Working conditions of the dentist -

factors in the labor process and

working environment. Applied
ergonomics in dentistry - basic
principles
 Working conditions of the dentist
(DM)
The doctor of DM performed following types of work
in the workplace:
 Preparatory, diagnostic and therapeutic,
prophylactic.
 Diagnosed apply proper treatment, advise patients
undergoing dental prophylaxis.
 Formed medical records.
 Develop methodologies for integrated research
and treatment of dental diseases.
The work of the physician is mostly mental work with
creative (heuristic nature) with neuro-sensory, motor
and psycho-emotional tension with a high degree of
liability arising from:

 Risk to the health and lives of patients.

 Requirement for quick decisions in the diagnosis

and treatment of patients, suggesting a good
qualification and experience, moving of memory and
thought processes.

 Personal responsibility to the public, patients and

their relatives.
Working conditions affecting health and performance of the
physician in DM can be divided into two groups:
1 group factors of employment.
2 group Factors of work environment.

Labor process factors are related to:

 Weight and pressure of work.
 Workplace, working posture and working movements.
 Mode of work and rest.
 Psychosocial factors (psychological climate in the
workplace, professional satisfaction, motivation, pay, benefits,
etc.)..
 I. Disadvantages in the labor process

1. Not physiological (involuntary) work posture

with torzio and tilt forward. Species:
 Sitting bent forward with hands and gently twist
the body.
 Standing bent (30 º to vertical) slope and hands
forward, slightly bending the body.

Forced sitting posture is more advantageous than

standing. In the seat active movements are
performed only by the wrist and forearms.
Not physiological working posture reflects mainly on the
following physiological function:
 energy expense
 heart rate
 muscle activity

Create additional tension:

 maintaining tool
 load of visual system
 need for greater precision and accuracy
 significant empowerment

Maintaining work posture leads to increased static muscle

work.
2. A major disadvantage of the musculoskeletal system of the
physician in DM is a static muscle effort of holding tool and
continuous operation at the same forced working posture.

Maintaining the working posture is associated with maintenance

of long static effort of certain groups of muscles of the arm,
shoulder girdle, neck, back and legs, leading to early onset:
– discomfort, fatigue, reduced efficiency
– congestive phenomena (edema, varices)
– load on the cardiovascular system

The less a static muscular effort, the more rational is working

posture.
Working movements of upper limbs are small (lower), with a
requirement for accurate high degree of coordination and
involvement of both hands.
3. Neuro-sensory, psychomotor and emotional tension.

Main factors that determine the neuro-sensory, psychomotor

and emotional tension:
 Need fast information processing, decision making in a
short time when a diagnosis.
 Need for long-term memory, knowledge and practical
experience.
 Need for greater precision and accuracy, distribution and
stability of attention in the performance of dental work.
 Responsibility for health and life of the patient.
4. Load of visual system, resulting in:
 significant contribution of vision in the eye fixation on the
object of treatment (teeth, gums).

5. Work stress related to work process, which can be:

Eustres - a condition in which there is adaptation and
mobilization of body defenses.
Distress - a condition characterized by adverse reactions,
depletion of nerve processes and the development of
pathological conditions (neurosis, depression)

Average 30% of dentists are in a state of constant stress, with

more pronounced eustres.
6. Irrational mode of work and rest:

 Not used consistently regulated holidays, which may be

active semipassive, passive.

 Longer duration of operational time in maxillofacial

surgeons.

 Improperly organized and conducted daily, weekly and

annual holidays.

7. Non-ergonomic workstation and work area.

 II. Disadvantages of working
environment
Work in hospitals for outpatient and hospital care, which
takes place dental activity is associated with certain
disadvantages of working environment.

Typical for them is:

 Usually they are small in intensity.

 Acting in combination, sequentially, continuously or
intermittent fixed or variable intensity.
 They are of different nature (type), with similar or
different effects on the body.
 Acting chronic and combine more often with unhealthy
lifestyles.
When the work environment factors were less intense but
chronic active and combine with other psychosocial
factors and unhealthy lifestyles, they do not cause specific
illnesses, but decreased performance and
imunobiologichnata reactivity.

Adverse impacts here are characterized by so „hidden

symptoms“, occurring after challenge affecting the entire
organism.

