6x Keplerian loupes from Precision SCOPE with 3W LED-Pro

Now there are some definitive findings about vision enhancement, which take into consideration comfort, ergonomics, and fatigue, that this article details. In the final analysis, you can definitely improve your vision and reduce fatigue by determining the combination of magnification and lighting that fits your specific needs, but you have to do the research, try the products, and learn new techniques. You have to be prepared to change, explore new possibilities, and endure the learning curves if you want to improve your physical health, vision, and quality of care. Determining the best vision enhancement for your specific needs is kind of like getting in shape; you can talk about it ad nauseam, but you won’t see results until your own sweat spills.

Vision fitness is highly personal. Only you can read the eye chart, have your eyes examined, and obtain a prescription that optimizes your vision. Don’t delegate the task to colleagues or vendors. Only you can judge the best magnification and lighting prescription for your needs. This article will inspire you with possibilities, provide guidelines for conducting research, and update you about lighting and vision concerns and technologies.

Light

Ambient light and operating light affect vision and endurance. Standards for ambient light have changed over time as dentists consider their clinical needs as well as their patients’ comfort. For example, many dentists have moved away from lighting their operatories with rows of fluorescent tubes, because it is not only uncomfortable for patients when their eyes are flooded with bright light when supine, but it is also ineffective to light 100 square feet of space to provide light to the oral cavity, an area measuring less than 4 percent of that space. Reducing ambient light outside the mouth region is more comfortable for patients and clinicians. A famous lighting study (http://ergo.human.cornell.edu/lighting/lilstudy/lilstudy.htm) published by Cornell University proved that indirect light reflected off a luminous surface (i.e., the ceiling) was healthier and more comfortable.

KAVO overhead light, ceiling mounted with 150W halogen bulb

Dr. David Ahearn, who practices in Massachusetts and heads Design Ergonomics (www.desergo.com), a dental office design firm, says, “Traditional rules of thumb that the luminosity ratio of operating light to ambient light should be 3:1 to 5:1 are impractical to achieve and obsolete. When traditional operating lights emerged in the 1920s with big reflectors to focus inefficient incandescent bulbs that produced around 1,000 foot candles, you would need about 300 to 500 foot candles of ambient light to satisfy this ratio. Applying these ratios to today’s operating lights that produce 3,000 foot candles means having ambient light of at least 1,000 foot candles, which would create a room so bright that nobody would want to be in the room.”

While there is not an abundance of in-depth research about ambient and operating light levels, there is plenty of anecdotal information that supports reduced ambient light levels. Some dentists work without an operating light and use only a headlight where there is a substantial difference between ambient and operating light levels.

Dr. Gordon Christensen doesn’t believe that light level differences are a problem: “It’s like driving a car at night. You can see the road ahead without fatigue.”

Supporting this view is B.J. Chang, PhD, president of Surgitel, a manufacturer of magnification and lighting for dentists: “Any kind of room lighting is fine as it is very easy for the eye to adapt in a matter of seconds from bright to dark light. For example, a change in the pupil’s diameter from 1 mm to 2 mm will accommodate a 425 percent change between task and ambient light levels. The eye is amazing in that it can accommodate a 6,000 percent change in light intensity from sunlight to starlight. A major source of eye fatigue is caused when light levels are too dark or too bright.”

The bottom line in the primary concern about ambient light is that it provides a comfortable setting for you and the patient.

See the light

Many dentists use additional light to augment the operating light. Fiber-optic handpiece lighting is a popular choice along with headlights. New technologies include Isolite (www.isolitesystems.com), which illuminates the oral cavity from within, and the TLC Technology Lighting Center (www.tlcdentist.com), which replaces the traditional operating light with a cold, glare-free fiber-optic operating light. Significant technological advances in headlights are making them more practical and powerful. Light sources have been greatly improved as metal halide lights have replaced halogen lights.

Oliver Nash, director of sales and marketing at Precision SCOPE, says, “The Precision SCOPE metal halide light source is extremely bright and supports a seven foot, thin, long fiber-optic cable (1.6 mm diameter) that weighs only 8.5 grams.” The system offers a 2.0 mm diameter fiber-optic cable that is, according to the company, “three times brighter than other systems.”

Portable, battery-powered LED headlights have also improved greatly, and while not as bright as fiber-optic systems, they offer untethered operation.

Dr. Christensen comments, “The aggressive, well-organized dentist going from op to op may find that being tethered to a fiber-optic headlight is a limitation and may wish to consider a battery-operated LED headlight.”

It is important to evaluate the entire headlight system, which includes seven major items:

① Intensity of the light source
② Throughput of the fiber-optic cable
③ Performance of the optics
④ Portability
⑤ Color temperature and CRI (color rendering index)
⑥ Battery life (LED only)
⑦ Operator comfort

While it is helpful to know specifications, the bottom line about headlights is how they perform for your personal style of practice, which means that you need to evaluate the complete product under actual operating conditions.

