PATIENT AND OPERATOR POSITIONS

DILU DAVISIInd YEAR MDS

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CONTENTS Introduction History Factors To Be Kept In Mind Regarding Dental Chair Chair

Upright Position Almost Supine Reclined 45 Degree

Operating Position Right Front Position (7 O'clock) Right Position (9 O'clock) Right Rear Position (11 O'clock) Direct Rear Position (12 O'clock) Operator Position Requiremnets Considerations Sequence For Positioning

Ergonomics

Importance Of Posture

Ergonomics For Dentists

Musculoskeletal Disorders

Classification

Signs

Symptoms

Risk Factors

Prevention

Ergonomics For Dental Students

Body Strengthening Excercises

Future Of Ergonomic Dentistry

Conclusion

References

INTRODUCTION

Chair position is a very important aspect in the success of a dental treatment.

The correct positioning helps the operator to have a good visibility and accessibility

of the oral cavity

Proper positioning of the patient and the operator, illumination and retraction for

optimal visibility are the fundamental pre-requisites to proper dental treatment

If operator maintains proper position and posture during treatment, the operator is

less likely to get strain, fatigue, be more efficient and less chances of getting

musculoskeletal disorders.3

Until a few decades ago , most dental procedures

were performed with patient seated upright and

dentist standing next to patient ,this prolonged

period caused musculoskeletal disorders for dentists.

Proper positioning of the patient and operator, illumination and retraction

for optimal visibility are fundamental pre requisites to proper dental

treatment

• 1790 was a big year for dentistry, as this was the year the

first specialized dental chair was invented.

• It was made by Josiah Flagg, an American dentist from a

wooden Windsor Chair with a headrest attached.

•Before this, dental patients sat in a wooden chair without any

head rest at all.

HISTORY

Flagg also attached an arm extension for convenient placement of the

necessary dental equipment.

Forty years later, James Snell designed and created the first fully reclining

dental chair.

However, Snell's model did not allow for height adjustments.

The first pump-style chair incorporated the adjustable features of the

Snell model, and provided a foot pump that raised and lowered the

patient.

This functionality was a tremendous benefit for both dentist and patient,

both of whom could now remain relatively comfortable for long periods

of time.

In 1867, British dentist James Beall Morrison

patented his dental chair design.

Building upon the advances of Josiah Flagg and

James Snell, Morrison constructed a chair that

could be raised up to three feet.

It allowed the patient to recline fully, and was

also capable of tilting to the left and right.

This lateral tilt proved exceptionally useful during

dental procedures focused on only one side of

the mouth, such as extraction of wisdom teeth or

filling cavities in the molars.

Modern dental chairs offer an ever-increasing list of benefits for

patients and dental professionals.

They are built out of aluminium, steel, and heavy plastic, and most

offer smooth electric or hydraulic height and tilt adjustments.

These models also usually have a bevy of electrical ports to

accommodate drills and other medical equipment.

This keeps all electrical cords in one convenient place and lowers

the danger of tripping; it also allows the dentist to control the tools

with a series of foot pedals attached to the base of the chair.

FACTORS TO BE KEPT IN MIND REGARDING DENTAL CHAIR:

It should be able to provide comfort to the patient

It should be able to provide total body support

Headrest of chair should be attached for supporting patient's chin and reducing

strain on chin muscles

It should be able to provide maximum working area to the operator

It should be placed at the convenient location with adjustable control switches

Foot switches are preferred to improve infection control

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For restorative dental procedures, the most preferred operating

positions are:1. Upright position

2. Almost supine

3. Reclined 45 degree

The most common patient positions for operative dentistry are almost

supine or reclined 45 degrees. The choice of patient position varies with the

operator, the type of procedure, and the area of the mouth involved in the

operation.

CHAIR POSITIONS

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UPRIGHT POSITIONThis is the initial position of chair from which further adjustments are made

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ALMOST SUPINE• In this, chair position is such that head, knees and feet are approx. at same level

• Patient’s head should not be lower than feet except in case of syncopal attack

•The head should not be positioned below the feet level as blood pressure increases gradually

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RECLINED 45 DEGREES• In this position , chair is reclined at 45 degree

• Mandibular occlusal surface are almost 45 degree to the floor

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PATIENT POSITIONS

• Patient should be seated so that all his body parts are well supported.