Modern work environment factors are noise and vibration

generated by the introduction of new modern dental
equipment.
1. Noise - in outpatient primary and specialized dental care
and dental laboratories have measured noise levels of
around 72-85 to 98 db / A.
Limits on noise levels:
40 db / A (from 7.00 to 23.00 pm)

2. Vibration - relatively weaker risk factor. DM doctors and

dental technicians are exposed to local vibration (when
working with turbine handpieces, burs with motor, gear
for filing, polishing, etc.). which adversely affect the
sensation of hands and hence the efficiency of labor.
Local vibrations are combined with static muscular effort
and forced working posture.
3. Microclimatic factors - air temperature, relative humidity
and velocity of air movement.
In medical establishments for outpatient and hospital
care, where doctors work in DM, the most common type
of microclimate is uniform (static) - characterized by
persistence of microclimatic factors throughout the day.

The absence of some changes in microclimatic factors at

work can lead to dezaptatsiya of thermoregulation.

Health standards:
Air temperature - 20 º C
Relative humidity - 40-60%
Speed of movement of air - from 0.2 to 0.4 m / sec.
4. Chemical factors - they are less intense, but act in combination,
consistent and chronic.
 Occupational allergens - in dentistry are used more than 500

substances that can cause allergic reactions.

 A variety of plastics, which are over 20 types of ceramic

structures, Metal, temporary dental structures, seals, etc..

 Mercury in the manufacture of mercury amalgam for fillings (MAC -

0.01 mg/m3).

5. Biological factors - they are at risk for health physician in DM.

When working with biological material and service to patients with
infectious disease are at risk of contamination with pathogens,
viruses (including with HIV - virus). These are mainly pathogens and
viruses in the air at the workplace or on contaminated work
surfaces, work furniture and medical instruments.
6. Lighting as a risk factor in the working environment.
 Natural light - coefficient of natural lighting NLC - 5%
Light coefficient LC - 1 / 3 - 1 / 4
 Artificial lighting - luminous (with a spectrum close
to natural light).

Health standards:
 lighting - at least 300 lux
 workplace applies combined lighting that provides at
least 3000 lux, with a spectrum of rich yellow-green
rays.
 Applied ergonomics in dentistry

Ergonomics is an independent, complex science that

studies the functionality and features of the person
and work process to create such conditions,
methods and organization to make human labor
and high performance to ensure safety and hygiene
and maintaining health and performance of human .

Ergonomics is the science field, primarily related to

occupational medicine, studied the system "man -
machine ".
1. Ergonomic requirements for work:
 Types of work postures and requirements to them.
 Working area of the upper limbs.
 Organization of work movements: accuracy, coordination,
working rhythm, speed of operation.

2. To reduce the static load of work posture is appropriate:

 Periodic change of working posture during the workday.
 In long-standing working posture to create the conditions for
changing a sitting posture, or at work the doctor is able to sit,
which is necessary ergonomic chair with seat and back.
3. Ergonomic requirements for work area.
Main rule: ergonomic design of furniture work is consistent
with the main anthropometric characteristics of the human
(patient, doctor).

4. Physiological mode of work and rest of the physician in DM.

In order to create conditions for quality and safety and
increased capacity necessary to meet the following
requirements:
The total time for statutory holidays to 60 minutes.
To provide three break time:
– first (15 min) - 2.5 hours after starting work
– second (30 min) - lunch dining
– third (15 min) - 2 hours after lunch
Statutory holidays, depending on the working posture
of the physician in DM may be:

 Active (physical activity, sport and exercise).

Applies to:
 sitting posture with
 work with reduced physical activity and high
neuro-psychological and emotional tension.

 Semipassive (walking, sports games, light

exercise). Applies to:
 sitting and standing posture with
 increased neuro-mental and visual workload.
 Illustrative scheme for the allocation of statutory
holidays in the workday of the physician in DM
(at 8.5 hours work)

Work Rest Work Rest Work Rest Work

7.30 – 10,00 h. 10,00 – 10,15h. 10,15 – 12,00h. 12,00 – 12,30h. 12,30 – 14,30h. 14,30 – 14,45h. 14,45 – 17,00 h.

150 15 105 30 120 15 135

min. min. min.. min. min. min. min.
Thank you for attention!