USAF Dental Evaluation & Consultation Service Musculoskeletal Disorders and Ergonomics in Dentistry: An Introduction 5/06 (Reviewed 10/10) Objectives Provide information on musculoskeletal disorders in dental health-care personnel. Provide information on musculoskeletal disorders in dental health-care personnel. Provide information on ergonomics for dental health-care personnel. Provide information on ergonomics for dental health-care personnel. USAF Dental Evaluation & Consultation Service Musculoskeletal Disorders (MSDs) Include a group of conditions that involve nerves, tendons, muscles, and supporting structures such as intervertebral discs Include a group of conditions that involve nerves, tendons, muscles, and supporting structures such as intervertebral discs Severity of Symptoms Mild periodic Severe chronic & debilitating conditions USAF Dental Evaluation & Consultation Service MSDs = Ergonomics Musculoskeletal problems are the problem and ergonomics is a solution. Musculoskeletal problems are the problem and ergonomics is a solution. USAF Dental Evaluation & Consultation Service Types of MSDs Neck and Shoulder Disorders Neck and Shoulder Disorders Myofascial Pain Disorder Myofascial Pain Disorder Cervical Spondylolysis Cervical Spondylolysis Thoracic Outlet Syndrome Thoracic Outlet Syndrome Rotator Cuff Tendinitis/Tears Rotator Cuff Tendinitis/Tears Back Disorders Back Disorders Herniated Spinal Disc Herniated Spinal Disc Lower Back Pain Lower Back Pain Sciatica Sciatica Hand and Wrist Disorders Hand and Wrist Disorders DeQuervains Disease Trigger Finger Carpal Tunnel Syndrome Guyons Syndrome Cubital Tunnel Syndrome Hand-Arm Vibration Syndrome Raynauds Phenomenon USAF Dental Evaluation & Consultation Service MSDs Signs Symptoms Decreased range of motion Decreased range of motion Deformity Deformity Decreased grip strength Decreased grip strength Loss of muscle function Loss of muscle function Pain Pain Numbness Numbness Tingling Tingling Burning Burning Cramping Cramping Stiffness Stiffness USAF Dental Evaluation & Consultation Service Contributing Factors for Work-Related MSDs (WMSD) Routine exposure to: Routine exposure to: Forceful hand exertions Forceful hand exertions Repetitive movements Repetitive movements Fixed or awkward postures Fixed or awkward postures Vibrating tools Vibrating tools Unassisted frequent or heavy lifting Unassisted frequent or heavy lifting USAF Dental Evaluation & Consultation Service What Factors Contribute to WMSDs? Forceful hand exertions Forceful hand exertions Grasping small instruments for prolonged periods Grasping small instruments for prolonged periods Forceful squeezing/release of instruments Forceful squeezing/release of instruments Repetitive movementse.g., scaling, root planing, polishing Repetitive movementse.g., scaling, root planing, polishing USAF Dental Evaluation & Consultation Service What Factors Contribute to WMSDs? Fixed or awkward postures Fixed or awkward postures Neck, back, shoulder posture Neck, back, shoulder posture Hand/wrist positions Hand/wrist positions Standing/sitting Standing/sitting Operatory organization Operatory organization Patient positioning Patient positioning USAF Dental Evaluation & Consultation Service What Factors Contribute to WMSDs? Prolonged use of vibrating hand toolsdental handpieces, laboratory equipment Prolonged use of vibrating hand toolsdental handpieces, laboratory equipment USAF Dental Evaluation & Consultation Service Contributing Factors for WMSDs A risk factor is not always a causation factor A risk factor is not always a causation factor The level of risk depends on The level of risk depends on Length of time a worker is exposed to these conditions Length of time a worker is exposed to these conditions How often they are exposed How often they are exposed Level of exposure Level of exposure Usually a combination of multiple risk factors (vs. a single factor) contributes to or causes a MSD Usually a combination of multiple risk factors (vs. a single factor) contributes to or causes a MSD USAF Dental Evaluation & Consultation Service Contributing Factors for WMSDs Do not focus solely on the workplace Do not focus solely on the workplace Risk factors may be experienced during non-occupational activities (e.g., certain sports, exercising, working with computers, needlework, playing musical instruments) Risk factors may be experienced during non-occupational activities (e.g., certain sports, exercising, working with computers, needlework, playing musical instruments) USAF Dental Evaluation & Consultation Service Contributing