After a chat with friends and fellow hygienists Lauren Welton, Nikki Singelton and Camilla Caldwell, Nick Coller presents opinions on the pros and cons of loupes.
While out for lunch recently with some fellow dental hygienists, I mentioned that I had started to wear loupes. To my surprise, all bar one of them were already using them.
On the back of the enlightening chat that followed, we decided to put together an article on why we decided to wear loupes and the pros and cons of wearing them. To state from the outset, this article is based on my own and my friends’ opinions and not on a large qualitative project. Nonetheless, we found many similarities in our opinions, which seemed to be worthy of consideration.
Types of loupes
There are two main types of dental loupe: TTL (front-mounted) and flip-up.
TTL loupes are known for being lighter, TTL loupes provide a wider field of vision. This type of loupe is customised to the wearer, taking into consideration such things as pupillary distance, focal distance, working distance and angle of declination to ensure a comfortable neck position. They also tend to be more expensive.
Flip-up loupes are mounted on a hinge, so can be flipped up (as the name suggests) when not in use. The angle of declination and pupillary distance can be adjusted to suit the wearer, so they tend to be cheaper. However, they are also heavier and this can cause neck pain.
Barriers to wearing loupes
During our discussion, we established some barriers to buying loupes, including cost, necessity and time pressures.
Cost For us all, cost seemed to be the main barrier to wearing loupes. This is hardly surprising, given the fact that, on average, we had spent in excess of £1,500. It is also of no great surprise that colleagues who had more recently qualified seemed to be most put off by the price. As one friend commented: ‘You’ve just left training, you’re saddled with debt and want to get on and earn some money. Buying loupes is way down the list of financial priorities.’
Not necessary While training, we were required to wear loupes for therapy. It wasn’t compulsory, however, to wear them for routine scaling or during periodontal therapy. It would appear that this approach had stuck. We all saw loupes as a handy but not entirely necessary tool for routine hygiene treatment.
Hard to adjust to Wearing loupes isn’t for everyone. There are some people who cite that loupes make them feel sick or dizzy and haven’t been able to adjust to them over time.
Time pressure For some, wearing loupes added an extra layer of complication during an already overstretched session (especially the case for those working 20 minute sessions).
Overreliance One of our group, who doesn’t wear loupes, said: ‘I don’t feel I am less of a hygienist without them. I hear colleagues say that they feel like cancelling their day if they forget their loupes or the light is broken and I think to myself I’d rather not get so reliant. No one has ever complained that I did a bad job because I wasn’t wearing loupes.’
Decision making process
Before investing, there are a few strategies worth trying before handing over your hard-earned pennies. These are all strategies tried and tested by myself and my friends.
Off-the-shelf loupes This is a good way to adjust to magnification without great cost. Further, they are an easy way to test if TTL or flip loupes suit the practitioner best.
Prism glasses These are worth consideration if the practitioner is simply looking to sit up straight and doesn’t suffer from other postural issues, such as twisting or head tilt.
Try before you buy Some manufacturers offer a free trial period. Why not get in touch and check?
Drivers and pros to wearing loupes
Even given these barriers, most of us had chosen to wear loupes. So, what were the drivers behind this and what were the pros of wearing them?
Back pain All of us who wore loupes cited back pain as the main driver to wearing loupes. Having worked for several years without loupes, we were all suffering aches and pains in our backs and necks to various degrees of intensity. Wearing loupes forces you not to twist or contort your body so much and helps in the maintenance of an upright posture. As one friend pointed out: ‘When I started to wear loupes, I realised how I must have been twisting all the time while I worked. I also noticed how I must have been tipping forward to help me see in the patient’s mouth’
Improved vision It goes without saying that wearing loupes improves visibility. Those with lights further mentioned that they felt that buying a light added another dimension of visibility than using loupes alone. As one friend commented: ‘I didn’t realise what I couldn’t see until I started wearing loupes! The first few weeks I was always running late as I was able to see things I would have left before’. Another friend highlighted: ‘Sometimes the overhead light isn’t that good. I feel if I wear loupes with the light, I won’t miss something that I might not have seen before, especially on the soft tissues’. This said, there was consensus amongst us that wearing loupes might be more beneficial for supragingival scaling and that tactile sensation is still key for subgingival treatment.
Fatigue and headaches Some of us had noticed eye strain and associated headaches, particularly at the end of the day. Wearing loupes had laid this problem to bed.
Cons to wearing loupes
Despite the many benefits, everyone in the group was able to list some cons associated with using loupes.
Cost of repair/replacement parts Interestingly, a couple of us had had problems with our loupes, and repairs had not been cheap.
Ease of maintenance Compounding the point above, one of us had dropped our loupes and they had needed to be sent to Italy for repair. She had been without them for six weeks.
Adjustment period When starting to wear loupes, we had all noticed a period of adjustment. One friend stated: ‘I felt like I was constantly on a ship. I felt so seasick’. We all had noticed that treatments took us longer as a result. Further, some of us found we still found slight difficulty bringing tools from outside the field of vision into the working area. We were concerned about catching the patient’s face or lip. One friend pointed out: ‘I still now put my finger over the tip of the sickle before I angle into the patient’s mouth. It worries me about judging the distance incorrectly and catching them.’
Back problems not entirely cured There didn’t seem to be a total stop to visiting the osteopath because we had started to wear loupes. We had found that loupes hadn’t fully stopped us tilting our heads, holding stress by raising our shoulders or uneven shoulder alignment.
Difficulty when working alone Wearing loupes and holding the high volume aspiration seems to pose particular problems for some operators.
Lack of full face protection/visor Many of us missed wearing a full face visor and expressed concerns about the amount of bacteria spraying directly into our faces as a result.
Pros to wearing loupes: • They can ease back and neck pain • They can improve vision • They can ease eye strain and associated headaches
Cons to wearing loupes: • Repairs can be costly • Maintenance can be inconvenient
• There is a period of adjustment • Full face visors cannot be worn
Seeing the light
In conclusion, it can be seen that wearing loupes is not for everyone. Some find that they cannot adjust to them and experience a prolonged sense of dizziness or sickness when wearing them. Further, loupes represent an expensive outlay, which a newly-trained dental hygienist might find off-putting. This said, it would seem that most operators who convert to wearing loupes would not be without them. The addition of a light, in particular, seems to be of great benefit.
Article By Nick Coller
Contributing authors: Lauren Welton, Nikki Singelton and Camilla Caldwell
Source: Oral Health November / December 2018