In January of 1952, Drs. Horn and Hammond from the American Cancer Society put together the largest cohort study about the long term health ramifications of both direct and indirect cigarette smoke exposure. Their findings, I’m sure you are not surprised to learn, were simple: Cigarettes are bad for you. Cigarettes cause lung cancer.
Cigarettes make you die earlier.

The study was very robust. The two used the most scientific and reliable methods, as they had anticipated a social and economic backlash to their results, and wanted to show the maximum objectivity and minimum bias in their results.

So, what happened? The backlash was brutal. Newspapers refused to publish the results, as the newspaper editors feared that the cigarette companies might pull advertising from their papers. Doctors and scientists, often funded by the cigarette industry, began publishing their own articles, disputing the Horn and Hammond’s results.

The public, confused and untrusting after being bombarded with so much conflicting information, did what the public does — continued on with their lives. Those who smoked kept on smoking, and those who didn’t kept on tolerating smoking sections in restaurants and airports.

It wasn’t until the early 2000s, fifty years after the cohort study from Horn and Hammond, that, as a population, our society accepted the dangers of a pastime that had been ubiquitous for so long. Which makes me wonder…what is today’s cigarette? What is the thing that we all are doing, that is ubiquitous and normal in our society, that is slowly undermining our quality of life? Depending on who you are and what you’re into, you can come up with all sorts of ideas: processed food, video games, social media, etc. But today, I want to discuss a trend that may have significant ramifications on us dentists.

Our heads weigh 11 pounds. Ideally, this bowling ball mass should rest itself, centered, above our shoulders, so that our entire body mass can support that weight. As our bowling ball heads begin to tilt forward, all of that weight needs to be supported by the muscles at the back of our necks. For every inch that our heads tilt forward, the burden on those muscles increases. A lifetime of carrying such a burden has pretty obvious repercussions. All we have to do is spend some time at a dental conference and interact with a few dentists who have been practicing for 3-4 decades. Nice people, but their heads seem to be coming from out of their chests. The muscles in the back of their necks have given up, leaving them with a permanently “hunched over” look.

But that’s ok. They’ve lived life. They enjoyed life as 40-, 50- and 60-year-olds being physically able and energetic. It was only after decades of practicing dentistry that things started falling apart. I don’t think we are going to be so lucky. See, these older dentists with the hunched backs never grew up with supercomputers in their pockets. They couldn’t simply reach for a device at any time or place to check their emails, connect with friends, look at funny memes or promote their businesses. But we can. And we do.

Walk through an airport, and look at where people’s heads are. With only a few exceptions, those heads are not sitting above the shoulders. Sitting, standing, waiting, we have all developed a new posture: one that is normal and ubiquitous, just like cigarettes once were, where a phone is held near our stomachs, and all 11 pounds of our heads are fully tilted off of our shoulders.

We are speeding up the process. What took 3-4 decades for our older dental colleagues is going to take much less time for all of us, as we are wearing out those muscles behind our necks at a much faster pace. It is already happening. The Cleveland Clinic Department of Physical Therapy has reported a 3x greater incidence of posture-related pathology among patients aged 30-40. That’s young, and while it may result in professional disability, it will definitely result in an overall decline in our quality of life. Back and neck pain make it harder to get up from lying or sitting, to get dressed, to drive, and to play sports. It doesn’t matter that studies already exist that proclaim that our overuse of cell phones has decimated our postural health. People aren’t going to change their habits because our habits are “just too normal.” It looks weird to sit up straight while waiting for your flight at an airport. It looks weird to perform back and breathing exercises while sitting in your office at work.

My challenge to you is to be weird. How? Here are my favorites:

1. Limit cell phone usage by keeping it out of your pocket. Keep it in your office, in your jacket pocket or in the team lounge while at work. When at home, plug it into the charger and keep it on the countertop. When you do use it, be intentional about how you hold it. Break the habit of holding it adjacent to your stomach, and, instead, hold it out in front of you.
2. Get a foam roller. Ever since my kids were born (they are old now), my wife and I have always enjoyed the hour after the kids go to bed so that we can watch TV. Now, 10 minutes of that TV time is not on the couch but on the floor, rolling out backs, necks, hips, shoulders, you name it. Once you get a foam roller, just search “How do I use a foam roller?” on YouTube.
3. Print out a back and neck stretching/strengthening chart from Google Images, laminate it, and post it on the wall both at your practice and in your home. Spend 3-5 minutes doing a variety of exercises, preferably twice a day — once at work and once at home.
4. Do the “double-chin” exercise in the car. This is where, while sitting up straight in your car, you push your head straight back, strengthening the muscles along the back of your neck. You know you are doing it right if the flesh below your jaw bunches up, giving you a double chin.
5. If you are not already, invest in loupes, a headlight and a saddle stool while at work. Unless you have a microscope, I don’t believe it is possible to maintain perfect posture as dentists, but all of these help. The good news is that, while all of these items were really expensive when I first became a dentist in 2005, the prices just keep going down. One of the saddle stools in my office I got from Amazon for $39. It happens to be my favorite one! Don’t be discouraged the first few days as these things do have a tendency to give a mean wedgie.
6. Get one of those sets of stretchy bands, choosing a medium resistance. Between patients, during lunch, before the day, etc., hold it out in front of you, and pull your arms apart. Experiment with modifications to your arm height and band resistance, as this will strengthen all of those muscles around your shoulder blades.

The nice thing about the list above is that none of them require major investment or professional intervention. They just involve a little bit of time and a small change in your routine. Habit change is often difficult, so don’t try to accomplish all of the above list in one swoop. Just gradually add one item to your routine only after you have created consistency with the one before.
Cell phones aren’t cigarettes. Yes, we are addicted to them, but we don’t necessarily have to “quit” in order to avoid the negative ramifications. Even though it isn’t hard to notice the individuals who have fallen prey to long-term bad posture, the good news is that, while sitting at the airport or dental conferences, I also see men and women in their 70s and 80s, who are upright, robust and able to move without discernible pain. No matter your age, make it a goal to move in that direction.

Ankur A. Gupta, DDS, after completing a one-year GPR in Cleveland, started a practice from scratch in 2005. Armed with what he considered adequate knowledge, hand skills and a personable demeanor, he watched as his practice floundered, finances became unpredictable, and his lower back and spirit toward his profession became worrisome. Rather than continue the trend, he made a guinea pig out of his office, his family and himself in attempting any and all personal and professional “experiments” in self-improvement. More than a decade later, he enjoys excellent new patient numbers and case acceptance, a solution-oriented dental team, and, most importantly, a meaningful and positive identity. He happily shares the failures and successes with dental and community groups throughout the country, always ending his presentations with practical, implementable, step-by-step ways to be better. You can e-mail him at drgupta@northridgevillefamilydentistry.com or check him out on his website www.bebetterseminars.com