Factors for WMSDs Not everyone exposed to any or all of the risk factors will develop a MSD Not everyone exposed to any or all of the risk factors will develop a MSD Individuals do not respond to them in the same way Individuals do not respond to them in the same way Predisposing factors such as age, arthritis, renal disease, hormonal imbalances, diabetes, and hypothyroidism may play a role Predisposing factors such as age, arthritis, renal disease, hormonal imbalances, diabetes, and hypothyroidism may play a role USAF Dental Evaluation & Consultation Service Neck and Shoulder Disorders Risk factors associated with dentistry Risk factors associated with dentistry Prolonged static neck flexion and shoulder abduction or flexion Prolonged static neck flexion and shoulder abduction or flexion Lack of upper-extremity support Lack of upper-extremity support Inadequate work breaks Inadequate work breaks USAF Dental Evaluation & Consultation Service Neck and Shoulder Disorders Dental health-care personnel (DHCP) commonly assume awkward work postures Dental health-care personnel (DHCP) commonly assume awkward work postures To obtain better views of the intraoral cavity To obtain better views of the intraoral cavity To provide a more comfortable position for the patient To provide a more comfortable position for the patient To coordinate their position relative to the dentist or assistant To coordinate their position relative to the dentist or assistant While operating equipment and reaching for instruments and supplies While operating equipment and reaching for instruments and supplies USAF Dental Evaluation & Consultation Service Neck and Shoulder Disorders Examples Examples Myofascial Pain Disorder Myofascial Pain Disorder Cervical Spondylolysis Cervical Spondylolysis Thoracic Outlet Syndrome Thoracic Outlet Syndrome Rotator Cuff Tendinitis/Tears Rotator Cuff Tendinitis/Tears USAF Dental Evaluation & Consultation Service Neck and Shoulder Disorders Myofascial Pain Disorder Pain and tenderness in the neck, shoulder, arm muscles Pain and tenderness in the neck, shoulder, arm muscles Painful trigger pointsmay twitch upon touch or massage Painful trigger pointsmay twitch upon touch or massage Restricted range of motion Restricted range of motion Possible causes: overloaded neck/shoulder muscles Possible causes: overloaded neck/shoulder muscles USAF Dental Evaluation & Consultation Service Neck and Shoulder Disorders Cervical Spondylosis Intermittent/chronic neck and shoulder pain or stiffness Intermittent/chronic neck and shoulder pain or stiffness Headache Headache Hand and arm pain, numbness, tingling, clumsiness may occur Hand and arm pain, numbness, tingling, clumsiness may occur Possible causes: age-related spinal disc degeneration leading to nerve compression and spinal cord damage; arthritis Possible causes: age-related spinal disc degeneration leading to nerve compression and spinal cord damage; arthritis USAF Dental Evaluation & Consultation Service Neck and Shoulder Disorders Thoracic Outlet Syndrome Pain in the shoulder, arm or hand (can be all three) Pain in the shoulder, arm or hand (can be all three) Numbness, tingling of fingers Numbness, tingling of fingers Muscle weakness/fatigue Muscle weakness/fatigue Cold arm or hand Cold arm or hand Possible causes: compressed nerves or blood vessels passing into arms; trauma; slouching forward or dropping shoulders Possible causes: compressed nerves or blood vessels passing into arms; trauma; slouching forward or dropping shoulders USAF Dental Evaluation & Consultation Service Neck and Shoulder Disorders Rotator Cuff Tendinitis/Tears Pain and stiffness in the shoulder associated with backward and upward arm movements Pain and stiffness in the shoulder associated with backward and upward arm movements Weakness of rotator cuff muscles Weakness of rotator cuff muscles Possible causes: swelling or tearing of rotator cuff soft tissue; shoulder joint bone spurs/abnormalities; poor shoulder posture Possible causes: swelling or tearing of rotator cuff soft tissue; shoulder joint bone spurs/abnormalities; poor shoulder posture USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Risk factors associated with dentistry Risk factors associated with dentistry Chronic repetitive movements of the hand and wrist Chronic repetitive movements of the hand and wrist Abnormal or awkward positions of the wrist Abnormal or awkward positions of the wrist Mechanical stresses to digital nerves such as sustained grasps on instrument handles Mechanical stresses to digital nerves such as sustained grasps