Ergonomics in Dentistry

Ergonomics In Dentistry
By/ Hams Hamed

Objectives:
By the end of this lecture you will be able to:
• Become familiar with the field of Ergonomics.

• Identify risk factors and stressful individual behaviors in dentistry
which lead to injuries.
• Learn how to apply preventive strategies, including good posture
and positioning.
Outline:
• Definition of ergonomics.
• Ergonomics design goals.
• Risk factors for MSDs.
• Application of ergonomics in dentistry.
• Four Handed Dentistry.
• Work Simplification Techniques.
Defintion:
• Derived from the Greek…”ergo” 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 which Leads to improved
productivity, reduced injuries, and greater worker
satisfaction.
Ergonomic Design Goals:
1. Improve job process by eliminating unnecessary tasks,

steps & effort.
2. Reduce potential for overexertion injury.
3. Minimize mental/physical fatigue potential.
4. Leverage workers ’skills/knowledge of their jobs to
increase their satisfaction, comfort and fulfillment.
Consequences of Poor Design:
• Discomfort →Chronic Pain

• Accidents →Injuries
• Fatigue →Increased Errors
• Work-Related Musculoskeletal Disorders (WMSDs):
-Low back pain**most common**
-Tendonitis
-Epicondylitis
-Carpal tunnel syndrome( CTS)
• More than 70 percent of dental students of both
sexes reported neck, shoulder and lower back pain
by their third year of dental school.
• Present in up to 81% of dental operators.
• The common reason for early retirement among

dentists is MSDs (29.5%)
(JADA, Vol. 136, January 2005)

Risk factors contribute to MSDs:
Prolonged use of Static neck, back,
vibrating hand and shoulder
tools. postures.
Repetitive motions Grasping small

(e.g., scaling, instruments for
polishing). prolonged periods.
Excessive Force
(e.g. tooth
extraction).
Application of Ergonomics in Dentistry
Application of Ergonomics in
Dentistry
Instruments Equipments Work postures
Hand Lighting Patient

instruments magnification position
Vibrating Operator and Dentist

handpieces patient chair position
1-Instruments:
• Hand instruments:
Goal: to reduce force exertion while allowing for neutral joint
positioning.
Handle shape and size:
-Dental instrument diameter ranges from 5.6 to 11.5 mm.
-larger handle diameters reduce hand muscle load and pinch force.
-Sleeves that fit over the handles of mirrors.
-A round handle VS hexagon handle.
1-Instruments:
• Hand instruments:
Weight:
-Light weight instruments (15 g or less).
- Hollow VS Resin
Balance:
-The instrument should be equally balanced within the hand so that the
tendency to deviate the wrist is reduced.
Sharpness:
-As a tool becomes dull, additional force is required to perform tasks.
Texture:
-Knurled handles such as diamond-shaped or crisscross patterns
Color coded instruments are easier to be identified
1-Instruments:
• Dental Hand Pieces:

When selecting hand pieces, look for:
• Lightweight, balanced models (cordless preferred).
• Sufficient power.
• Built-in light sources.
• Angled vs. straight-shank.
• Easy activation.
2-Equipments:
• Equipment layout:
Dental equipment should be located in a

manner which allows you to maintain a
neutral working posture and reduce
postural deviation while working.
2-Equipments:
Frequently used items: Less frequently used items:

-“comfortable distance” - Should be placed within
(22–26 inches) the maximal horizontal
-within a normal horizontal reach which created when
reach which is the arc the arm is fully extended.
created while sweeping the
forearm when the upper
arm is held at the side.
2-Equipments:
• Lighting:
Goal: to produce even, shadow-free, color-corrected
illumination concentrated on the operating field to also
awkward working postures.
• Overhead light should be positioned as close as

possible to the sight line.
• Hand mirrors to reflect the light intra orally.
• Use fiber optics in handpiece.
2-Equipments:
• Magnification:
Goal: to improve the neck posture and provide clear
vision.
• Use of various magnification systems, dental

professionals are able to increase their working
distance and assume more of an upright body posture.
• “surgical loupes” and can be mounted to a headband