Magnification

Magnification helps you see better and clearly identifies ways to improve the quality of dentistry. Numerous magnification options may be confusing at first, but there are some simple guidelines that allow you to see better immediately. Options available today are:

● Loupes (2.5X-5.0+X $600-$1,800)
● Surgical optical microscope ($16,000 and up)
● Surgical video microscope ($23,000 and up)

Loupes

It is critical that you use any form of magnification under consideration in an actual clinical setting. You can adapt almost instantly using low-magnification loupes, but other forms of magnification can take up to a year to become comfortable and productive. Many loupe vendors offer money-back satisfaction guarantees of at least a month to allow you to truly evaluate the product for your specific needs.

“Magnification, working distance, and angle of declination are three important attributes to consider,” says John Walsh at Designs for Vision. “Each loupe prescription is customized to the user’s eyes. If you use someone else’s prescription, you won’t get the best results.”

Dr. Gordon Christensen says that the use of loupes will continue to expand and that dentists should go with a relatively high-quality product that typically costs $1,000 to $1,500. He cautions, “Be careful about cleaning, because it’s not difficult to scratch them within a few months of use and reduce their performance.”

Get magnification because it will help you perform your job better. You are not going to damage your eyes. You can see the margins and detail. You don’t miss things that you otherwise miss.

Remember that working distance and magnification are related, so it is better to place more emphasis on how a complete system works for your personal style of practice rather than purchase a product based on specifications. You may be happier with a particular system because it is brighter, the image area is more appropriate (greater magnification reduces the field of view), and the loupes are more comfortable than specifications would indicate.

“Be sure to get loupes that are comfortable and ergonomic because the potential for neck problems (C6 and C7 vertebrae) exists,” cautions B.J. Chang at Surgitel.

The bottom line is that good magnifying loupes reduce fatigue, improve posture, and enhance vision.

Surgical optical microscope

Surgical microscopes have increased in popularity during the past few years as dentists have become more aware of their potential. They have been most popular for endodontics, but they are also used for other procedures.

“Don’t be intimidated by the technology or the money. It’s a lifetime investment,” says Jeff Kopp, marketing director for Global Microscopes. “An advantage of the surgical microscope is ergonomics because you sit upright, put your arms on armrests, and do micro-movements with your hands.”

Zeiss OMPI surgical microscope.

Surgical optical microscopes definitely have a place in dentistry, and one of the best ways to evaluate them is to take a one- or two-day course. The learning curve can be six months to a year, but the benefits are great.

“The surgical optical microscope augments vision, but only a few dentists, especially endodontists, are using it routinely. Currently, in fixed prosthodontics and operative dentistry, for example, 2.5X to 4.0X loupes are used by most dentists instead of a microscope. The trend toward use of a microscope in restorative dentistry is slow but definitely evident, particularly to finish preparations and restorations,” comments Dr. Christensen.

Surgical video microscope

Sitting upright and viewing the operating field on a monitor while you work is commonplace in many medical procedures and is now available for dentistry. MagnaVu, for example, offers a “heads-up” product that eliminates crouching, leaning, and placing yourself in unhealthy positions.

Don’t wait to improve your health and patient care

You should try magnification and better lighting immediately. Many vendors offer money-back guarantees. Consider purchasing your top two choices. Evaluate them in clinical practice for at least two weeks. Keep the winning product and return the loser for a full refund. Beware. Magnification and lighting can be as addicting as wearing prescription glasses every day. They help you see better and work more efficiently with less fatigue. Improve your life and your dentistry with better lighting and magnification. There is no reason to wait any longer.

Dr Tim Wagner, DMD, Presidents of Medical Ergonomics.

One of the major challenges in dentistry is viewing the oral cavity. Since the early days of fiber optic lights to today’s highly-refined procedure scopes, visualizing the oral cavity has come a long way. With the advancements in magnification, dentists are now more productive and confident in the treatment that is provided to patients. Additionally, magnification comes with many ergonomic benefits. Today, magnification aids, such as surgical loupes or telescopes, are becoming a worthy investment in the field of dentistry.

It has been shown in many studies that students who use magnification loupes work in much better ergonomic positions than those who only use safety glasses. But why should good posture matter? Neck pain is associated with working conditions in which a person holds a forward head position of 20 degrees or more for 70 percent of the working time. Dentists and hygienists routinely work with a forward head position of 30 degrees for up to 85 percent of their working time. This leads to the staggering statistic that 70 percent of dental professionals experience neck pain.

What happens when the head is held in an awkward, unbalanced working position is that the vertebrae cannot support the spine, which causes the shoulders’ stabilizing muscles to quickly fatigue. When other muscles, such as the levator and trapezius, try to compensate to hold the neck and shoulders stabile, they too fatigue because they are performing tasks for which they are not designed. These factors lead to what is known in the field of dentistry as “tension neck syndrome,” or TNS. The symptoms of TNS include chronic neck pain, headaches, shoulder pain and pain radiated into the arms. In more severe conditions, excessive forward head positions can lead to cervical disc degeneration and spondylosis.

