Dental Ergonomics

Dentists have a physically and mentally demanding job – they relieve pain, provide comfort and distribute lovely smiles. Each day dentists treat thousands of patients throughout the world.

While they are busy bringing smiles to the faces of their patients, they often neglect one thing: their personal health and care.

A number of studies have indicated the occurrence of general musculoskeletal disorders (MSDs) among dentists and other dental professions. It is now an established fact that oral health workers are far more prone to develop musculoskeletal pain and communicable diseases than any other occupational group.

A recent comparative study showed that musculoskeletal pain was most prevalent among dentists 61%, followed by surgeons 37% and physicians 20%.

Due to these Problems, dentists lose many millions of dollars annually through the canceled appointments and subsequent loss of patients.

Types of Disorders Faced by Dentists

MSDs are caused mostly due to work stress, uncomfortable posture, repetitive tasks, and bad working habits.

Back Problems

MSDs relating to the back are normally categorized as upper back pain and lower back pain. However, some researchers have included a third category of a mid-back pain.

• Lower Back Pain- this is the most common disorder reported among dental workers. Research suggests that up to 90% of workers report recurrent episodes of back pain. Among them, nearly one third reported persistent pain in the lower back. The deterioration increases with age unless the risk factors are eliminated or minimized.
• Upper Back Pain- Pain in the upper back is not as common as a lower region. The main reason for such pain is more muscular than “bone-related” because the bone structure is quite strong and not under much stress. The problem is primarily related to improper posture and muscular weakness.

Hand and Wrist Problems 

Hands, wrists, and fingers carry out the maximum movements of extension and flexion, especially when holding (pinch position) an instrument like the handpiece.

Movements with the wrist in an abnormal or awkward position, working for extended periods without rest, overstress of digital nerves due to sustained gripping of instrument handles, application of unusual force and prolonged use of vibrating instruments can contribute to the development of MSDs.

The Risk Factors

The primary risk factors are repeated motions of stretching and rotation along with the minimizable factor of improper postures. Dentists have to routinely execute such motions and postures, and hence are most prone to the above problems. But don’t worry, there is a solution!

Dental Ergonomics is the Solution!

If you want to enjoy a long and successful career while ensuring a healthy lifestyle, then your only option is to adopt an ergonomic design in your dental practice.

It is not necessary that you should buy new equipment from scratch.

Rather, simple modifications and changes can bring a lot of improvements to your productivity and health.

The following adaptations should help:

1. Workstation

Dental office workstations should be designed to include the following: 

• Chair Height and Posture – you should make sure that you choose an operatory stool seat which is tilted 5-10° forward, such that your hips are higher than your knees. In this way, your pelvis will be positioned that your spine is in a balanced position.
  The upper part of your body should be perpendicular with respect to the seat. In this way, you will not have to curve your spine when you make forward movements.
  If you feel that your chair can’t go high enough to make you comfortable, consider ordering a stool or chair with a longer cylinder.
  Presence of an arm, thoracic or lumbar supports the dentist’s chair.
• Instrument Table – The instrument table should be placed at a position which is accessible to the members of the dental team, especially the dentist.
  Frequently used instruments should be placed within easy reach of the dentist.
  Dentists should easily be able to reach instruments placed within a 22-26 inches diameter around their stool.
  Similarly, the height of the instrument table should be adjusted so that it does not strain the hands or arms while reaching for instruments.
• Use Magnification – using high-quality magnification loupes allows to maintain optimal distance between your head and the patient while ensuring that your shoulders are relaxed, and forearms are roughly parallel with the floor.
  In this way, you will not have to tilt your back or head to obtain a better view of the patient’s oral cavity.
  When you treat patients while tilting your head for more than 20° tends to considerably increase the risk of neck pain.
  The magnification scopes allow you to work without excessively tilting and straining your back and neck.
• Adequate adjustable lighting – you don’t want your eye muscles to be strained while you’re performing procedures. Good illumination also improves visibility.
  The type and source of the light used in your dental office play a pivotal role in determining your posture while performing dental surgery.
  You must make sure that you select a shadow-free and color corrected light source which is concentrated towards the area of operation.
  Usually, a single source illumination provides the best results.
  For the visualization of mandibular or maxillary teeth, the light source must be directly above so that it illuminates the most posterior regions of the oral cavity.
  As a general rule, the ratio between the ambient light of the operatory and the light source should be between 1.6-3.
• Using Gloves with Proper Size – this aspect is often ignored by dentists. Using gloves which are too small for you will put a lot of pressure on the hands and fingers, thereby increasing the chances of MSDs.
  Therefore, you should select gloves which exactly fit your hands and do not put excessive pressure on the fingers.
  Another advantage of using high quality, ergonomically designed gloves is the enhanced grip and ease of instrument handling.
• Comfortable Surface Edges – Work surface edges should be comfortable. If they are too sharp or jagged, they carry a higher risk of causing injury.
• Ventilation and Room temperature – Ventilation should be adequate with comfortable room temperature.
  Although there are no set guidelines for setting the room temperature, it should be comfortable for the patient and members of the dental team.
  Generally, a temperature of 25°C is considered comfortable for the dental office.