or onto the operator’s glasses.
2-Equipments:
• Patient’s chair:
Goal: to promote patient comfort and maximum 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 operation.
2-Equipments:
• Operator chair:
Goal: is to promote mobility and patient access and to
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.
2-Equipments:
• Operator chair:
RGP’s new Straddle stool
-provides optimal seating allowing for proper
positioning of the spine and the pelvis.
-the Straddle stool pre-positions you into an anterior
pelvic tilt.
-The angle of seat allows for proper balance of core
muscles and allows for the maintenance of normal
curvature without the use of a backrest and without
placing stress on the lower spine.
Normal stool RGP Straddle Stool
3-Position and postures:
• Patient position:
“Supine position”
-The patient’s heels should be slightly higher than the tip of the nose.
This position maintains good blood flow to the head.
-An apprehensive patient is more likely to faint if positioned with the
head higher than the heels.
-The chair back should be nearly parallel to the floor for maxillary
treatment areas. (Chin up)
-The chair back may be raised slightly for mandibular treatment areas.
(Chin down)
Chair position when treating

Chair position when treating
mandibular arch
maxillary Arch
• Operator position:
Neutral position is the ideal positioning of

the body while performing work activities
and is associated with decreased risk of
musculoskeletal injury.
• Neutral seated position in relation to the patient:
1. Forearms parallel to the floor.
2. Weight evenly balanced.
3. Thighs parallel to the floor and knees are apart.
4. Hip angle of 90°.
5. Seat height positioned low enough.
6. Shoulders relaxed & parallel with floor.
7. Eyes directed downward.
8. (14-16) inches distance should be between the patient’s mouth & clinician’s
eyes.
9. Elbows close to sides.
10. Patient’s mouth at elbow height.
Some wrong Postures In Dental
Office
SCHEDULING
How to avoid all this pain!!!!

Scheduling
Recommendations when scheduling include:
• Incorporate brief “stretch break” periods between patients.

• Develop a patient difficulty rating scale to ensure difficult
treatment sessions are not performed consecutively.
• Increase treatment time for more difficult patients.
• Alternate heavy and light calculus patients throughout the day.
• Alternate procedures performed.
LOWER BACK STRETCH EXCERCISE
Four Handed Dentistry
Four handed dentistry:
• Definition:
“It is an ergonomically sound way to practice dentistry using the skills
of the dental assistant while including work simplification techniques.”
- The term “Four handed dentistry” was first recorded in a conference

on “training dental students to use chair side assistants” in 1960.Since
then, this term has been widely used.
-Goal: to allow the dentist and assistant to function as a team in a seated

position with maximal efficiency and minimal strain.
• Basic tenets of four-handed dentistry:
To practice true four handed dentistry, the following criteria must
be met:
1. Minimize unnecessary motion, equipments must be
ergonomically designed.
2. Both the operating team and the patient should be comfortably
seated.
3. Pre-set trays are utilized.
4. The dentist assigns all legally delegable duties to qualified
auxiliaries based on the state’s guidelines.
5. Treatment Plan of the patient is designed in advance in a logical
sequence.
• Zones of activity:
- The work area around the patient is divided into four
“zones of activity”.
- Zones of activity are identified using the patient’s face as
the face of a clock.
• The four zones are:
a) Operator’s zone.
b) Assistant’s zone.
c) Transfer zone.
d) Static zone.
N.B: The static zone, which is the zone of least activity. Instruments that are
infrequently used such as the blood pressure equipment and portable curing light
can be stored in this area.
• Equipment setup design:
The basic dental unit designs available today include:
- Side delivery.
- Rear delivery.
- Split unit.
- Transthorax.

Transthorax:
- Promotes good ergonomic positioning.

- Save Time and less motion.
- The unit over the patient’s thoracic area.
- The assistant can easily retrieve the handpieces and transfer
them to the doctor who does not need to remove his or her
eyes from the operating site.

Side delivery:
- This unit requires the dentist to pick up the handpieces,

which forces him to remove his eyes from the treatment
site, twist and turn to grasp the instrument, and then
refocus, this results in stress and fatigue.
- The assistant can’t reach the instruments to exchange

handpieces or change burs, reducing productivity. (HVE)

Rear delivery:
- The units are mounted in a fixed position that cannot be

moved and HVE hosing and air/water syringes are
permanently fixed to an assistant’s work area.
- The doctor must pick up the handpiece then transfer it

from the retrieval hand to the operating hand.

