The Dentist >

By  CECIL PINCUS, B. D. Sc., L. D. S. Melbourne, Australia.

            There are five factors which tend to make dentistry an unhealthy occupation, and they may be summarized briefly as follows:

(1) The continual inhalation of the breaths of the patients.

(2) The bad ventilation of most dental surgeries.

(3) The cramped position of the dentist at the chair, and consequent lack of exercise of the abdominal muscles.

(4) The nerve wracking nature of most of the routine technical procedures in dental surgery.

(5) The physical and professional isolation of the average dentist from his fellow practitioners, during the course of his daily occupation.

These five factors will now be discussed separately.

(1) A dentist can do nothing to directly counteract the first factor; he cannot avoid inhaling the breaths of his patients, but can prevent ill-effects by keeping himself physically fit, as will be explained subsequently.

(2) With regard to the second factor, the writer has frequently been surprised at the odor which has assailed his nostrils on entering the surgeries of some of his confreres; not only are these dentists obviously ignorant of the elementary principles and necessities of ventilation, but their olfactory senses must have become dulled from the continual working in a stuffy atmosphere. The writer is not diffident about frankly criticizing a fellow dentist’s technique, when he thinks he can show him any improved methods or materials; but he hesitates to mention this matter of a badly ventilated surgery, as it is matter of personal surgery, as it is a matter of personal hygiene, and might seems as great and insult as to tell another man that he needed a bath. However, this matter is serious for both dentist and patient; the writer is continually being complimented by patients on the fresh atmosphere of his suite of rooms, and it is surely a slur on the profession that this should happen.

The writer practices in a large building with frontages to two streets, and every room is liberally provided with windows, and every door with a fanlight; but very few of these windows and/or fanlights are even partially open throughout the winter, in spite of the fact that none of these rooms have any ventilators whatever. A single open window or fanlight will not ventilate a room; there must be another similar opening elsewhere in the room, preferably arranged so that a continual current of air passes through the room. It is astonishing that there should be dentists seemingly ignorant of the fact that people suffer from coughs and colds in the winder simply because they do not ventilate their homes to the same extent that they do in the summer.

It may be argued that most business men and public servants spend all day indoors without detriment to their health, but few of the men in these categories are cooped up in one small room all day as is a dentist, in fact most of them work in large well-ventilated offices, with open doors, as in the case of banks warehouses, shops, and stores.

Open Air Recreation

Although a dentist may ventilate his surgery sufficiently, he should endeavor to counteract the evil effects of his daily confinement in one small room by spending as much time as possible out of doors. Most dentists spend their lunch hour in a restaurant, but it would be far better for them to have a light lunch in their rooms, and spend the remaining half to three-quarters of the lunch hour in the open air. Restaurant meals are not usually as wholesome or as nourishing as freshly cut sandwiches; most entrees contain re-cooked meats, and it is time that the fallacy that a hot meal is more nourishing than a cold meal, was exploded. Quite apart from this aspect of the restaurant meal, the intervals of waiting before the order is taken, and between the courses, etc., are precious minutes that could be spent out of doors. The writer suggests sandwiches as most convenient for a dentist’s lunch, for the following reasons –they can be freshly prepared within a few minutes after they have been ordered; the can be made as tasty, appetizing, and nourishing as any other form of food; their possible variety is almost infinite; they are extremely portable, and the writer sometimes literally “put his lunch in his pocket”, and takes it to some quiet open air spot, when the weather is favorable; no cutlery or crockery is necessary for a sandwich lunch. For those who must drink with a meal, a cup of tea of coffee can easily be prepared; but the writer cured himself of chronic indigestion years ago by relinquishing his former habit of drinking with meals. An orange after a meal will cure the craving for a drink. The writer drinks a pint of hot water every morning immediately after rising from his bed; he also drinks water (sometimes hot, sometimes cold) at 11 a.m. and 4 p.m., and is sure he is in much better health as a result of adopting this water drinking in place of his former morning and afternoon tea habit. While on this subject, the writer regrets that many dentists have forgotten that more people die prematurely from over eating than from under eating. Also, morning and afternoon teas, and suppers, are simply bad habits; three meals a day will usually supply the body with all the food necessary for health. The cocktail habit is another abuse of the bodily functions; the writer is not a prohibitionist, but he is of the opinion that the habitual artificial stimulation of the appetite is a predisposing cause of malignant disease of the alimentary canal. When a dentist comes home from work, quite fagged out, a glass of sherry or a cocktail, is a wonderful reviver, and in this instance has a definite medicinal value; but it is the height of foolishness for a person to imbibe cocktails for some social reason. Also, a dentist has potent other reasons, apart from the question of his own bodily health, for moderation in eating and drinking, but these cannot be entered into here. But the writer feels that far too many dentists err in thinking that it does them some good to be known as “men of the world” and “good sports”; this matter is so important that it will bear repetition and reiteration, and every dental student should be taught that it will pay him in the long run to strictly observe  nature’s laws as far as his professional and domestic responsibilities will permit him.

