Degenerative Disc Disease and the Dentist
By: Edward O. Comitz, Esq.
I meet with dentists on a regular basis to discuss physical health issues that impact their ability to practice. Many of my clients have been diagnosed with cervical or lumbar degenerative disc disease and want to know more about this disease, their options for continued practice, and how this condition will impact their practice. As someone who has suffered from neck and back pain for years, and who has undergone multiple treatment modalities (including surgery), I understand how debilitating degenerative disc disease can be. As an attorney, I am able to make it through the day without the fear of hurting myself or others. For dentists, this may not be the case.
Common Signs of Degenerative Disc Disease
For many of my dentist clients, common signs of degenerative disc disease include pain related to specific behaviors such as sitting for long periods or pain that increases when lifting, bending, turning or twisting—all material duties of dentistry. Pain typically flares up during these activities, then returns to a lower baseline level with time. Baseline levels vary, depending on the person, from minor and occasional aches to constant or severely disabling pain. For others, their pain can last for days or weeks on end with no relief. Unfortunately, continuing to practice (even with loupes or ergonomic support) can add additional pressure to an already compromised spine.
The most common symptoms dentists identify include:
- Radicular Pain and Numbness. Degenerative disc disease can cause a nerve impingement in the neck. This may produce pain (either sharp or dull) and numbness in the forearm and fingers. Similarly, an impingement in the lower back can produce the same symptoms in the leg and foot. These symptoms can compromise your ability to practice as you may not be able to hold instruments steadily, drop instruments, may not be able to gauge pressure accurately, or be distracted by the pain during procedures.
- Weakness. Nerve impingement caused by degenerative disc disease can also affect the muscles that they serve. This can produce weakness, making it difficult for you to hold instruments, or causing you to stumble.
Causes of Degenerative Disc Disease
The pillow-like cushions between you vertebrae are the discs that provide the shock absorbing capacity and elasticity your spine needs for complex motion and flexibility. Degenerative disc disease commonly follows the wear and tear of joint and muscle stress. The prolonged static postures and repetitive processes necessary to practice dentistry can cause disc dehydration, which leads to weakened and thinner discs. As they degenerate, discs often become incapable of dealing with mechanical stress or normal spine flexing. The vertebrae compress together, or against nearby spinal nerve roots, and cause the pain and weakness associated with degenerative disc disease.
Frequency of Degenerative Disc Disease Among Dentists
Most of my clients are dentists and other surgeons who frequently suffer from this condition because they sit, lean, bend, twist, or stoop in order to treat patients. When dentists consistently perform these types of motions each day, they are more susceptible to degenerative disc disease than other professionals. The Institute of Dental Ergonomics estimates that three out of four dentists suffer from musculoskeletal disorders. Kristina Lynch, My back is hurting my practice, Part I, AGD Impact, Feb. 2006, agd.org/support/articles. Another study estimates the percentage of dental professionals suffering from general pain in the back, neck shoulder or arm to be as high as 81%. Bethany Valachi and Keith Valachi, Mechanisms leading to musculoskeletal disorders in dentistry, JADA, Oct. 2003, at 1344.
Treatment Options for Degenerative Disc Disease
Physicians recommend various different treatment options to my clients who suffer from degenerative disc disease. Options may include physical therapy to strengthen the back or neck, stretching and stabilization exercises, low impact aerobic conditioning (including walking, swimming or biking), heat and ice, trigger point injections, steroid injections into the spine used to reduce swelling and for diagnostic purposes, medication management, and in some cases surgery.
I feel lucky to live in Arizona, close to places like the Mayo Clinic and Barrow Neurological Institute. These institutions have world class reputations and I was able to obtain a significant amount of relief by following my doctors’ instructions. My progress was slow, and I still have pain and limitations, but I’m much better off than I was before I sought treatment.
Degenerative Disc Disease and Your Dental Practice
Many dentists attempt to lessen their discomfort by altering their appointment schedules to give themselves time to rest and recover between patients. Many of our clients have tried new chairs or stools designed to support their back and legs properly. Others have tried using loupes, magnification lenses, or video scopes to compensate for their pain. Some of these options have worked, but for many of my clients they have proved unsuccessful, and they have had to file disability insurance claims.
Disability Insurance Difficulties for Dentists with Degenerative Disc Disease
Many dentists modify their schedules at some point in their careers due to degenerative disc disease or other injuries associated with practicing dentistry. In 2013, I co-authored an article entitled, “The Injured Physician: Is Your Work Ethic Hurting You and Your Patients?” where I discussed the some of the unintended consequences of working through pain and injuries, including how doing so can adversely impact your disability insurance coverage.
Unfortunately, musculoskeletal disability claims are more difficult to prove. In a previous article entitled, “Disability Insurance: Who Gets Denied?” we noted that those suffering from neck and back pain are commonly denied disability insurance benefits. Insurance companies urge that most people have radiographically visible disc degeneration and that changes in the spine are typical as we age. They further urge that pain is subjective, and that positive MRI finding alone are insufficient proof that you cannot continue working.
Our firm understands degenerative disc disease and the pain it causes firsthand. We also understand how to develop sufficient evidence in support of legitimate claims.
* Edward O. Comitz, Esq. heads the Health and Disability Insurance Practice Section at Comitz | Beethe. Mr. Comitz has extensive experience in disability insurance coverage and bad faith litigation, primarily representing medical and dental professionals in reversing denials of their disability claims. Comitz | Beethe has offices in Scottsdale (Phoenix), Tucson and Flagstaff, Arizona.
The information in this article has been prepared for informational purposes only and does not constitute legal advice. Anyone reading this article should not act on any information contained therein without seeking professional counsel from an attorney. The author and publisher shall not be responsible for any damages resulting from any error, inaccuracy or omission contained in this publication.