2. Correct Dentist Posture

An incorrect posture is probably the most common reason for musculoskeletal disorders among dental professionals.

Here are a few tips which can help:

• Use of chair with appropriate thoracic, lumbar and arm support.
• Make sure that you always keep an erect posture while treating patients.
• To prevent back and neck pain, frequently perform stretching exercises throughout the day. Perform stretching exercises of the neck, arms, legs, and hips. One of the best ways to naturally perform stretching exercises is to shift positions between sitting and standing.
• Keep moving your feet slightly while treating patients. By making subtle feet movement, you will shift the weight from the overworked group of muscles to another group, thereby replenishing the nutrients in the tensed muscles.
• Avoid unnecessary wrist and finger movements.
• The illumination light of the dental chair should be fully adjustable to provide the dentist with a clear view of the site of operation.

3. Patient Positioning 

While the height of the dental chair should be adjusted such that the patient is in a comfortable position, it should also be adjusted so that the dentist can visualize the oral cavity of the patient without excessively tilting the head, neck or back.

Supine positioning of the patient is usually helpful for the dentist in maintaining a neutral posture.

4. Choosing Dental Instruments 

You should choose instruments which allow optimal grip and handling to your hand.

Therefore, keeping “universal sized” instruments in the office is not recommended.

If a dentist who has big hands has to use instruments which were selected by a dentist who has tiny hands, it will not only create difficulties for him or her during the surgery but also put a lot of unnecessary pressure on the hands and fingers.

When choosing dental instruments, especially the ones which are frequently used as the mirrors, probes, and forceps make sure that they fit you perfectly.

Ergonomically Practical Design

An ergonomically optimized layout and use of ergonomically designed chairs, assistants’ stools, and instruments will greatly reduce the occurrence of MSDs and improve your productivity and income.

Thus, it is important that you buy high-quality dental supplies.

Often dentists tend to reduce their operational costs by comprising on the quality of their dental office equipment. This is very dangerous, for your health and your practice!

Professional dental suppliers may charge you a little more, but they certainly provide you with very high quality and equipment which will ultimately help you in preserving your health and saving money in the longer run, thereby increasing your efficiency and preventing missed patient appointments.

Resources

1. Anshul Gupta et. Al., Ergonomics in Dentistry, Int J Clin Pediatr Dent. 2014 Jan-Apr; 7(1): 30–34. PMCID: PMC4144062, PMID: 25206234
2. Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord. 2004 Jun 9;5:16. doi: 10.1186/1471-2474-5-16.
3. Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in dentistry. Int J Clin Pediatr Dent. 2014;7(1):30-4.