Doctor maintains good posture while using loupes

Poor posture without dental loupes

With quality surgical and dental loupes (or telescopes), a proper head position of 0 to 25 degrees can be easily achieved. This is because loupes, microscopes and procedure scopes maintain a set focal range, or working distance while keeping an image in focus, allowing the user to maintain a correct working position.

On the market today, the three basic types of magnification systems: loupes (TTL or flip-up), surgical microscopes and the procedure scope. Similarly to other technical device, all of these systems require proper selection, accommodation time and adjustments. The learning curve with microscopes and procedure scopes is a few months, whereas, most users feel comfortable with the loupes after one to two weeks. Numerous surveys show that the loupes users notice immediate improvement with the forward head position and lessening of TNS symptoms.

Understanding Loupes.

Well made loupes need to be light, have good declination angle and high quality optics. They are much preferred over the older styles of loupes that are heavy and bulky. Today, more and more dental professionals are “discovering” the value that the surgical and dental loupe systems have to offer. Loupes also stand today as the most popular magnification system in the field.

Loupes are also known as telescopes. And while they do not provide a neutral head position (ear-over-shoulder), they do enable a working head position of less than 25 degrees forward. The magnification strength available in loupes range from 2X to 8X. Two distinct styles are available: flip-up loupes and through-the-lens (TTL) loupes.

Flip-up loupes are the most popular type of system. It features magnification loupes that are mounted on a hinge mechanism in front of an eyeglasses lens. As the name implies, the scopes can be flipped up when magnification is not needed. Flip-up loupes offer the steepest declination angle for correct head posture. This angle is adjustable and, therefore, can be customized to any working style. Dental flip-up loupes allow for easy changes to eyeglass prescriptions without expensive changes to the lenses.

Most advanced surgical flip-up loupes are being offered by Precision SCOPE, a US company based in Maine. The system was developed by a dentist and distinguishable by a barely noticeable 1mm bar that is located under the magnification loupe. Such unique bar position makes looking over the loupes easer with less weight.

6x Keplerian loupes by Precision SCOPE, 3W LED headlight

TTL loupes feature a magnification scope mounted directly onto the eyeglasses lens and have a fixed declination angle. TTL loupes have a wide field of vision since the scope is closer to the dentist’s eye. There are a few downsides to TTL loupes. If the dentist changes the eyeglasses prescription, the loupes must be modified by the manufacturer increasing the cost. In addition, not all procedures require magnification at all times, whereas safety eyeglasses might be necessary. Some doctors find that since the magnification loupes are positioned very close to the eyes, the user has to bend forward too much to see over the loupes. Such repetitive movement is not ergonomic and increases chances of neck disorders.

Understanding Procedure Scopes.

Procedure scopes enable a neutral head position and reduce eye fatigue. It features an extra oral camera positioned above a patient’s mouth from which an image is projected onto a flat LCD video screen. The screen is at the dentist’s eye level and allows the provider to move around freely while still viewing the LCD screen. Equipment is sanitized similarly to microscopes.

The procedure scope’s depth of field is four inches, so the entire oral cavity can be in focus at the same time. It takes a few months for most providers to feel comfortable using a procedure scope. The scope offers a great deal of flexibility and does not require additional prescription lenses except safety glasses.

Understanding Microscopes

Microscopes enable a near-neutral head position and indirect viewing of the oral cavity. An upright posture is maintained because a microscope can bend the path of an image 90 degrees or greater (via inclinable binoculars).

Some degree of customization to achieve an optimal working position is possible by adding vertical spacers to the microscope or by replacing the objective lens to increase working distance. Microscopes can achieve the magnification power of up to 40x. Due to their size and small field of view, microscopes are primarily limited to the field of endodontics.

Finding the Right Loupes

As the most popular and cost-effective magnification means, the surgical and dental loupes had become the standard of practice. Loupes can range from $700-$2,200 for either flip-up or TTL styles; whereas microscopes range from $14,000 to $45,000 and procedure scopes can cost in excess of $30,000.

It is important to cover the main criteria, such as quality, for selecting the right pair. Poorly made loupes and lenses can actually worsen symptoms of TNS, muscle strain and headaches. It is important to select a reputable company with high quality standards since you will use the loupes daily for many years. The three criteria to consider for proper loupe selection are working distance, declination angle and frame shape/size.

The working distance is the essentially the distance from the dentist’s eyes to the work area. If the working distance is too short, a dentist will hunch and experience excessive neck flexion. A proper working distance is dependent on the size of the operator, but generally it is between 14 and 20 inches when measured sitting in a neutral position with the patient’s mouth at or slightly above the elbow.