• The patient's head should always be supported by adjustable / articulated

headrest.

• Preferably the patient's head should be in line with his back

• The chair height should be kept low, backrest should be upright and armrest

should be adjustable while making the patient to seat in the dental chair.

• Now, the chair can be adjusted to place the patient in reclining position.

• Patient position can vary with operator, type of procedure and area of the oral

cavity.15

OPERATING POSITIONS

• Once the patient has been comfortably positioned,

the dentist and the assistant should sit themselves

in the proper positions for treatment.

• Usually sitting position is preferred in modern

dentistry to relieve stress on operator's leg and

support the operator's back.

• The level of teeth being treated should be placed

at same level as the level of operator's elbow.

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• For better understanding, sitting positions of

operator are related to a clock.

• In this clock concept, an imaginary circle is drawn

over the dental chair, keeping the patient's head at

the center of the circle.

• Then the numbering to circle is given similar to a

clock with the top of the circle at 12 o'clock.

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ACCORDINGLY THE OPERATOR'S POSITIONS

Right Handed Operator

1. Right front or 7’o clock position

2. Right or 9’o clock position

3. Right rear or 11’o clock position

4. Direct rear or 12’oclock position

Left Handed

5. 5 o'clock

6. 3 o'clock

7. 1 o'clock .

Forearm parallel to the floor Thighs parallel to the floor Hip angle of 90 degrees Seat height positioned low enough so

that the heels of your feet touch the floor

OPERATOR POSITION REQUIREMENTS

When working from clock positions 9-12:00,

feet spread apart so that your legs and the

chair base form a tripod which creates a stable

position

Avoid positioning your legs behind the

patient’s chair

Back of the operator should be always straight

Head erect and should not be bent of drooping

RIGHT FRONT POSITION (7 O'CLOCK) 1. It helps in examination of the patient2. Working areas include:

a) Mandibular anteriorb) Mandibular posterior teeth (right side)c) Maxillary anterior teeth

3. To increase the ease and visibility, the patient's head may be turned towards the operator.

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Torso Position : Sit facing the patient with your hip in line with the patient’s upper arm.

Leg Position : Your thighs should rest against the side of the patient chair.

Arm Position: To reach the patient’s mouth, hold your arms slightly away from your sides. Hold your lower right arm over the patient’s chest.

Line of Vision: Your line of vision is straight ahead, into the patient’s mouth.

Hand Position: Rest the side of your left hand in the area of the patient’s right cheekbone and upper lip. Rest the fingertips of your right hand on

the anterior teeth in the patient’s maxillary left quadrant.

NOTE: Do not rest your arm on the

patient’s head or chest.

NOTE: It is difficult to maintain neutral arm

position when seated in the 8 o’clock

position. For this reason, use of this position

should be limited.

RIGHT POSITION (9 O'CLOCK)

1. In this position, dentist sits exactly right to the patient

2. Working areas include:

a) Facial surfaces of maxillary right posterior teeth

b) Facial surfaces of mandibular right posterior teeth

c) Occlusal surfaces of mandibular right posterior teeth.

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Torso Position. Sit facing the side of the patient’s head. The midline of your torso is even with the patient’s mouth.

Leg Position. Your legs may be in either of two acceptable positions: (1) straddling the patient chair or (2) underneath the headrest of the patient chair. Neutral position is best achieved by straddling the chair; however, you should

use the alternative position if you find straddling uncomfortable.

Arm Position. To reach the patient’s mouth, hold the lower half of your right arm in approximate alignment with the patient’s shoulder. Hold your left hand and

wrist over the region of the patient’s right eye.

Hand Position. Rest your left hand in the area of the patient’s right cheekbone. Rest the fingertips of your right hand on the premolar teeth of the mandibular

right posterior sextant.

Line of Vision. Your line of vision is straight down into the patient’s mouth.

RIGHT REAR POSITION (11 O'CLOCK)

• Dentist sits behind and slightly to the right of the patient

and the left arm is positioned around patient's head

• This is preferred position for most of dental procedures

• Most areas of mouth are accessible from this position either

using direct or indirect vision

• Working areas include:

a) Palatal and incisal (occlusal) surfaces of maxillary teeth

b) Mandibular teeth (direct vision).

