry Through a Hygienist's Eyes

DDD and RDH

DDD and the RDH

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What is Degenerative Disc Disease?

Degenerative disc disease is not a disease per se. It is a condition to describe chronic pain caused by a disc in the spine or neck. Typical person with DDD is a healthy active person in his/her 30’s or 40’s.

What Do Discs Do?

The discs of the spine are designed to make the back and neck flexible. These discs are shock absorbers made of 2 layers that help with this flexibility. The annulus fibrosus is the outer fibrous band layer. The nucleus pulposus is the innermost layer and can be described as jelly like.

If the inner disc material comes out of its enclosed area due to damage to the annulus fibrosus it may come in contact with the nerve root extending from the spinal cord and create pain. This pain may radiate to the leg causing what is called sciatica or lumbar radiculopathy or down the arm causing cervical radiculopathy. Once a disc is damaged it cannot repair itself due to its limited blood supply.

The body, sensing less stability in the spine due to disc herniation, tries to create more stability by adding bone to the spine. These bony spurs or osteophytes can potentially impinge on the nerve roots extending from the spinal cord and cause pain.

Symptoms of DDD

The first sign of a problem with the neck or spine is stiffness. One may notice periods of severe pain that comes and goes. The pain may be felt when seated and worsening when bending and twisting. Numbness or tingling in arms and fingers and weakness in extremities caused by damage to nerve roots extending from the spine and should not be ignored as nerve damage can occur. It has been found that some alleviation of some pain symptoms may occur when walking or changing positions.

Causes and Risk Factors of DDD

There is no one reason degenerative disc disease occurs. The drying out of discs decreasing the height of the space between vertebrae is a factor as is injury. The injury that occurs could be an acute trauma, such as a car accident, or chronic trauma, such as high repetitive tasks that occur over years.

This is where the practice of dental hygiene would be considered a risk factor for disc problems. The act of providing dental hygiene services to patients is a highly repetitive act. Many hygienists favor keeping their patients comfortable rather than worrying about the effects of their posture on their health. A slight change in head tilt, just a mere 15 degrees adds 27 pounds to the head!

Diagnosis

Since there is radiating pain from the spine the source of the pain may not be brought to physicians first. Shoulder pain may not be shoulder pain at all. The pain may be radiating from the neck. All symptoms must be accounted to physicians including pain, numbness, tingling.

Magnetic resonance imaging (MRI scan) can help to determine damage to discs and a neurologist may perform a nerve conduction study to determine nerve damage of numbness and tingling are symptoms.

Treatment

Conservative therapies such as physical therapy can be helpful as well as exercise.   Alternating 30 min strengthening with low impact aerobic exercise such as walking, biking or swimming can keep the areas limber and make muscles of the back and shoulders stronger this must include stretching.

Proper body mechanics and keeping hydrated will help decrease the chance of a flare up as well. Twisting and bending from the back could cause more pain. Using arms to help raise the body from a seated position as well as using larger muscle groups such as quadriceps for bending instead of bending from the hips/back are ways to use proper ergonomics.

When the pain is severe doctors may prescribe anti-inflammatories and steroids as well as heat/cold compresses. Epidurals can be used to diminish the inflammation as well, although only work about 50% of the time.

Surgical intervention such as a fusion or a cervical disc replacement may be necessary if all conservative therapies have been tried with limited success. From personal experience, this may be an option that alleviates the pain you have had for years.

What is an RDH to do?

You are the most valuable tool of your career! You need maintenance just as your instruments do. Spending money on loupes and an ergonomically designed chair is only the beginning.

Be self-aware. What you do everyday will impact your life. Do you feel a twinge somewhere? Investigate. You may be positioning yourself, or your patient, incorrectly. Sit, stand and change positions frequently. Take a walk. Drink water.

Degenerative disc disease may not be preventable but managing is possible with the right information and a great medical team.


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