DENTAL HYGIENISTS, MUSCULOSKELETAL DISORDERS, AND WORKERS’ COMPENSATION: MEDICAL PROFESSIONALS AT RISK OF INDUSTRIAL ORTHOPEDIC INJURIES: WHAT YOU NEED TO KNOW

Many occupations are susceptible to work injuries.  One of these occupations is that of a Dental Hygienist.  More specifically, Dental Hygienists are at risk for musculoskeletal disorders (MSDs.)  This has been recognized by the California Department of Public Health (CDPH.)

This article will discuss the occupation of Dental Hygienist, how Dental Hygienists are at risk for musculoskeletal disorders, and caselaw of interest.

What is a Dental Hygienist?

Per the American Dental Association(ADA), a Dental Hygienist is a licensed position which varies from state to state.  Note: The practice of dental hygiene in California is regulated by the Dental Hygiene Board of California.

The tasks of Dental Hygienists can include “patient screening procedures; such as assessment of oral health conditions, review of the health history, oral cancer screening, head and neck inspection, dental charting and taking blood pressure and pulse, taking and developing dental radiographs (x-rays), removing calculus and plaque (hard and soft deposits) from all surfaces of the teeth, applying preventive materials to the teeth (e.g., sealants and fluorides), teaching patients appropriate oral hygiene strategies to maintain oral health; (e.g., tooth brushing, flossing and nutritional counseling), counseling patients about good nutrition and its impact on oral health, making impressions of patients’ teeth for study casts (models of teeth used by dentists to evaluate patient treatment needs,)[and] performing documentation and office management activities.”

Dental Hygienists can work in a variety of locations.   This locations include Dental Offices.  This can include Dental Offices of General Practitioners as well a Specialty Practitioners’ Offices such as Periodontics and Pediatric Dentistry.

Dental Hygienists also may work at Public Health Agencies, Hospitals and Community Health Clinics. They can work for public school systems, dental schools and dental hygiene educational programs.  Dental hygiene services can be performed in hospitals, nursing homes, prisons and public health clinics.

Note: Activities of interest involve the activities in which the patient is in the dental chair and the Dental Hygienist is performing services upon them.

What Are Musculoskeletal Disorders (MSD)?

Per the Centers for Disease Control and Prevention (CDC), Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs.

What Types of Musculoskeletal Injuries Do Dental Hygienists Sustain?

Dental Hygienists are susceptible to a multitude of musculoskeletal disorders.  Upper Extremity problems are common.  These upper extremity diseases or conditions include tendonitis, tennis elbow, and carpal tunnel syndrome.

Has There Been Any Caselaw Concerning Dental Hygienists with Cumulative Trauma Musculoskeletal Injuries?

Yes. In Barnes vs. WCAB (2013) 78 C.C.C. 1137 (writ denied), the case involved a Dental Hygienist who suffered a cumulative trauma musculoskeletal injury to her neck and back.  In the matter, there was a dispute as to whether there was also an aggravation of an underlying fibromyalgia and chronic fatigue syndrome.  In the case, there was a finding of industrial causation for those body parts.

Are Musculoskeletal Disorders for Dental Hygienists a Concern for the State of California?

Yes.  The State of California is concerned over the risk of injury for Dental Hygienists. The State recommends ergonomics programs in order to promoted a safe and efficient workplace.

What Are Ergonomics?

Per OSHA,  “ [w]orkers in many different industries and occupations can be exposed to risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures and performing the same or similar tasks repetitively. Exposure to these known risk factors for MSDs increases a worker’s risk of injury.

Work-related MSDs can be prevented. Ergonomics — fitting a job to a person — helps lessen muscle fatigue, increases productivity and reduces the number and severity of work-related MSDs.”.

Are There Ergonomic Tools for Dental Hygienists?

Yes. The State of California offer videos designed for Dental Hygienists.  Here is the link. https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/Pages/ErgonomicsDentalHygiene.aspx

There are videos which include topics such posturing and position, use and choice of instruments and body strengthening.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

CLEANING PRODUCTS AND WORK-RELATED ASTHMA: HOUSEKEEPERS, PROFESSIONAL CLEANERS, JANITORS, AND HEALTHCARE WORKERS: WHAT YOU NEED TO KNOW

Cleaning Products can be a source of Industrial Asthma also known as Occupational Asthma.   There are certain occupations that account for a large percentage of these claims.  This article will discuss Industrial Asthma, the occupations that are at risk for Industrial Asthma.  It will also discuss caselaw on the issue as well.

What is Industrial Asthma?

Per the American Academy of Allergy, Asthma, and Immunology, “Occupational asthma has become the most common work-related lung disease in developed countries. However, the exact number of newly diagnosed cases of asthma in adults due to occupational exposure is unknown. Up to 15% of asthma cases in the United States may be job-related. Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while “on the job.”  Often, …symptoms are worse during the days or nights…work[ed], [and] improve[d] when…[there is]time off and start again when…[there is a return] to work.”