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Torso Position. Sit at the top right corner of the headrest; the midline of your torso is even with the temple region of the patient’s

head.

Leg Position. Your legs should straddle the corner of the headrest.

Arm Position. To reach the patient’s mouth, hold your right hand directly across the corner of the patient’s mouth. Hold your left hand

and wrist above the patient’s nose and forehead.

Hand Position. Rest your left hand in the area of the patient’s left cheekbone. Rest the fingertips of your right hand on the premolar

teeth of the mandibular left posterior sextant.

Line of Vision. Your line of vision is straight down into the mouth.

DIRECT REAR POSITION :

Here the dentist sits directly behind the patient and looks down over the patient’s head

This position is mainly used only for working on lingual surfaces of mandibular anterior teeth , lingual surfaces of maxillary anterior teeth.

This position has limited application.

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1. While doing work in maxillary arch, maxillary occlusal surfaces should be

perpendicular to the floor.

2. In mandibular arch, mandibular occlusal surface should be oriented 45° to the floor.

3. Patient's head can be rotated backward or forward or from side to side for operators

ease and visibility while doing work.

4. Maintain proper working distance during dental procedure. This will lead to an

increase in the cooperation and confidence among the patient.

5. Operator should not rest forearms on the patient's shoulders and hands on the face

of the patient.

CONSIDERATIONS WHILE OPERATOR POSITIONING

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6. Dentist should not use patient's chest as a instrument trolley.

7. The operator should leave left hand free during most of dental

procedures for retraction using mouth mirrors or fingers of left hand.

8. Operator should keep changing position if procedure is of long

duration to decrease the muscle strain and fatigue.

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For successful instrumentation, it is important to proceed in a step-by-step

manner. A useful saying to help remember the step-by-step approach is

“me, my patient, my light, my non-dominant hand, my dominant hand.”

SEQUENCE FOR OPERATOR POSITIONING

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SEQUENCE FOR ESTABLISHING POSITION

1 MEAssume the clock position for the treatment area

2 MY PATIENTEstablish patient chair and head position

3 MY EQUIPMENTAdjust the unit light. Pause and self-check the clinician, patient, and equipment position

4 MY NONDOMINANT HANDPlace the fingertips of my non-dominant hand as shown in the illustration for the clock position

5 MY DOMINANT HANDPlace the fingertips of my dominant hand as shown in the illustration for the clock position

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WHAT IS ERGONOMICS ?Ergo – work

Nomos – natural laws or systems

An applied science concerned with designing and arranging things people use

so that the people can do work most efficiently and comfortably

ERGONOMICS IN DENTISTRY

Ergonomics may positively impact dentists throughout their professional

lifespan

More than 70 percent of dental students reports neck, shoulder and lower

back pain by their third year in dental school

Dentists and dental students often assume awkward physical positions while

providing treatment

IMPORTANCE OF POSTURE

The elements of an improper workstation setup force the dental

practitioner to assume many harmful postures when performing various

procedures on the patient.

These positions put pressure on nerves and blood vessels, cause

excessive strain on muscles, decrease circulation and cause wear and tear

on the joint structures.

Forward bending/overreaching at waist Shoulders flexed and abducted. Elbows flexed greater than 90°. Wrists flexed/deviated in grasping. Thumb hyperextension. Position maintained for 40+ minutes per

patient

Some Improper Postures That Dentists Take:

Working with the neck in flexion and tilted

to one side.

Shoulders elevated.

Side bending to left or right.

Excessive twisting

Some Tips for Working with Good Posture1. Maintain an erect posture: by positioning chair close to the patient, one can minimize

forward bending or excessive leaning over the patient. Place feet flat on the floor to

promote a neutral or anterior tilt to your pelvis, which keeps back aligned and

promotes the natural curvatures of back

2. 2. Use an adjustable chair with lumbar, thoracic and arm support: A good chair is

essential for maintaining good posture. A chair should have important features like,

adjustable height, width, tilt, backrest, seat pan and armrests, because in most dental

offices, many people of different sizes use the same workstation.

3. Work close to your body: Position the chair close to the patient and position

the instrument tray close to the chair. This way, dentist does not have to

overextend himself to reach the patient or instruments, putting excessive stress

on back, shoulders and arms. Think of the 90° rule of having elbows, hips, knees,

and ankles all forming 90° angles.