on instrument handles Forceful work Forceful work Extended use of vibratory instruments Extended use of vibratory instruments Inadequate work breaks Inadequate work breaks USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Examples Examples DeQuervains Disease DeQuervains Disease Trigger Finger Trigger Finger Carpal Tunnel Syndrome Carpal Tunnel Syndrome Guyons Syndrome Guyons Syndrome Cubital Tunnel Syndrome Cubital Tunnel Syndrome Hand-Arm Vibration Syndrome Hand-Arm Vibration Syndrome Raynauds Phenomenon Raynauds Phenomenon USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders DeQuervains Disease Pain in thumb and wrist area when grasping, pinching, twisting Pain in thumb and wrist area when grasping, pinching, twisting Swelling in thumb area Swelling in thumb area Decreased range of motion of thumb with pain Decreased range of motion of thumb with pain Possible causes: synovial sheath swelling; thickening of tendons at base of thumb; repeated trauma or twisting hand/wrist motions Possible causes: synovial sheath swelling; thickening of tendons at base of thumb; repeated trauma or twisting hand/wrist motions USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Trigger Finger (Tenosynovitis) Pain during movement that place tendons in tension Pain during movement that place tendons in tension Warmth, swelling, tenderness of the tendon when palpated Warmth, swelling, tenderness of the tendon when palpated Possible causes: sustained, forceful powerful grip and/or repetitive motion Possible causes: sustained, forceful powerful grip and/or repetitive motion USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Carpal Tunnel Syndrome Hand or finger numbness, pain, tingling, burning, clumsiness Hand or finger numbness, pain, tingling, burning, clumsiness Eventual muscle weakness and atrophy Eventual muscle weakness and atrophy Symptoms often worse with increased activity Symptoms often worse with increased activity Pain or tingling that awakens the patient at night with relief via shaking/massaging the hand is considered a hallmark symptom for diagnosis Pain or tingling that awakens the patient at night with relief via shaking/massaging the hand is considered a hallmark symptom for diagnosis Possible causes: compressed median nerve in wrist via trauma, forceful exertion, repetitive and awkward movements that deviate from near-neutral positions Possible causes: compressed median nerve in wrist via trauma, forceful exertion, repetitive and awkward movements that deviate from near-neutral positions USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Carpal Tunnel Syndrome All hand pain does not mean carpal tunnel syndrome All hand pain does not mean carpal tunnel syndrome DHCP do not appear to be at greater risk compared to the general population for developing carpal tunnel syndrome DHCP do not appear to be at greater risk compared to the general population for developing carpal tunnel syndrome Hamann C, Werner RA, Franzblau A, Rodgers PA, Siew C, Gruninger S. Prevalence of carpal tunnel syndrome and median mononeuropathy among dentists. J Am Dent Assoc 2001;132: Werner RA, Hamann C, Franzblau A, Rodgers PA. Prevalence of carpal tunnel syndrome and upper extremity tendinitis among dental hygienists. J Dent Hyg 2002;76: USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Guyons Syndrome Pain, weakness, numbness, tingling, burning in the little finger and part of the ring finger Pain, weakness, numbness, tingling, burning in the little finger and part of the ring finger Symptoms may worsen at night or early morning Symptoms may worsen at night or early morning Possible causes: compressed ulnar nerve in Guyons canal at the base of the palm; repetitive wrist flexing; excessive pressure on palm/base of hand Possible causes: compressed ulnar nerve in Guyons canal at the base of the palm; repetitive wrist flexing; excessive pressure on palm/base of hand USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Cubital Tunnel Syndrome Pain, numbness, tingling and impaired sense of touch in the little and ring fingers, side and back of hand Pain, numbness, tingling and impaired sense of touch in the little and ring fingers, side and back of hand Loss of fine control Loss of fine control Reduced grip strength Reduced grip strength Possible causes: compressed ulnar nerve in elbow due to trauma or repeated use; prolonged use of elbow while flexed Possible causes: compressed ulnar nerve in elbow due to trauma or repeated use; prolonged use of elbow while flexed USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Hand-Arm