What Occupations Are Impacted by Industrial Asthma?

The highest percentages worked in healthcare (41.1%), and were building cleaners (20.3%), or registered nurses (14.1%.) Cleaning Products and Work-Related Asthma 10 Year Update DOR 10.1097 JOM.0000000000001771

It has been found that Cleaners are at risk of some asthma‐associated symptoms and reduced lung function. Respiratory health in professional cleaners: Symptoms, lung function, and risk factors https://doi.org/10.1111/cea.13597

A “study found that professional cleaners have an increased risk of current asthma and reduced lung function. Cleaners identified as having asthma were more likely to be non‐atopic, less likely to have a doctor diagnosis of asthma ever, and had airway obstruction that was less responsive to bronchodilator administration. Amongst cleaners, working in cafes/restaurants/kitchens and/or use of multi‐use cleaner and upholstery sprays was associated with a significantly increased asthma risk, whilst exposure to glass cleaning sprays was associated with reduced (pre‐bronchodilator) lung function.” Respiratory health in professional cleaners: Symptoms, lung function, and risk factors    https://doi.org/10.1111/cea.13597

Further, concerns of Industrial Asthma relate to domestic cleaners as well.  See Job hazards and respiratory symptoms in Hispanic female domestic cleaners Kristina W. Whitworth,Brenda Berumen-Flucker,George L. Delclos,Sonia Fragoso,Claudia Mata & David Gimeno Ruiz de Porras,Pages 70-74 | Published online: 29 Apr 2019 https://doi.org/10.1080/19338244.2019.1606774 (“In conclusion, this vulnerable population has high prevalence of physician-diagnosis asthma and BHR(bronchial hyperresponsiveness) symptoms and is potentially exposed to myriad occupational hazards.”)

What Types of Agents Do Cleaners Use that May be Involved with Industrial Asthma? 

“Cleaners are frequently exposed to a range of agents including chlorine/bleach, ammonia, ethanolamines, chloramine‐T, aldehydes, and quaternary ammonium compounds (QACs),7 which may contribute to both new‐onset asthma through sensitization (in a minority) or irritation, and exacerbation of pre‐existing asthma.8 Importantly, as many people worldwide, other than cleaners, are exposed to cleaning products, asthma due to, or exacerbated by cleaning products is a considerable public health concern.”  Respiratory health in professional cleaners: Symptoms, lung function, and risk factors,  https://doi.org/10.1111/cea.13597

Is There Any Caselaw Concerning Cleaners and Asthma? 

In LAUSD vs. WCAB (2007) 72 C.C.C. 1719 (writ denied), a Health Care Assistant was found to have sustained an injury to her lungs and in the form of asthma when Applicant was exposed to toxic fumes during daily cleaning duties from chlorine gas that evaporated from hypochlorite found in the cleanser, “Dispatch.”

Is there anything Important that an Injured Worker can do if They believe that They have Industrial Asthma?

There are three things that are recommended.   First, the Injured Worker should seek medical attention to diagnose and treat their condition.   Second, the Injured Worker should documents the chemicals and cleaning material that they use on the job.   Third, the Injured Worker should seek a consultation whether an industrial injury claim should be pursued.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

Insurance Companies and their Duty to Investigate in Workers’ Compensation Cases

With respect to my Workers’ Compensation Claim, Does the Insurance Company handling my Claim have a duty to treat me fairly?

Yes. California law requires that Injured Workers be treated fairly. Regulation Section 10109 section (e) provides that “Insurers, self-insured employers and third-party administrators shall deal fairly and in good faith with all claimants” Not only does this section apply to the injured worker, it also applies to any dependent’s claims as well. Dependent’s claims may arise upon the injured worker’s death. In those circumstances, there can either be a death claim or an accrued benefits claim on a “live” claim. In other terms, any outstanding unpaid benefits owed up to the date of death.

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What Are California Workers’ Compensation Medical Appointments and Evaluations?

How Can They Damage a Worker’s Claim of Industrial Injury?

In California Workers’ Compensation Law, Injured Workers attend both medical treatment appointments and medical legal evaluations as part of their claims. While these appointments are intended to provide either treatment or assess aspects of Injured Worker’s claim, such as permanent disability, these examinations and evaluations can also inform Insurance Companies of information that cast doubt as to the validity or the severity of both, the Injured Worker’s claim and/or their entitlement to benefits. These items are frequently called “red flags.” Many doctors who contract with insurance companies will note these “red flags” within their reporting.

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What is Maximum Medical Improvement (MMI)?

Why is MMI Important to Your Workers’ Compensation Claim?

Maximum Medical Improvement is the term used within California Workers’ Compensation Law which applies to when one has recovered from their industrial injury.  Previously, in Workers’ Compensation Law, the term “Permanent and Stationary” was used. Continue reading

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