Dental Ergonomics 1:

Objectives: the student will:

Become familiar with the field of Ergonomics
Learn the common occupational injuries
associated with Dentistry
Define work-related musculoskeletal disorders
(WMSDs) and be aware of the scope of the
problem
Identify risk factors and stressful individual
behaviors in dentistry which lead to injuries
Learn how to apply preventive strategies,
including good posture and positioning

2
 What is Ergonomics?
Derived from the Greekergos meaning work and
nomos the study of..literally the study of work.
Ergonomics is the study of work including the tasks,
the technology and the environment, in relation to
human capabilities.
In essence, it is fitting the job to the worker instead
of vice versa.
Ergonomics is a way to work smarternot harder
by designing tools, equipment, work areas and tasks
to fit the individual worker.
Leads to improved productivity, reduced injuries, and
greater worker satisfaction.

3
 Ergonomic Design Goals
Improve job process by eliminating unnecessary
tasks, steps & effort
Reduce potential for overexertion injury
Minimize mental/physical fatigue potential
Leverage workers skills/knowledge of their jobs to
re-design work to increase their satisfaction,
comfort, morale and fulfillment

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Consequences of Poor Design
Discomfort Chronic Pain
Accidents Injuries
Fatigue Increased Errors
Work-Related Musculoskeletal
Disorders (WMSDs)
Low back pain**most common**
Tendonitis
Epicondylitis
Bursitis
Carpal tunnel syndrome( CTS)
Tumors
7
 OSHA Ergonomics Standard 2004

Program-oriented approach - elements:

Management leadership (Dean, Dept. Chairs)
Employee participation (Students)
Hazard identification (Faculty)
Job hazard analysis and control
Training (This Course, FSDC sessions)
Medical management
Program evaluation
Applicable to manufacturing and manual handling
operations; workplaces where WMSDs are
reported, including dental offices
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? WMSDs in Dentistry ?
? ?
? ? ?
? ?
?
?

? ? ?
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WMSDs: Definition
Work-Related Musculoskeletal Disorders
(WMSDs): disorders of muscles, nerves,
ligaments, tendons, joints, cartilage, and/or
spinal discs (examples: Carpal Tunnel Syndrome)
Gradual chronic development rather than acute
episode
Work-related
Also known as Cumulative Trauma Disorders (CTDs)
or Repetitive Motion Injuries (RMIs)

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WMSDs in Dentistry
Reasons for Early Retirement Among
Dentists

Musculoskeletal Disorders (29.5%)

Cardiovascular Disease (21.2%)
Neurotic Symptoms (16.5%)
Tumors (7.6%)
Diseases of the Nervous System (6.1%)
Alsoeyestrain and hearing loss (handpiece
noise)

Source: Burke et al., 1997

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Work Related Musculoskeletal
Disorders in Dental Care Providers
A review of the literature clearly identifies
various anatomical sites affected in DCPs
including:
neck
shoulders
upper extremities (elbows, hands, wrists
and fingers)
back

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 WMSD Symptoms Among
Dentists
80%
70%
% Reporting

60%
50% Males
40%
Females
30%
20%
10%
0%
ck
k

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ds

s
s
ck
ec

ee
w
ld

Ba

an
Ba

bo
N

ou

Kn
H
er

El
er
Sh

/
pp

ts
w

ri s
Lo
U

Body Part
18
Source: Finsen et al., 1998
What Factors Contribute to
WMSDs?

Repetitive motions (e.g., scaling, polishing)

Excessive Force (e.g. tooth extraction) 20
What Factors Contribute to
WMSDs?

Static neck, back, and shoulder postures

21
 What Factors Contribute to
WMSDs?

Grasping small instruments for prolonged periods22

What Factors Contribute to
WMSDs?

Prolonged use of vibrating hand tools

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 Ergonomics in Dentistry
Magnification Systems
Goal: Improve neck posture; Provide clearer
vision
Consider:
Working distance

Depth of field

Declination angle

Convergence
angle
Magnification
factor
Lighting needs 28
Ergonomics in Dentistry
Operator Chair
Goal: Promote mobility and patient access;
accommodate different body sizes

Look for:
Stability (5 legged base w/casters)
Adjustable lumbar support
Seat height adjustment
Adjustable foot rests
Adjustable, wrap-around body
support or arm supports
Seamless upholstery 30
Ergonomics in Dentistry
Patient Chair
Goal: Promote patient comfort; maximize
patient access
Look for:
Stability
Pivoting or drop-down arm
rests (for patient ingress/egress)
Supplemental wrist/forearm
support (for operator)
Articulating head rests
Hands-free or preset 31
operation
Ergonomics in Dentistry
Posture/Positioning
Goal: Avoid static and/or awkward postures
Potential Strategies:
Position patient back far enough so that their
mouth is at the operators elbow. Elbows are
elevated no more than 30 degrees.