Vibration Syndrome Intermittent or chronic finger and hand numbness and blanching Intermittent or chronic finger and hand numbness and blanching Reduced dexterity, grip strength, and sensation Reduced dexterity, grip strength, and sensation Greater sensitivity to cold Greater sensitivity to cold Possible causes: vibrations may injure nerves leading to decreased blood flow and lower oxygen supply to surrounding tissues Possible causes: vibrations may injure nerves leading to decreased blood flow and lower oxygen supply to surrounding tissues USAF Dental Evaluation & Consultation Service Hand and Wrist Disorders Raynauds Phenomenon Intermittent spasm of finger and toe blood vessels causing blanching, numbness, and pain Intermittent spasm of finger and toe blood vessels causing blanching, numbness, and pain Increased sensitivity to cold temperatures Increased sensitivity to cold temperatures Possible causes: carpal tunnel syndrome, connective tissue diseases, repeated vibration or use of tools that vibrate Possible causes: carpal tunnel syndrome, connective tissue diseases, repeated vibration or use of tools that vibrate USAF Dental Evaluation & Consultation Service Back Disorders Risk factors associated with dentistry Risk factors associated with dentistry Awkward posture Awkward posture Examples Examples Herniated Spinal Disc Herniated Spinal Disc Lower Back Pain Lower Back Pain Sciatica Sciatica USAF Dental Evaluation & Consultation Service Back Disorders Herniated Spinal Disc Back and leg numbness, tingling, pain, weakness Back and leg numbness, tingling, pain, weakness Worsens with coughing, sneezing, sitting, driving, bending forward Worsens with coughing, sneezing, sitting, driving, bending forward Possible causes: bulging or fragmenting of intervertebral discs into spinal canal compressing and irritating spinal nerves; excessive heavy lifting without adequate rest Possible causes: bulging or fragmenting of intervertebral discs into spinal canal compressing and irritating spinal nerves; excessive heavy lifting without adequate rest USAF Dental Evaluation & Consultation Service Back Disorders Lower Back Pain Pain Pain Stiffness in lower spine and surrounding tissues Stiffness in lower spine and surrounding tissues Possible causes: heavy lifting and forceful movements; whole body vibration; bending/twisting; awkward static postures Possible causes: heavy lifting and forceful movements; whole body vibration; bending/twisting; awkward static postures USAF Dental Evaluation & Consultation Service Back Disorders Sciatica Pain from lower back or hip radiating to the buttocks and legs Pain from lower back or hip radiating to the buttocks and legs Leg weakness, numbness, or tingling Leg weakness, numbness, or tingling Possible causes: prolapsed intervertebral disc pressuring the sciatic nerve; worsened with prolonged sitting or excessive bending/lifting Possible causes: prolapsed intervertebral disc pressuring the sciatic nerve; worsened with prolonged sitting or excessive bending/lifting USAF Dental Evaluation & Consultation Service Treatment and Management of MSDs Obtain an accurate diagnosis from a qualified health-care provider Obtain an accurate diagnosis from a qualified health-care provider Early intervention is key Early intervention is key Self-diagnosis is not recommended Self-diagnosis is not recommended MSD origins are complex with a broad range of symptoms MSD origins are complex with a broad range of symptoms USAF Dental Evaluation & Consultation Service Treatment and Management of MSDs Diagnostic tests may include physical exams, provocative tests, and electromyography Diagnostic tests may include physical exams, provocative tests, and electromyography Treatment may range from pain-relief medications and rest to surgery, and ergonomic interventions both at work and home Treatment may range from pain-relief medications and rest to surgery, and ergonomic interventions both at work and home USAF Dental Evaluation & Consultation Service What is Ergonomics? Ergo means work Ergo means work Nomos means natural laws or systems Nomos means natural laws or systems Ergonomics is the science of work Ergonomics is the science of work Ergonomics is much broader than preventing work-related musculoskeletal disorders Ergonomics is much broader than preventing work-related musculoskeletal disorders Ergonomics plays an important role in preventing injury and illness Ergonomics plays an important role in preventing injury and illness USAF Dental Evaluation & Consultation Service What is Ergonomics? An applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely An applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely Job Demands Worker Capabilities "fitting the job task to the person performing the job" USAF Dental Evaluation & Consultation Service Consequences of Poor Design Fatigue Fatigue Discomfort Discomfort Illness/Injury Illness/Injury Absenteeism Absenteeism Errors Errors Lower productivity Lower productivity Customer dissatisfaction Customer dissatisfaction USAF Dental Evaluation & Consultation Service Ergonomic Design Goals Enhanced performance by eliminating unnecessary effort Enhanced performance by eliminating unnecessary effort Reduce opportunities for overexertion injury Reduce opportunities for overexertion injury Improve comfort by curtailing the development of fatigue Improve comfort by curtailing the development of fatigue Job Demands Worker Capabilities "fitting the job task to the person performing the job" USAF Dental Evaluation & Consultation Service Goals Improved Improved Productivity Productivity Safety Safety Health Health Job Satisfaction Job Satisfaction Job Demands Worker Capabilities "fitting the job task to the person performing the job" USAF Dental Evaluation & Consultation Service Dental Ergonomic Stressors Sustained/awkward postures Sustained/awkward postures Repetitive tasks Repetitive tasks Forceful hand exertions Forceful hand exertions Vibrating operational devices Vibrating operational devices Time pressure from a fixed schedule Time pressure from a fixed schedule Coping with patient anxieties Coping with patient anxieties Precision required with work Precision required with work USAF Dental Evaluation & Consultation Service Preventing Ergonomic Injuries Identify risk factors Identify risk factors Educate DHCP about ergonomic hazards and preventing MSDs Educate DHCP about ergonomic hazards and preventing MSDs Identify symptoms as soon as they become apparent Identify symptoms as soon as they become apparent Intervene quickly Intervene quickly USAF Dental Evaluation & Consultation Service Preventing Ergonomic Injuries Change human behavior Change human behavior Consider ergonomic features for dental equipment (e.g., patient chairs, operator stools, hand/foot controls, instruments) when purchasing new equipment Consider ergonomic features for dental equipment (e.g., patient chairs, operator stools, hand/foot controls, instruments) when purchasing new equipment Modify working conditions to achieve optimal body posture Modify working conditions to achieve optimal body posture Achieve optimum access, visibility, comfort, and control at all times Achieve optimum access, visibility, comfort, and control at all times USAF Dental Evaluation & Consultation Service Workplace Intervention Make the job fit the person not vice versa Make the job fit the person not vice versa Minimize extreme joint position Minimize extreme joint position Keep wrist in neutral (i.e., straight) position Keep wrist in neutral (i.e., straight) position Keep joints held at midpoint of range of motion Keep joints held at midpoint of range of motion Reduce the use of excess force Reduce the use of excess force Reduce highly repetitive movement Reduce highly repetitive movement USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Provide Sufficient Space Awkward bending, twisting, and reaching places stress on the musculoskeletal system and can lead to discomfort Awkward bending, twisting, and reaching places stress on the musculoskeletal system and can lead to discomfort USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Provide Sufficient Space Permanently place equipment used in every clinical procedure within comfortable reach (within 20 inches of the front of the body) 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 equipment Use mobile carts for less commonly used equipment Allows convenient positioning when required Allows convenient positioning when required USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Provide Sufficient Space Provide a clear line of sight to the oral cavity and all required equipment Provide a clear line of sight to the oral cavity and all required equipment Maintain a neutral, balanced position position of an appendage when it is neither moved away from nor directed toward the bodys midline; it also should not be laterally turned or twisted Maintain a neutral, balanced position position of an appendage when it is neither moved away from nor directed toward the bodys midline; it also should not be laterally turned or twisted USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Accommodate