4. Minimize excessive wrist movements: Try to keep them in a neutral position (palms

facing each other, shoulder width apart with wrists straight), which puts wrist muscles

and tendons in a much better relationship to perform the work.

5. Avoid excessive finger movements: When one can combine the excessive forces

needed to hold the instruments with the amount of repetitions that he/she can

perform each day, one can see the tremendous toll that this takes on the small

muscles of fingers. Retraining of shoulders and arms to position hands, rather than

making the small, forceful movements with fingers.

6. Alternate work positions between sitting, standing and side of patient: Switching

positions allows certain muscles to relax while shifting the stress onto other muscles

and increasing your circulation. Allow each side of your body to share the stress

rather than performing the same motion in the same way which causes cumulative

trauma in the overused side

7. Adjust the height of your chair and the patient’s chair to a comfortable level: If

dentist’s chair is too low and the patient’s chair is too high, this causes elevation of

shoulders and can lead to neck problems and can pinch nerves. Alternately, if

dentist’s chair is too high and the patient’s chair is too low, flexion of neck down and

bend wrists back to compensate can lead to neck and hand problems. Remember

the 90° rule and keep elbows at a 90° angle with wrists straight and shoulders

relaxed.

8. Consider horizontal patient positioning: If workstation allows the patient to

recline into a horizontal position, it will allow a dentist to sit above the patient’s

head with good ergonomic posture and he can use each arm equally in more

natural position.

9. Check the placement of the adjustable light: Position the adjustable light to

avoid strain on the neck

10. Check the temperature in the room: Temperature of workspace should not be

too cold because this will decrease the circulation and blood flow of extremities.

Most often, the dental work environment is damp and cold, so be certain to wear

gloves and warm up the hands before working

Lake in 1995 implicates several mechanisms in the generation of pains and soreness in dentists, such as:

a. Elevated work area with permanent static positions of more than 30 degrees, which

would produce a reduction of blood flow in the supra spine tendon and would also

originate high muscle tension on the trapezoids.

b. Lack of support of the forearms during repetitive holding of instruments which would

compromise different body segments such as spine, shoulder, and wrists.

c. The handling of vibrating instruments is associated with specific lesions such as nerve

trapping, early arthrosis and even, with Raynaud syndrome.

d. Forced cervical static postures.

ERGONOMICS FOR DENTISTS

e. Poor posture when seating. The flexion of the lumbar spine, when seating forward,

produces marked pressure increments between the interdiscal spaces.

f. Lighting at the work place: the lack or excess of light can generate myopia and

irreversible retinal lesions, among others.

g. Temperature, ventilation and humidity at the work place. If the temperature is

high and the air is saturated with humidity, there is exhaustion, increased body

temperature and, respiratory and circulatory disorders.

h. Intermittent and continuous noise produced by high and low speed instruments

i. Present dental chairs allow adaptation of the patient´s position in height,

inclination of the torso, flexion or hyper extension of the head of the patient.

REASONS FOR EARLY RETIREMENT AMONG DENTISTS

MUSCULOSKELETAL DISORDER (MSD)– 29.5% CVS – 21.2% NEUROTIC SYMPTOMS – 16.5% TUMORS – 7.6% DISEASE OF NERVOUS SYSTEM – 6.1%

- BURKE ET AL

Good ergonomic practices can drastically reduce the likelihood that MSD will slow u down

MUSCULOSKELETAL DISORDER Work-related musculoskeletal disorder (WMD) is an injury—affecting the musculoskeletal,

peripheral nervous, and neurovascular systems—that is caused or aggravated by prolonged repetitive forceful or awkward movements, poor posture, ill-fitting chairs and equipment, or a fast-paced workload

The result is injury to the muscles, nerves, and tendon sheaths of the back, shoulders, neck, arms, elbows, wrists, and hands that can cause loss of strength, impairment of motor control, tingling, numbness, or pain

The human body was not designed to maintain the same body position or engage in fine hand movements hour after hour, day after day

B.A. Silverstein defined a repetitive task as a task that involves the same fundamental movement for more than 50 percent of the work cycle

More than 50 percent of the time a dentist performs very controlled, fast motions which requires excessive upper body immobility while the tendons and muscles of the forearms, hands, and fingers overwork.