The declination angle is the angle at which an operator’s eyes are inclined downward toward the working area. It is important that this angle is steep enough to attain a comfortable working position without too much forward head tilt.

Generally, flip-up loupes allow for the steepest declination angle and a more neutral head position over TTL loupes. Flip-up loupes are preferred by many dentists, because the scopes can be flipped up when the magnification is not used. For example, during treatment the doctor can talk to the patient, apply additional anesthetic or trim temporaries while seeing the entire working field. All can be achieved without removing the loupes and gloves. When possible, request the steepest declination angle available from the manufacturer of the surgical loupes.

Proper frame shape and size is built around the simple concept that larger frames sit lower on an operator’s face, thereby allowing a steeper declination angle (even on TTL loupes). Still, always request the lowest placement of the scopes on the eyeglasses lenses as the manufacturer allows. Ideal frames should wrap around the face with minimal fogging of the lenses while wearing the mask.

Magnification Strength and Illumination.

Selecting the right magnification strength depends on the type of work being performed. In general, hygienists and general dentists prefer 2.5X to 3.0X magnification; and endodontists/periodontists prefer a power between 3.5X and 4.5X, or higher. It is often best to choose the lowest magnification. This way one can both view and control the surgical field. Remember that the higher the power of magnification, the shorter the depth of field, the more difficult the hand eye coordination.

Illumination is also important for efficient working postures, as shadows in the oral cavity can encourage the provider to lean or hunch. It is recommended that operatory light be placed parallel to or within 15 degrees of the operator’s line of sight. Surgical headlamps can significantly reduce shadowing by aligning the light’s direction with the operator’s line of sight. Loupe manufacturers often carry a wide selection of surgical headlamps or portable LED headlights.

Article by Dr. Tim Mauri, MD, Ph.D

Ophthalmologists are tasked with performing microsurgery on one of the smallest organs in the human body, the eye. They perform operations with incredible detail and precision. It would be essentially impossible for ophthalmologists to do their work with such accuracy if they did not rely on the variety of magnification instruments available to them. From operating microscopes to surgical flip-up loupes, the ophthalmologist uses magnification for cataract, vitreoretinal and corneal procedures, as well as for pediatric and oculoplastics procedures.

As these procedures vary greatly in the level of detail and skill needed to perform them, so does the difference in magnification between operating microscopes and surgical loupes. Microscopes are necessary for performing surgery on structures of less than one or two millimeters wide. Operating microscopes can provide up to 40 times magnification. Quality surgical loupes, however, can provide magnification of up to six or eight times. Such magnification is sufficient to complete most of the procedures. Mobility and size make them more versatile, less expensive and easier to use when compared with microscopes. Surgical loupes are well-suited for a wide range of surgical subspecialties and great for procedures requiring less magnification than an operating microscope.

Microscopes provide up to 40x magnification

Surgical flip –up loupes are used the most among ophthalmologists. There are several key factors to be taken into consideration when purchasing surgical loupes. Perhaps the most important factor is the surgical loupe’s resolution. It is the most important factor in assessing the overall quality of surgical loupes. Resolution is the device’s capacity to distinguish small structures from each other. Resolution can vary greatly among different brands of surgical loupes. Some surgical loupes may have good resolution across a central portion of the visual field only, but not the perimeter. Such design makes images appear distorted at the edges on the picture. Quality surgical flip-up loupes will have excellent resolution across all of the visual field with edge to edge clarity. Images with quality loupes appear very flat and easy to view. In addition, superior magnification loupes are made with Apochromatic lenses, such as Precision SCOPE (Portland, ME, USA), that are known to eliminate visual distortion,.

Another important factor in determining the quality of surgical loupes is the width of the loupe field. The width of the field is how large the area of focus is in the field of view. Ophthalmologists often prefer surgical loupes with a large field width, allowing them to keep their instruments in perspective at all times, and thereby simulating the normal wide visual field of the naked eye and reducing eye fatigue. Width of field is partially determined by the quality and design of the surgical loupes, but more so it depends on the level of magnification the loupes offer. A stronger power lens will have a smaller field width than a lower power lens. It is best to try on surgical loupes with different magnification powers to find the best width of field. Generally, ophthalmic surgeons prefer surgical loupes with a magnification between 2.5X and 4X. However, two surgeons performing the same procedure may prefer surgical loupes with entirely different magnification powers. Different manufacturers also use different explanations of magnification. As there is no true standard to measure magnification, differences in magnification up to 10 or 15 percent among similar surgical loupes is not uncommon.

Precision SCOPE offers loupes with improved working angle, visibility and lighter weight without obtrusive hinges.

A surgical loupe’s depth of field is also very important in how they perform for the ophthalmologist. The field depth relates to the loupe’s capacity to focus across a given distance. A long field depth will allow the surgeon to focus over a long range in the surgical field. Conversely, a short field depth restricts the surgeon to a narrow range.