Individual Preferences Individuals vary in size, shape, training, and experience Individuals vary in size, shape, training, and experience Ensure equipment and work areas allow flexibility; examples may include: Ensure equipment and work areas allow flexibility; examples may include: Allows right- or left-handed use Allows right- or left-handed use Allows different working postures Allows different working postures Provides a choice in methods used Provides a choice in methods used USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Reduce Physical Effort Avoid bent or unnatural postures Avoid bent or unnatural postures Ideally, equipment should allow work in a relaxed and well- balanced position Ideally, equipment should allow work in a relaxed and well- balanced position DHCP should adjust equipment to the appropriate height Position the patient to allow easy access from the desired position USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Reduce Physical Effort Use reasonable operating forces and minimal repetitions reduces overall physical effort required by a task Use reasonable operating forces and minimal repetitions reduces overall physical effort required by a task Minimize sustained effort Minimize sustained effort Brief but frequent rest pauses can minimize fatigue and enhance productivity Brief but frequent rest pauses can minimize fatigue and enhance productivity Try to incorporate a variety of different activities to shift musculoskeletal demands from one part of the body to another Try to incorporate a variety of different activities to shift musculoskeletal demands from one part of the body to another USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Instrument Design Goal: reduce force exertion; maintain hand/wrist in neutral position (no wrist bend) Goal: reduce force exertion; maintain hand/wrist in neutral position (no wrist bend) Considerations Considerations Overall shape/size Overall shape/size Handle shape/size Handle shape/size Weight Weight Balance Balance Maneuverability Maneuverability Ease of operation Ease of operation Ease of maintenance Ease of maintenance USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Hand Instruments When selecting instruments, look for When selecting instruments, look for Hollow or resin handles Hollow or resin handles Round, textured/grooves, or compressible handles Round, textured/grooves, or compressible handles Carbon-steel construction Carbon-steel construction Color-coding may make instrument identification easier Color-coding may make instrument identification easier USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Dental Handpieces When selecting handpieces, look for When selecting handpieces, look for Lightweight, balanced models Lightweight, balanced models Sufficient power Sufficient power Built-in light sources Built-in light sources Angled vs. straight-shank Angled vs. straight-shank Pliable, lightweight hoses (extra Pliable, lightweight hoses (extra length adds weight) length adds weight) Swivel mechanisms Swivel mechanisms Easy activation Easy activation Easy maintenance Easy maintenance USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Syringes and Dispenser When selecting look for When selecting look for Adequate lumen size Adequate lumen size Ease in cleaning Ease in cleaning Textured/grooved handles Textured/grooved handles Easy activation and placement Easy activation and placement USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Lighting Goal: produce even, shadow- free, color-corrected illumination concentrated on operating field Goal: produce even, shadow- free, color-corrected illumination concentrated on operating field Overhead light switch readily accessible Overhead light switch readily accessible Hand mirrors can be used to provide light intraorally Hand mirrors can be used to provide light intraorally Fiberoptics for handpieces add concentrated lighting to the operating field Fiberoptics for handpieces add concentrated lighting to the operating field USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Magnification Goal: improve neck posture; provide clearer vision Goal: improve neck posture; provide clearer vision When selecting magnification systems consider When selecting magnification systems consider Working distance Working distance Depth of field Depth of field Declination angle Declination angle Convergence angle Convergence angle Magnification factor Magnification factor Lighting needs Lighting needs USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Operator Chair Goal: promote mobility