CLASSIFICATION OF MSDS Nerve entrapment disorders : Carpal Tunnel syndrome, ulnar neuropathy Occupational disorders of the neck and brachial plexus : tension neck syndrome, cervical

spondylosis, cervical disk disease, brachial plexus compression Shoulder disorders : trapezius myalgia, rotator cuff tendonitis, rotator cuff tears, adhesive

capsulitis Tendonitis of the elbow, forearm and wrist : deQuervain’s disease tendonitis, tenosynovitis,

epicondylitis Hand arm vibration syndrome : Raynaud’s disease Low back disorders : chronic low back pain

Symptoms

Excessive fatigue in the shoulders and neck

Tingling, burning, or other pain in arms

Weak grip, cramping of hands

Numbness in fingers and hands

Clumsiness and dropping of objects

Hypersensitivity in hands and fingers

Signs

Decreased range of motion

Loss of normal sensation

Decreased grip strength

Loss of normal movement

Loss of co-ordination

Some Risk Factors for MSDs Repetition Forceful exertions Awkward postures Contact stress Vibration Poorly designed equipment workstation Improper work habits

A risk factor is not always a causative factor

Amount

DurationLevel of exposure

Mechanisms Leading to Musculoskeletal Disorders in Dentistry

Prolonged Static Postures (PSPs): Dentists frequently assume static postures. When the

human body is subjected repeatedly to PSPs, it can initiate a series of events that may

result in pain, injury or a career-ending MSD.

Muscle Ischemia/Necrosis and Imbalances: During treatment, operators strive to

maintain a neutral, balanced posture and find themselves in sustained awkward

postures. These postures often lead to stressed shortened muscles which can become

ischemic and painful, exerting asymmetrical forces that can cause misalignment of the

spinal column

Hypomobile Joints: During periods of PSPs or when joints are restricted due to muscle

contractions, synovial fluid production is reduced and joint hypomobility may result.

Prevention of Musculoskeletal Disorders among Dental Professionals

ERGONOMICS FOR DENTAL STUDENTS According to an article published in the January 2005 issue of JADA, more than

70 percent of dental students reported neck, shoulder and lower back pain by

their third year of dental school

Dentists and dental students often assume awkward physical positions while

providing treatment to

(a) get a better view of the intraoral cavity;

(b) provide a more comfortable position for the patient; and/or

(c) operate equipment and reach for instruments and supplies.

Spinal Disk Herniation and Degeneration: In unsupported sitting,

pressure in the lumbar spinal disks increases. During forward flexion

and rotation, a position often assumed by dental operators, the

pressure increases further and makes the structure vulnerable to injury.

Neck and Shoulder: Repetitive neck movements and continuous arm

and hand movements affecting the neck and shoulder demonstrate

significant associations with neck MSDs.

Wrist and Hand: Carpal Tunnel syndrome (CTS) has been associated

with both repetitive work and forceful work. Symptoms can appear

from any activity causing prolonged increased (passive or active)

pressure in the carpal canal

Low Back Pain: Low-back discomfort has been associated with dental work in numerous studies. Good posture correlated negatively with back pain and dentists who sat 80 percent to 100 percent of the day reported more frequent lower-back pain, than those that do not sit as often.

Psychosocial Factors: Dentists with work-related MSDs show a significant tendency to be more dissatisfied at work and to be more burdened by anxiety, experiencing poor psychosomatic health and feeling less confident with their futures.

FOUR HANDED DENTISTRY is ergonomically the most favourable way to provide dental services since it minimizes undesirable movements of the operating team and expedites the progress of

most dental procedures

ERGONOMICALLY FAVOURABLE POSITION

Research shows that maintaining the low back curve-the lumbar lordosis-when sitting can reduce or prevent low back pain.

Proper selection, adjustment and use of magnification systems have been associated with decreased neck and low back pain, as they allow operators to maintain healthier postures.

Operators also need to know how to adjust the features of their chairs to obtain maximal ergonomic benefits and take the time to position their patients properly for mandibular and maxillary procedures.