The working angle, or optical declination angle, is another factor the user needs to consider. This is the angle at which a surgeon lowers his or her eyes in order to reach the optimal working position through the surgical loupes. Flip-up loupes offer different working angles due to their design. This is the main reason why surgeons prefer the flip-up loupes over the TTL loupes that have the loupe build into the lens. Shallow working angles can lead to poor neck health and muscle strain, so this should be an important consideration in finding quality surgical loupes. By trying on several pairs of loupes, an ophthalmologist can find the pair perfectly suited to perform a wider variety of procedures without strain.

Article by Mike Patellie, MS, PT, CEAS

Many dentists experience neck and back pain while working. Since dentists often find themselves stretched forward in prolonged positions, with arms outstretched, it is easy to understand why this happens. To help with posture related body problems that are associated with incorrect working postures, dentists are encouraged to use external lighting source, dental magnification loupes and ergonomic chairs with arm support. Dental magnification loupes (flip-up and TTL loupes), LED headlamps and properly designed dental chairs can considerably relax the back and neck muscles, improve ergonomics, increase much needed productive work hours. In addition, a proper stretching routine and regular exercise must also be incorporated into the dentist’s day. Healthy ergonomic habits will inhibit years of chronic and acute neck and back pain.

In the most common hunched over position, the anterior neck, chest and hip muscles become shortened and tight, essentially freezing the body in a flexed position with the muscles working in reduced capacities.

Poor working posture without dental loupes. Pelvis is twisted, anterior neck muscles shortened leading to neck and back injury.

Such body posture is common for dentists working without dental loupes or without adequate illumination.

The pelvis is also commonly twisted. Since the pelvis is the foundation of the spine, it forces the spine to over-compensate with drastic curves from the neck down to the lower back in order to correct the head’s position. If the pelvis begins to tilt forward, in part due to shortened or tight hip flexors and quadriceps, the curvature of the lower back is increased and the abdomen may begin to protrude.

Being able to perform self-myofascial release (SMR) using limited exercise equipment can assist with releasing muscle tension and aiding muscles in returning to their normal length. The exercises set forth below can help decrease lower back pain and increase core stability.

Myofascial release has been used for many years by practitioners to loosen soft tissues and increase one’s range of motion and flexibility, which then decreases pain and stiffness.

Imagine a dentist sitting in a chair in the same position for most of the day. His or her hips are at a 90-degree hip flexion, the trunk may be twisted or bent with the head leaning forward to see inside the oral cavity. If a dentist stays in this position for an extended period, muscles begin to shorten and tighten, leading to muscle weakness and pain. The longer the dentist goes without addressing the root problem of the pain, the more severe the ache becomes.

It is common for dentists to experience pain in localized areas, such as a “stiff neck”. This is also why some attempts to alleviate pain only where it is felt and underestimating the problem. The root of the problem, however, may lie in a group of muscles in the back, chest or hips that are foreshortened and overly tightened. Massaging your neck muscles may alleviate the pain temporarily, but will not result in a lasting fix, and before long the dentist is again experiencing the same symptoms.

The benefits of the following stretches and exercises are that they require very little extra equipment, can be done in small rooms (such as an office or at home) and, lastly, do not require an extensive time commitment. In fact, it is often better to break up the routines throughout the day instead of performing them all at once.

A simple 20-minute self-myofascial release and stretching routine, performed daily, is all that is needed to lengthen muscles that have been shortened due to a static working position. Adhering to this routine will decrease one’s pain and increase one’s range of motion and levels of muscle function.

These stretches work particularly well because they incorporate the dentist’s own body weight, and when performed on a foam roller or medicine ball, the muscles and tendons are stretched while applying pressure to an inflammation (or trigger point). Typically, pain is decreased in the sore spot within 30 seconds. As this routine is repeated over several weeks, those sore spots usually disappear altogether.

Daily Stretches

The Door Stretch: This simple stretch should be performed two to three times per day. Stand in a doorway with one arm raised out to the side at 90 degrees. Put the forearm on the back of the door’s jamb with the palm faced forward. Draw in at the belly and smoothly bring the same side leg forward until a slight stretch is felt in the chest and shoulder. Always keep your shoulders even and hold the stretch for 30 seconds. Now repeat with the other arm.

Scapular/Thoracic Stretch: Performed once or twice daily, lie on the floor with a foam roller behind the shoulder blades at a right angle to the length of your body. Cross your hands behind your head and place your feet flat on the ground, with knees bent. Now raise your hips off the floor and slowly roll the foam roller to the middle of your back. You can position the foam roller over any tender spots for 30 seconds.

Stability Ball Stretches/Exercises

Stretching

The Stability Stretch: Sit on a stability ball and slowly walk your feet forward. Now lie back on the ball, draping your body over the ball and extend your arms out to the side, allowing gravity to pull your arms down. Move your arms over the head. Hold for 30 to 45 seconds.