and patient access; accommodate different body sizes Goal: promote mobility and patient access; accommodate different body sizes Look for: Look for: Stability Stability Lumbar support Lumbar support Hands-free seat height Hands-free seat height adjustment adjustment Fully adjustable Fully adjustable USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Patient Chair Goal: promote patient comfort; maximize patient access Goal: promote patient comfort; maximize patient access Look for: Look for: Stability Stability Pivoting or drop-down Pivoting or drop-down arm rests (for patient arm rests (for patient ingress/egress) ingress/egress) Fully adjustable head rest Fully adjustable head rest Hands-free operation Hands-free operation USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Posture/Positioning Goal: avoid static and/or awkward positions Goal: avoid static and/or awkward positions Potential strategies Potential strategies Position patient so that operators elbows are elevated no more than 30 degrees Position patient so that operators elbows are elevated no more than 30 degrees Adjust patient chair when accessing different quadrants Adjust patient chair when accessing different quadrants Alternate between standing and sitting Alternate between standing and sitting USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Work Practices Goal: maintain neutral posture; reduce force requirements Goal: maintain neutral posture; reduce force requirements Potential strategies Potential strategies Ensure instruments are sharpened, well-maintained Ensure instruments are sharpened, well-maintained Use automatic handpieces instead of manual instruments wherever possible Use automatic handpieces instead of manual instruments wherever possible Use full-arm strokes rather than wrist strokes Use full-arm strokes rather than wrist strokes USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Scheduling Goal: provide sufficient recovery time to avoid muscular fatigue Goal: provide sufficient recovery time to avoid muscular fatigue Potential strategies Potential strategies Increase treatment time for more difficult patients Increase treatment time for more difficult patients Alternate heavy and light calculus patients within a schedule Alternate heavy and light calculus patients within a schedule Vary procedures within the same appointment Vary procedures within the same appointment Shorten patients recall interval Shorten patients recall interval USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Personal Protective Equipment Glasses Glasses Lightweight, clean, well-fitted Lightweight, clean, well-fitted Magnifying lenses and head lamps are encouraged Magnifying lenses and head lamps are encouraged Clothing Clothing Fit loosely, lightweight, pliable Fit loosely, lightweight, pliable USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Personal Protective Equipment Gloves Gloves Be of proper size, lightweight, and pliable Be of proper size, lightweight, and pliable Should fit hands and fingers snugly Should fit hands and fingers snugly Should not fit tightly across wrist/forearm Should not fit tightly across wrist/forearm USAF Dental Evaluation & Consultation Service Applying Ergonomics to Dentistry Personal Protective Equipment Gloves Gloves Ambidextrous (i.e., non-hand specific): exert more force than fitted gloves across palmar region of hand and may exacerbate symptoms of carpal tunnel syndrome Ambidextrous (i.e., non-hand specific): exert more force than fitted gloves across palmar region of hand and may exacerbate symptoms of carpal tunnel syndrome Hand-specific (i.e., right vs left) is recommended Hand-specific (i.e., right vs left) is recommended Fit better Fit better Place less force on hand Place less force on hand USAF Dental Evaluation & Consultation ServiceReferences 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. 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. Grant KA. Ergonomics: is it optional? PowerPoint presentation. Grant KA. Ergonomics: is it optional? PowerPoint presentation. Murphy DC. Ergonomics and the Dental Care Worker. American Public Health Association, United Book Press, Washington, DC;1998. Murphy DC. Ergonomics and the Dental Care Worker. American Public Health Association, United Book Press, Washington, DC;1998. NIOSH. Work-related musculoskeletal disorders NIOSH. Work-related musculoskeletal disorders SmartTec. Musculoskeletal disorders: their symptoms and possible causes. Smartpractice;2002. SmartTec. Musculoskeletal disorders: their symptoms and possible causes. Smartpractice;2002.