Split unit/cart:
- This concept places part of the dental unit on the

operator’s side and the (HVE) and air/water
syringe on the assistant’s mobile cabinet.
- Doctor and assistant?

• Types of Instrument Transfer:
Single Handed Transfer Double Handed Transfer

Work simplification techniques
Dentistry is a “hands on” profession, where the office team must
maximize the usage of time effectively through proper planning to
provide an optimal treatment for each patient.
Work simplification techniques:
• Definition:
These techniques are applied in dental office for making work easier,
safer and more effective and to make the work environment
comfortable.
• four principles of work simplification:
1. Elimination: A 100% saving can be accomplished by elimination of
unnecessary equipment, instruments, steps in procedures and
movements.
2. Combination: If the functions performed by two instruments or

pieces of equipment can be combined into one instrument or a piece
of equipment, or if two steps in a procedure can be combined to
accomplished in one step, a 50% saving can be realized.
• four principles of work simplification:
3. Rearrangement: It may be possible to rearrange equipment and
materials in the operatory, scheduling of patients, or steps in clinical
procedures to take better advantage of available space and time.
4. Simplification: Every effort should be made to simplify dental office

equipment and patient treatment procedures in order to introduce a
minimum number of variables and permit the team to function most
effectively.
Conclusion:
• Considering the impact of ergonomically designed and chosen
equipment on the efficiency, One must modify the workplace to
reduce the possibility of injuries.
• Among the various occupational hazards, MSDs are very much at the
disposal of the clinician himself.
• Adopting newer techniques, armamentarium and work strategies can

definitely prevent detrimental changes in the future.
Reference:
• http://www.caut.ca/docs/default-source/health-safety-fact-
sheets/ohcow-handbook.pdf?sfvrsn=10
• http://www.dentistryiq.com/articles/dem/print/volume-11/issue-
3/equipment/let-ergonomics-and-true-four-handed-dentistry-help-
you.html
• http://www.lm-
dental.com/sites/default/files/materials/the_value_of_an_ergonomic
_instrument_grip_article_0114_id_18653.pdf
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144062/

Ergonomics in Dentistry

Uploaded by

Copyright:

Available Formats

Ergonomics in Dentistry

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ergonomics in Dentistry

Uploaded by

Copyright:

Available Formats

Ergonomics In Dentistry

By/ Hams Hamed

• Become familiar with the field of Ergonomics.

• Derived from the Greek…”ergo” meaning work and

• Ergonomics is the study of work including the tasks,

1. Improve job process by eliminating unnecessary tasks,

• Discomfort →Chronic Pain

• Present in up to 81% of dental operators.

• The common reason for early retirement among

(JADA, Vol. 136, January 2005)

Repetitive motions Grasping small

Instruments Equipments Work postures

Hand Lighting Patient

Vibrating Operator and Dentist

• Dental Hand Pieces:

Dental equipment should be located in a

Frequently used items: Less frequently used items:

• Overhead light should be positioned as close as

• Use of various magnification systems, dental

• “surgical loupes” and can be mounted to a headband

Chair position when treating

Neutral position is the ideal positioning of

How to avoid all this pain!!!!

Recommendations when scheduling include:

• Incorporate brief “stretch break” periods between patients.

- The term “Four handed dentistry” was first recorded in a conference

-Goal: to allow the dentist and assistant to function as a team in a seated

• Equipment setup design:

- Promotes good ergonomic positioning.

• Equipment setup design:

- This unit requires the dentist to pick up the handpieces,

- The assistant can’t reach the instruments to exchange

• Equipment setup design:

- The units are mounted in a fixed position that cannot be

- The doctor must pick up the handpiece then transfer it

• Equipment setup design:

- This concept places part of the dental unit on the

- Doctor and assistant?

• Types of Instrument Transfer:

Single Handed Transfer Double Handed Transfer

2. Combination: If the functions performed by two instruments or

4. Simplification: Every effort should be made to simplify dental office

• Adopting newer techniques, armamentarium and work strategies can

You might also like