Bridging

Bridging: Lean back on the stability ball with your arms out straight in front and palms facing out. Draw in the abdomen and lift your trunk up slowly so that your arms and shoulders are parallel to the floor. Your body should be straight between your knees and shoulders. Squeeze your buttocks together and contract your abdomen, holding for three seconds and then slowly lower yourself back to the floor. Repeat 12 to 15 times.

lowering hips

Lowering Hips while Bridging: While sitting on the stability ball, walk your feet forward and lay back on the ball. Your head and shoulders should rest on the ball with the neck in a neutral position. Lower your hips slowly, pointing the tailbone toward the ball. Now lift the hips upwards toward the ceiling. The chest should also be lifted, with the shoulders, hips and knees forming a straight line. Hold for three seconds. Do not move your legs in or out. Keep the ball still. Repeat 12 to 15 times.

Scapular Retraction/Protraction: Lying on your back while draping your body over the stability ball, reach your arms toward the ceiling with palms facing in until your shoulder blades come off the ball. Keeping your arms straight, retract your shoulders toward the ball and pinch both shoulder blades together. Hold for three seconds. Repeat two sets of 10-12 repetitions.

Self-Myofascial Release

The following exercises and stretches can be done any time during the day or at home. For best results, break them up over the course of the day.

Pectoralis Muscles

Pectoralis Major and Minor: Place a medicine ball under your feet and lean on your arms. Roll the ball up and down, side to side, until you find the sore spot. Hold the position on the sore spot until tension is released (roughly 30 seconds). Repeat on other side.

Quadriceps: Lie prone on the floor with a foam roller on your thighs. Roll your legs up to the hips slowly and then back down to your knees. You can use your feet or upper body for support. Hold roller on any sore spots for 30 seconds.

Illiotibial Band: Lie on your side with the foam roller under your thigh. Keeping the bottom leg off the floor, roll from the hip to the knee on the lateral side of your thigh. Hold on any sore spots for 30 seconds. This exercise may be uncomfortable at first, so do it slowly. If you need assistance, bend the top leg and place the foot on the floor to decrease pressure on the illiotibial band.

latissimus dorsi

Latissimus Dorsi: Stand on the floor with your arms up above the head using a medicine ball. Move the ball up and down in front of you until you find a sore spot. Hold for 30 seconds. Repeat on the other side.

Tensor Fascia Latae: Lie with the foam roller under both thighs. Now place the foam roller just lateral to the anterior pelvic bone, halfway between where you had it for the quadriceps and illiotibial band exercises. Slowly roll the foam roller until you find a sore spot. Hold for 30 seconds. Repeat on the other side.

Illiopsoas: With a small medicine ball on the wall, lean into it while placing it on the anterior hip. Roll the ball in small circles until you find your sore spot. Hold for 30 seconds. Repeat on the other side.

Piriformis: Sit on a medicine ball with your arms placed just behind you, supporting some of your weight. Now cross the foot of one leg over the opposite knee and slowly roll on the posterior aspect of the crossed leg’s hip. Find your sore spot and hold for 30 seconds. Repeat on the other side.

Piriformis

These stretches and exercises are meant to be done daily. You may broke them up throughout the day. With a minimal investment of time, they can have a significant impact on your health and lead to a more pain-free practice.

*It is highly recommended that all individuals consult with a physician prior to beginning any active routine. All dental professionals should invest into quality dental loupes and headlights, either LED or fiber optic, to prevent or minimize body harm. Numerous studies indicate a consensus among leading professionals that dental and surgical loupes improve ergonomics.

Declination Angle

The declination angle is the angle created by the eyes being downwardly-inclined to the work area. A good working declination angle is 20 degrees or less, and without the right dental loupes in place, the head may be positioned too far forward in order to see through the loupe’s telescope. Flip-up loupes generally allow for a steeper declination angle and help achieve a neutral head position when compared to TTL loupes. Therefore, finding the right flip-up loupes will reduce the need for leaning forward and promote good posture and neck health.

Frame Size and Loupes

Frames rest differently on different faces. Identical loupe systems may have a slightly different declination angle on different people because of papillary distance and the height of one’s nose bridge. With frame size, it is generally easier to achieve a proper declination angle if the frames can sit low on the cheek. This allows a lower placement of the loupe’s scope in relation to the pupil and aids in improved working posture.

Working Distance

Perhaps the one factor most common in poor neck health and improper working posture is working distance. Working distance is the distance between the eyes and the work area. Generally, the distance is too short, which encourages excessive hunching or neck flexion. Even a distance of two or three inches can significantly impact neck health and working comfort. Proper working distance factors into the working ranges of the scopes on flip-up loupes and TTL loupes.

Working distance can be properly measured by having a patient in a chair while simulating treatment. From the 12, 10 and 8 o’clock positions, measure the distance (or have someone measure) between the patient’s mouth and the provider’s eyes. These measurements are generally between 14 and 20 inches, depending on the height of the provider.