When possible, dentists should position instruments within easy reach. To prevent injury of muscles and other tissues, the operator should allow for rest periods to replenish

and nourish the stressed structures. Operators may use various stress-reduction techniques to decrease stress-related muscular tension. It is important that dentistry incorporate these strategies into practice to facilitate balanced

musculoskeletal health that will enable longer, healthier careers; increase productivity; provide safer workplaces; and prevent work related MSDs

Hollow or resin handles Round, textured/grooved or compressible handles Carbon steel construction Colour coded instruments may make instrument

identification easier

HAND INSTRUMENTS

DENTAL HANDPIECES When selecting hand pieces look for :

Lightweight balanced models Sufficient power Built in light sources Angled/ straight shank Swivel mechanism Pliable, light weight hoses

PROVIDE SUFFICIENT SPACE Permanently place equipment used in every clinical procedure

within comfortable reach ( within 20 inches of the front of the body) Use mobile carts for less commonly used equipments Allows convenient positioning when required

LIGHTING Goal : produce even shadowless colour corrected illumination

conecentrated on the operating field The overhead light should be readily accessbile Hand mirrors can be used to provide light intra orally Use of fibre optics for hand pieces add concentrate lighting to

operating field

MAGNIFICATION Goal : improve neck posture, provide clearer vision Working distance Depth of field Eye loupes : single lens, multi lens, telescpoic, loupes

OPERATOR CHAIR Goal : promote mobility and patient access, accommodate different

body sizes Look for :

Stability Lumbar support Hands: free seat height adjustment Fully adjustable

PATIENT CHAIR Should promote patient comfort, maximise patient access Look for

Stability Fully Adjustable Head Rest Hands Free Operation Support Head And Torso And Feet

WORK PRACTICES Goal: maintain neural posture, reduce force requirements Potential strategies

Ensure instruments are sharpened and well maintained Use automatic handpiece instead of manual hand piece wherever

possible Use full arm stroke rather than wrist strokes

REDUCE PHYSICAL EFFORT

Avoid static / awkward postures Elbows elevated not more than 30 degrees Adjust patient chair when accessing different quadrants Sit tall, legs separated Adjust height of seat so that your feet is flat in the floor and

knees are little below the level of your hips thighs should be slanting downwards slightly

Eye : 14 – 16 inches away from patients oral cavity Shoulder relaxed and not elevated

SCHEDULING

Goal: provide sufficient recovery time to avoid muscular fatigue Potential strategies

Increase treatment time for more difficult patients Alternate heavy and light calculus patients within a schedule Vary procedures within the same appointment Shorten patient’s recall interval

PERSONAL PROTECTIVE EQUIPMENT

Glasses Lightweight, clean, well-fitted Magnifying lenses and head lamps are encouraged

Clothing Fit loosely, lightweight, pliable

PERSONAL PROTECTIVE EQUIPMENT

Gloves Be of proper size, lightweight, and pliable Should fit hands and fingers snugly Should not fit tightly across wrist/forearm Ambidextrous - deleterious Hand-specific (i.e., right vs left) is recommended

Fit better Place less force on hand

ERGONOMICS AND EVERYDAY LIFE Even dental students have a life outside of dentistry, everyday habits can add to the stress on your body and well

being

When using a computer keyboard, use padded rest

Avoid excessive use of mobile phones

Heavy plastic bags can concentrate stress in a small area of your hand

Holding your phone between your shoulder and ear

DON’TS:

BODY STRENGTHENING EXERCISES: Dentists should also perform specific exercises for the trunk and shoulder girdle to enhance the health and integrity of the spinal column; stretching exercises for the hands and head & neck; maintain good working posture; optimize the function of the arms and hands; and prevent injuries

The following exercises can be practiced and performed by dentists on a regular basis in order to improve your posture and reduce muscle fatigue in a clinical environment

THE "FIVE TIMES" HAND AND WRIST EXERCISES

Exercise 1

Make a tight fist, hold for five second and

release, relaxing hand and fingers.

Repeat five times

Exercise 2

Stretch your fingers wide.

Hold for 5 seconds, and then return hand to relaxed position.

Repeat five times.

Exercise 3

Hold arms out in front at shoulder height ,with

palms of hands facing downwards .Rotate your hands 5 times clockwise and 5

times anti-clockwise .

Exercise 4

Hold your arms out to the side of you at 90 degrees to your trunk at shoulder height Flap your hands up and down 5 times from the wrist.

