Dental News - The amazing opposable thumb

Colene W. House, USA

Tue. 29 November 2011

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For four years, I’ve been fascinated with thumbs, and rightfully so. In fact, I’ve got a thumb that just doesn’t function the way it used to when I first started working as a hygienist 40 years ago. When I go out to dinner with my husband, I notice how other patrons handle their knife and fork.

I find myself wondering things such as, “Why do they hold their eating utensils the way they do? Do they have arthritis? Why does that lady hold her glass in both hands, is there something wrong with her thumbs?”

I even watch the wait staff and worry about how long they will be able to heft the heavy trays with multiple plates of food.

Actors in movies, my patients, my friends, people I encounter during the course of the day, I am watching them all. My husband says I’m obsessed. I freely admit that I am. The thumb is our main claim to fame as humans. No other species has a digit that is so singularly talented. Without your thumbs, it is infinitely more difficult to tie a bow, cut with scissors, use a can opener, blow your nose, button a button. Oh, here’s a good one: try typing without your thumb to use the space bar. Go ahead, I’ll wait.

Now that I have your attention, try scaling someone’s teeth without using your thumb. There is one word for such an endeavor, and that word is impossible. There are several problems that can develop with our hands over time. The one we’ll focus on here is CMC arthritis. The long name for it is carpometacarpal arthritis, or in non-technical language, arthritis at the base of the thumb.

CMC arthritis develops over time as we constantly apply pinching force all day long, attacking tenacious calculus and stain. Not to mention struggling with stubborn lips, cheeks and tongues. Over the years, the force of constant pinching wears down the cartilage that is meant to protect the ends of the bones and help them move freely against each other. When that cartilage is worn away, the grinding of bone on bone gets painful, very painful.

Consider the mathematical problem of transference of pounds of pressure from the fingertips to the base of the joint where it meets the wrist. One pound of pressure at the fingertips increases anywhere from 10 to 16 times by the time it gets to the CMC joint. My surgeon has a gage to measure how much pressure one can exert with a pinch force. I can apply 12 pounds at my fingertips. So let’s see, that’s 120 pounds, at the very least, by the time it gets to the CMC joint. That’s a lot of pressure, and dental hygienists exert this force all day long and over a period of many years.

CMC arthritis symptoms

Most likely, the first symptom that is noticed is soreness and sometimes swelling in the pad of muscle at the base of the thumb. Another is difficulty putting your hand flat on the floor, especially trying to support your weight while doing pilates, yoga or push-ups.

Weakness in your grip is another symptom. I experienced sharp pains that radiated up my arm when I would turn the steering wheel of my car.

Fatigue occurs after doing things that never bothered you before. When you are fatigued, you start compensating by positioning your arm and shoulder in weird ways. The problem is then compounded.

However, don’t self diagnose if you feel discomfort. Go see a hand specialist. He or she will take an X-ray in order to make a final diagnosis of CMC arthritis.

Work smarter to work longer

After 40 years as a dental hygienist, two things come to mind. First, never use dull instruments. The duller they are, the harder you have to grip in order to remove any deposits on your patient’s teeth. The harder you grip, the more potential damage you do to your most important assets: those two money makers that are attached to the ends of your arms. Look at them. They are the only two hands you will ever be given.

I like to keep two or three sets of sharp instruments in an easily accessible place to switch out at a moment’s notice. Some hygienists keep a sharpening stone with each setup and sharpen as needed during the appointment.

Second, use powered scalers as often as you can. If you have to purchase your own, whether it be magnetostrictive, piezo-electric or even a sonic scaler, it will be one of the most important purchases you make. Invest in yourself. You are worth it. Your hands are worth it.

Make time for regular massages with a licensed massage therapist (LMT) who has in-depth knowledge of hands. My LMT knows what I do for a living, and that I have had multiple surgeries on my right hand. She carefully works on my arms, hands and shoulders, keeping the muscles in good shape, and the interstitial spaces between the bones open.

Even if you have to schedule a regular manicure to get a good hand massage, take the time. Learn what those simple stretches and massage techniques are so you can teach someone else to do it for you every day.

We know the importance of back care exercises, so why not give our hands the same consideration? Try this simple exercise. Place your hand, palm down on the seat of your chair and slightly spread your fingers. Now sit on your hand, slowly straighten your elbow, and hold it there for several seconds. Do this at each break you have. That little trick counteracts the position your hands have been in all day.

The practice of dental hygiene is hard on us physically. We all need to be pro-active in our physical care, just as we advise our patients in the preventive care for their teeth. Be smart. Practice smart. Take care of those amazing opposable thumbs.

Note: This article was published in Hygiene Tribune U.S. Edition, Vol. 4 No. 10, October 2011.

About the author

Colene W. House, RDH, has been a clinical dental hygienist for 40 years and has a passion for researching CMC arthritis. House may be reached at colenehouse1257@charter.net.

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