Also important when consider the working distance and applying that distance to the right pair of flip-up loupes or TTL loupes is the depth of field. Also known as the working range, this indicates how long an object will remain in focus as the operator moves closer or further away from the target. The magnification strength in loupe scopes affects the working range. In scopes with higher magnification, the working range is decreased. To compensate for the natural tendency to drift closer to a working area, it may be necessary to measure the working distance slightly longer than normal, which will give an operator a more flexible working range.

The Right Telescope

The three criteria above will factor into choosing the best flip-up or TTL loupe system. However, there are also general guidelines for selecting the right magnification strength for loupe telescopes. For general dentistry, a scope power of 2.5x up to 3x is preferred. Endodontists and periodontists often choose a magnification of 4x to 6x for surgical telescopes. As a reminder, magnification strengths factor into proper working ranges, and this is why a smaller magnification strength gives a general dentist a larger working range and makes working different areas of the mouth easier.

High magnification 4x, 5x, 6x Moderate magnification 2.5x, 3x

New loupe systems will need minor adjustments and an accommodation period. For a best practice, new dental or surgical loupes should only be worn for no more than two hours the first few days. Afterwards, gradually increase the wearing time over five to 10 days until it is comfortable to wear the flip-up or TTL loupes without neck strain. Any attempt to quicken the adjustment period could lead to headaches.

The Difference between TTL Loupes and Flip-Up Loupes

Knowing how the previous factors play into choosing the right loupe system can now help one choose between TTL loupes and flip-up loupes. There are several important differences between these two styles of dental and surgical loupes.

TTL (through-the-lens) loupes feature a telescope mounted directly onto an eyeglasses lens. They stay focused and adjusted. Their declination angle is preset and they are lighter weight than flip-up loupes. However, if the operator’s eyeglass prescription is changed, the TTL loupes must be returned to the manufacturer for adjustment.

Flip-up loupes are mounted in front of the eyeglasses lens on a hinge mechanism. This can offer a steeper declination angle, but the flip-up loupes can sometimes get knocked out of adjustment. They can be heavier than TTL loupes but, as their namesake implies, can be flipped up when not in use.

Neck health is important in the dental profession. Consider all these factors when choosing the best loupe system and fatigue and neck strain will be experiences of the past.

Katherin Whitney, RDH, MPH

Less than a half-century ago, the working world was hardly worried about workplace safety. In the field of dental health specifically, those who were injured because of poor working conditions were often forced to retire early. Eventually, dental clinicians started looking for ways to improve their work environment and stop the aches and pains of their daily routines. Pioneers began finding the equipment that could offer some protection for their bodies and their jobs.

The best answer for workplace health in the dental field was and still is being able to maintain a neutral body posture while being able to see the oral cavity clearly. But this can only be done if the dental clinician is wearing some type of magnification, such as surgical or dental loupes. When these magnification loupes are properly fitted to their user, they become a critical component for preventing injury, and they are now the standard in clinical dental hygiene.

In fact, those in the dental field who use fitted dental loupes regularly have come to fully understand and appreciate their benefits. The research of their use has shown that dental magnification loupes do, unequivocally, improve posture and enhance visual acuteness. The result, an increasing number of dental hygiene programs and dental schools either highly recommend or mandate the use of dental loupes.

Safe working posture is easily achieved with dental loupes

Just as no one would ride a bicycle that did not have good working brakes, dental clinicians should not practice without the right, safe tools that will protect their careers. This is why dental loupes are not an expensive luxury. They are necessary for health and good posture.

Some clinicians may believe that dental and surgical loupes are too costly, heavy, timely or simply not needed. However, once practitioners begin wearing them regularly they quickly become convinced of their usefulness and say the benefits far outweigh the cons.

The dental loupes work by providing a clear and enhanced view of the oral cavity without needing to bend over or tilt one’s head. They also protect the eyes and reduce neck, back, forearm and shoulder stresses.

Some dental clinicians opt for an economical version of loupes that clips to one’s reading glasses. Financially, it may seem to save money and be sensible. However, it is impossible for these dental loupes to perform in nearly the same caliber as true magnification loupes, since reading glasses are meant to view a flat, 2-D object (a book page), and the oral cavity is a deep, 3-D object. Users of the inexpensive loupes will experience poor depth of field with objects quickly becoming out of focus and with poor clarity. This effect is due to optical qualities. Usually, wearers of these economical clip-on loupes ultimately strain their neck and shoulders in order to see clearly inside the oral cavity.

Flip-up dental loupes by Precision SCOPE offer exceptional visibility around the loupes

Today’s dental and surgical loupes come in a wide variety of sizes, weight, frames with comfortable headbands. Models range from entry-level moderate magnification Galilean to highly specialized Keplerian surgical loupes). The possibilities are nearly endless for finding a suitable pair of dental loupes that will work for every clinician and any procedure. Magnification loupes are classified into three categories: through-the-lens (TTL) loupes, flip-up and headband-mounted loupes.