No dentist will continue the habit of spending his lunch hour in a restaurant after he has tried this idea of taking lunch in his rooms and spending the rest of the lunch hour in the open air. Whether the dentist practices in the city, suburbs, or country, there is always some park or gardens through which he can stroll, or some quiet spot where he can sit in the open air and read during the lunch period; he will then return to work feeling fit.

Very many dentist live in homes as poorly ventilated as their surgeries; this matter surely needs no further elaboration, except the repetition of the fact that a dentist, for reasons explained previously, needs to take more care than the average person, about the ventilation of every room in his home. A person who suffers from a “draught” complex, will not only be a continual sufferer from coughs, colds, and sore throats, but his habit of closing windows will cause the infection of the other inmates of his home.

Another method of counteraction of the effects of working all day in a dental surgery is the adoption of open air camping when on holidays; this does not mean the use of a caravan, but the usual ten equipment. Far more time will be spent in a caravan than in a tent; also, the work of pitching and stowing away the tent helps to fill in the time and prevent boredom. Too many dentists spend holidays that involve little change from their home environment; there is nothing so bracing to the system as the complete break in daily habits demanded by a camping holiday. The weekly half-holiday is another convenient “extra air” device.

(3) Volume two of Black’s Operative Dentistry (“Technical Procedures in Filling Teeth”) contains an exhaustive analysis of the various chair-side postures that dentists should adopt to counteract, as far as possible, the evil effects of the unnatural position that must be adopted while performing convative work. Further than this, nothing can be done except the provision of a comfortable armchair in the surgery in which the dentist can sit and relax on every possible occasion. If a dentist enters the work on the patient’s card immediately after it’s performance, the act of sitting at the desk for a few minutes between patients will be a welcome rest, it is also a far better plan than reckoning up on what was done long after the patient has left, or the management of this routine by the nurse of secretary.

Regular Exercise

It is not possible, or, indeed advisable, for any person who is on his feet for eight or more hours daily to take much exercise during the week, except on the weekly half-holiday previously mentioned. Exercise at the wrong time is much worse than no exercise at all; but regular exercise in the open air; every weekend at least, is as necessary to the body as food is for the maintenance of good health. Dentists, however, must take some daily exercise in order to counteract the ill-effects of the cramped operating position on the abdominal muscles; this cramped position interferes with the normal peristaltic action of the intestines tending to cause indigestion and constipation. Walking is the ideal exercise to counteract these troubles, and it has the additional advantage of being an open air recreation.

Dentists would be well advised not to subject themselves to any system of physical culture as a substitute for exercise in the open air. Furthermore, ten minutes “physical jerks” is more exhausting than, and not as beneficial as, ten minutes’ brisk walk in the open air. The healthiest and most long-lived of all the athletes are the walkers and the harriers; physical culture experts, presumed to be in perfect health and condition, are not noted for their longevity. Following up some freak method of physical culture today are dentists who, in the long run, are only adding to, instead of reducing, their physical and mental occupational disabilities. Adequate rest is just as necessary as regular exersice; jaded and tired business and professional men need rest, and not Turkish baths, massage and/or physical exercises. A man who cannot rest, but must rush of from one excitement to another is in a condition of neurasthenia, and should consult a nerve specialist.

Golf is Ideal for Dentists

The exercise and recreation pa excellence for dentists is golf; the writer will be supported in this view point by the many dentists who are keen golfers. Golf has advantages and attractions possessed by few other games and recreations; it can be played by persons of both sexes, and at all ages, and poor players get just as much pleasure and exercise from the game as top notchers. Golf is an ideal game for a dentist on a holiday; it will give him continuous daily exercise in the open air, and the occupational stress of dental practice will soon be removed by the concentration necessary for the game.