Tips Support arms when workingRemember to support forearms as this produces a reduction in muscle contraction in erector spinae and trapezius muscles and helps to prevent fatigue. Do this by resting arms on sides of dental chair

2 )TWO NECK EXERCISES

Neck and backstretches for use whilst working in a dental surgery chair or at a

computer or writing at a desk.

Horizontal Turns

Chin Tucks

Exercise 1) Horizontal turns

Keeping the chin up and in the horizontal plane turn head from side to side, 90 degrees

in each direction, keeping cervical spine straight.

Make smooth gliding movements.

Exercise 2) Chin tucks Keeping the head level ( keep looking straight ahead )

Tuck in chin and then lengthen back of neck

3 )TWO STRETCHES TO TRY WHILE SITTING IN THE DENTAL CHAIR

Shoulder Lifts Backward Arching

Exercise 1) Shoulder lifts

Raise shoulders towards your ears and then lower and

relax shoulders.

Breath in deeply whilst raising shoulders, breathe out on

relaxing shoulders.

Exercise 2) Backward Arching

Stretch backward over the edge of the backrest .Remember to stretch the neck at the same time

Hold arms at 45 degrees to the trunk; stretch arms at the

same time .Hold three seconds and return to the vertical position and

repeat .

4 )END OF CLINICAL SESSION STRETCHES FOR THE LOWER BACK

1 )Pelvic rocking 2 )At the end of a working session

3 )Whilst walking out through the door

Exercise 1) Pelvic rocking

Rock pelvis forward and backward whilst sitting in the

chair. Practice initially sitting on your hands to feel the

upward and then forward and downward movements of

your hipbones. Once you have mastered this movement

place your hands on your hips

Exercise 2) At the end of a working session

Stand up with feet slightly apart .Place hands on either side of the lower spine, gently

push hips forward, and then lean the body

backwards from the hips .Return to vertical position, relax and repeat five times.

Exercise 3)whilst walking out through the door

Stand in the doorway .Feet slightly apart .

Raise arms upwards and place hands on each side

of the lintel of the doorway .Supporting your weight with your hands and arms,

press body forward from the pelvis. Relax and

repeat .

FUTURE OF ERGONOMICS IN DENTISTRY Dental work requires considerable concentration and attention to detail. Dental professionals are concerned about patients’ comfort, but probably pay little attention to their own

until they begin to experience discomfort or pain. Today, more dentists are becoming aware of occupational hazards and paying more attention to the

prevention of hazards. Ergonomics have come into the profession in a big way. Further development of dental ergonomics must take place on the basis of a coherent vision of the future. In this regard it must be clear exactly what ergonomics is and what developments have already taken

place. Aspects of particular interest are the prevention of occupational diseases, legal responsibility for protecting

the health and safety of employees and students, education in dental ergonomics for dental and oral hygiene students, the academic development and research of dental ergonomics, using organizational models in daily dental practice, and the development of ergonomics at the global level.

CONCLUSION Repetitive strain injuries are on the rise in dentistry. Many dentists have been diagnosed with MSDs, and majority have experienced some type of

musculoskeletal pain in their shoulders and neck, hands and wrists, low back, or forearms and elbows.

More studies need to be conducted on the impact of dental work on the development of nerve and muscle pathologies, which would prevent dentists from providing the highest quality of service and could threaten their professional careers.

Meanwhile, the importance of following proper ergonomic principles should be realized so that these problems can be avoided by increasing awareness of the postures used during work, redesigning the workstation to promote neutral positions, examining the impact of instrument use on upper extremity pain, and following healthy work practices to reduce the stress of dental work on the practitioner’s body.

REFERENCES1. Ergonomics and Disability Support Advisory Committee (EDSAC) to the Council on

Dental Practice (CDP). An introduction to ergonomics: risk factors, MSDs, approaches and interventions. American Dental Association;2004.

2. Grant KA. Ergonomics: is it optional? PowerPoint presentation. 3. Murphy DC. Ergonomics and the Dental Care Worker. American Public Health

Association, United Book Press, Washington, DC;1998.4. NIOSH. Work-related musculoskeletal disorders. 1997.5. SmartTec. Musculoskeletal disorders: their symptoms and possible causes.

Smartpractice;2002.