While fit and personal preferences are important for finding the right pair of dental loupes, another key factor in loupe selection is optical resolution. It is critical to have a sharp, crisp and clear image viewable through the magnification loupes, and the better quality the glass, the better the resolution. High quality optics is the only thing that can produce a high-quality image. The best known class of lenses is made out of Apochromatic type glass. What makes this glass unique is its property to eliminate visual aberrations (distortion) and to produce a crystal clear flat image. Due to its high refractory property, the Apochromatic glass will produce a magnified image that is sharp and focused not only in the center, but at the edges as well. Hence, comes the term “sharp image from edge to edge”.

For visual acuity, it is important that the clinician selects the proper magnification for procedures one most commonly performs. Almost all general procedures in dentistry and general surgery can be performed with moderate 2.5x or 3x magnification. This type of loupes is made with the optics commonly known as Galilean design. This type of dental loupes has three lenses that are small and have compact design. Higher magnification loupes have Keplerian design. In addition to the lenses mentioned above, these surgical loupes contain prisms within the barrel. Prisms allow for an increased optical path from ocular to objective end, therefore increasing the magnification. The Keplerian type loupes are heavier and bigger than the Galilean loupes.

The reason for selecting moderate versus high magnification is that clinicians need to see the entire operating field in addition to the object of interest. Specialized procedures such as endodontics will benefit from high magnification because the structures that are being treated are minute and only that specific area needs attention. It is not uncommon for specialists to start the treatment with dental loupes of moderate power 2.5x and change to surgical loupes of higher magnification 5x as needed.

The magnification power in dental loupes is also correlated with the width and depth of field. High quality 2.5x Galilean dental loupes provide 3 inch field of view, which allows a clear view of the entire oral cavity. In addition, moderate power dental loupes will yield 5 inch depth of field, where operator can keep the magnified image in focus while moving and working. The Keplerian surgical loupes with 5x magnification will produce smaller the field of view and depth of field of 2 inches.

Field of view comparison chart

Ultimately, dental loupes should be designed for each individual user, as facial geometry, personal preference, nose profiles and other precise measurements all factor into finding the right pair of magnification loupes. Without the right fit, the clinician will not achieve the proper working distance. Ideally, the clinician should keep the patient’s head at waist level while keeping the forearms close to the body and parallel to the floor. When trying various powers of dental loupes, a clinician should also be measured while in a working position to ensure the right magnification power in their new pair of dental loupes.

As with any new tool, there will be a learning curve. Sometimes an adjustment after initial use is necessary. The most important factor, however, is the clinician’s decision that dental loupes are vital to a healthy work environment and a commitment to constant use of the loupes. It will take time to adjust, so the clinician must maintain a positive attitude during this time. For a clinician prone to motion sickness, the break-in period may take longer than normal. If, after a while, the dental loupes still do not seem comfortable or you experience dizziness, contact your representative. Customer service agents can provide pointers and tips for proper use.

Once a pair of dental or surgical loupes has been purchased, it is extremely important that the investment be protected. Always follow the manufacturer’s written instructions for care. The clinician must take extra precautions not to scratch the oculars when cleaning the loupes. Even micro-fine scratches can compromise visual acuity.

Proper care of your surgical loupes will guarantee their excellent performance over many years.

When not in use, the loupes should be stored in the provided case or pouch from the manufacturer. Always check with the company’s policies regarding trial periods, warranties, customer service and replacement.

Investing in dental and surgical loupes is a serious decision that should not be rushed. A clinician should research the important factors in owning and using magnification loupes and take the time to try several pairs side-by-side. However, the proactive clinicians who have chosen to invest in magnification loupes have moved their careers in a much safer direction and found the loupes to be a great return on their investment.

Starting at $89 per month or $991

Galilean weight 2.2oz (61g)
Keplerian weight 2.3oz (68g)

Titanium Frame

and carbon shell offer extreme durability and low weight. Apochromatic Glass.

Personalized Settings

soft bridge cushions. No ear and nose pressure.

Best Ergonomics

and balance due to excellent weight distribution

learn more

Starting at $98 per month or $1121

Galilean weight 1.7oz (47g)
Keplerian weight 1.9oz (54g)

Fixed Angle

loupes attach directly to the eyeglasses lens. Custom made with apochromatic glass.

Fields of View

diameter is 10% wider since loupes are closer to the eyes.

Superb Depth-of-Field

best resolution across the entire field

learn more

Starting at $81 per month or $923

Galilean weight 1.8oz (49g)
Keplerian weight 2oz (56g)

Loupes Can Be Flipped Up

when magnification is not needed. Custom made with apochromatic glass.

Extended Field of View

brilliant imagery with excellent depth-of-field.

Unobstructed Visualization

around the loupes without bulky hinges.

learn more