Many dentists now use their cars daily; it would be better for them if they used their cars at the weekends only, and walked to the tram, train or bus every day. The few minute’s walk morning and evening has a cumulative beneficial effect on the health; a dentist who tries this idea for a month will be unlikely to go back to his daily car rides. The use of a car daily has a further disadvantage, in that it tends to keep a dentist longer in his surgery. If a dentist knows that he has to catch a train at a certain time in order to be home for dinner punctually, he will arrange his work accordingly, and not commence at a late hour an operation or procedure lengthy enough to cause him to miss that train. But if he has his car, no such considerations will prevent him from being later than usual; the extra time spent at the end of a long day is often in the nature of the last straw that breaks the camel’s back. Also, patients are apt to come in late and say; “This won’t take you long, and you have your car to get you home.” A dentist will be saved much worry and trouble after his usual hours if he can say to a late caller: “I can’t see you now as I have to catch my train.” It is not suggested that a patient in pain should be turned away, but the knowledge that the dentist leaves his surgery at a certain time will usually cause emergency patients to call at a reasonable hour.

Dentists who practice at their homes labor under the disadvantage of being continually at the beck and call of their patients, and should endeavor to take a short walk every morning and afternoon, as well as the weekly half-holiday, which latter device has to be tried to be appreciated. This mid-weekly break acts as a wonderful rejuvenator; after a time, a dentist will look forward to this afternoon off and will wonder how he ever got on without it.

(4) The deleterious effect of dental practice on the nerves and the system generally can be counteracted by frequent and regular holidays. A dentist should take a week-end holiday at least once a month, and a week’s holiday every three months. Short holidays at short intervals are usually more beneficial than longer holidays at longer intervals. If a dentist works continually for a year without a holiday, he will need a long holiday to recover his normal health and strength; but if he takes a week off every three or four months, he will be likely to remain in the best of health all the year, because he will be taking a spell before his condition can become below par. Furthermore, a dentist who knows he will soon need a long holiday will soon need a long holiday will have a miserable time for the last month or two before he goes away; the man who goes away frequently has a more happy time throughout the year.

(5) From the very nature of their calling, dentists have little or no opportunity for social and professional contacts with their fellow practitioners. Lawyers, accountants, bankers, musicians, public servants, teachers, architects, and even medical men, meet their confreres habitually during their daily routine; but the average dentist is confined within the four walls of his surgery for the whole of his working period, being in this respect unique among all other professional men. This professional isolation and solitude of the dentist has a marked depressing effect on his health; he is apt to become introspective, and to forget that his confreres are beset with similar technical and economic difficulties. He must therefore employ every possible means of intercourse with his fellow practitioners; he should read the dental journals and regularly attend the meetings of his state dental society. Further than this, he should attend any dental conventions, congresses, or post-graduate classes held within his territory; form the mental health point of view, the social contacts with his fellow practitioners at these gatherings are more important than the lectures and demonstrations. The aim of every dentist should be to possesses a “mens sana in corpore sano”, but this will be impossible without occasional, or preferably frequent and regular contacts with his confreres.

Having thus briefly discussed the factors which, in his humble opinion, tend to cause dentistry to be an unhealthy occupation, the writer feels that he should state some facts to support his contention. Unfortunately, he cannot at the present time, give statistics, which he has at various times seen presented in dental periodicals, as he has been unable to trace these with the limited facilities at his disposal. But he has vivid recollections of the shocks which he has received during recent years when fellow practitioners, in the prime of life, have suddenly passed away. This happening has been, in some cases, in such a manner that one day he has been speaking to a dentist, and the nest day, metaphorically speaking, that dentist has died; the writer can recall five recent deaths of dentists under whether there are a dozen dentists practicing in this city over the age of sixty, and there are 450 of them, who attend to the dental needs of over a million people. He knows former school friends, of about the same age as himself (45), who practice dentistry, but who look much older than they are; some of these dentists are frequently absent from their work through sickness.

The writer can count on the fingers of one hand the number of days on which he has been absent from the surgery during the past ten years; this happy result is directly and entirely due to the fact that during this period he has been under the care of a physician who is also a dental graduate, and had practiced dentistry as assistant to a busy practitioner. This physician thus had personal experience of the mental and physical strain imposed on the system by the practice of dentistry. Prior to coming under the care of this physician, the writer had been frequently absent from his practice through ill-health; for a period of over ten years, he had suffered continually from such complaints as colds, influenza, indigestion, constipation, colic, rheumatism, etc., to such an extent that he had thoughts of being compelled to give up dentistry and enter an occupation more conducive to his bodily welfare.

In conclusion, the writer hopes that some of his thoughts and ideas may be of some benefit to those of his American confreres who do not enjoy the good health which should be the prerogative of every human being.

(Portions of the above article have appeared previously in the June 1937 issue of the Australian Journal of Dentistry and the August 1937 issue of the Dental Journal of Australia; additions have been made specially for the Nutrition and Dental Health magazine.)