Adjust patient chair when accessing different

quadrants.
Turn the patients head as needed
Alternate between standing and sitting
frequent rest breaks every 20-30 mins.
On-site stretching exercises
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Ergonomics in Dentistry
Work Practices
Goal: Maintain neutral posture, reduce force
requirements

Potential Strategies:
Ensure instruments are sharpened, well-
maintained
Use automatic handpieces instead of manual
instruments where possible

Use full-arm strokes rather than wrist strokes

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 Ergonomics in Dentistry
Scheduling
Goal: Provide sufficient recovery time for staff to avoid
chronic muscular fatigue

Potential Strategies:
Increase treatment time for more difficult

patients
Alternate heavy and light calculus patients

within a flexible scheduling system

Vary procedures within the same

appointment
Shorten patients recall interval 34
ERGONOMICS 1 SUMMARY

Good ergonomic design of tools, processes

and furniture DOES improve personnel
comfort, health, morale, productivity and
readiness.
Students and faculty working as part of a
team to improve posture & positioning and
maintain good work habits
Its critical to seek prompt medical aid for
symptoms of ergonomic stress / WMSDs,
CTDs 35
Dental and Dental Hygiene
Student Observation
Observational study findings*:
Students seen reaching for instruments
(too far from their seated locations)
Students frequently bend and twist upper
torso
Students contort their bodies in order to
get closer to the treatment site
_____________________________________
* these were findings from a study done almost 20 years ago
(George et al, 1987)how true are they today ???

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Simulation Lab Twisting torso

38
Simulation Lab Using pincer grip

39


Simulation
Lab Back
not flush
against back
of chair/stool

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Simulation Lab Twisted torso

41
Simulation
Lab - Static
flexed neck
position

42
Simulation
Lab Too
close to
patients
face

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Simulation Lab - Static flexed neck
position

44
Simulation Lab Hunched shoulders;
static neck position

45
Simulation Lab Using pincer
grip and vibrating instrument

46
Simulation Lab Using pincer grip
and gloves may be too large

47
Simulation Lab Neck bent;
right shoulder raised

48
Simulation Lab Hair is in patients
mouth !!!!

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 Patient Position
Supine
Chair nearly parallel to the
floor
Heels slightly higher than
nose
Patients Head
Even with end of headrest
Mandibular work - chin
DOWN
Maxillary work - chin UP
Change patients head
position for: good visibility,
access to teeth &
treatment area

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 Clinician Position
Clinician should
have:
Back against the seat back
Entire backside on seat
Feet flat on the floor
Thighs parallel with the
floor & hips slightly higher
than knees
Shoulders relaxed &
parallel with floor
Eyes directed downward

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Clinician Position
Clinician should have:
Eyes directed downward.
Neck flexion 10-20 max.
~14-16 inches distance
between patients mouth &
clinicians eyes (use loupes)
Elbows close to sides
Patients mouth at elbow
height
Shoulders/forearms relaxed
& parallel to floor
Knees spread apart--Hip
angle slight greater than
90. Feet flat on ground.

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Neutral Seated Posture
54
Clinician Position (clock)
The 8 oclock position The 10 - 11 oclock position

The 9 oclock position

The 12 oclock position

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8

56
9

57
The 10 oclock position

10 11

58
The 12 oclock position
1 11 2

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Visibility: Light position
(mandible)
For the Mandible:
Light must not be
obstructed by operators
head or hands
Light shines directly
above the patients head
with chin down position
Beam is nearly
perpendicular to floor,
angled 10 degrees down

60
Visibility: Light position
(maxillary)
For the Maxilla:
Light must not be
obstructed by operators
head or hands
Light shines into patients
mouth at an angle in
front of the patient with
chin up position
Beam is more parallel to
floor or 10 degrees
upward.

61
What do you think of this?
Shoulder too high?
Hows this positioning?
Typodont Intimacy?
Good working position?
Practice makes perfect!