Ergonomic Principles for

Dental Hygienists
Speaker: Karen W. Clark, OTR/L,
CEAS II
Ergo Rx, PLLC
 Outline
I. Introduction to ERGONOMICS and General
Anatomy
II. Risk Factors
III. Body Mechanics
IV. Exercises for Life and Work
V. Recommended Equipment/Compensatory
Techniques
VI. Questions and Answers
 What is Ergonomics?
Wikipedia states:
• Human factors and ergonomics (HF&E), aka
comfort design, functional design, and user-
friendly systems,[1] is a multidisciplinary field
incorporating contributions from psychology,
engineering, biomechanics, mechanobiology,
industrial design, physiology and anthropometry.
In essence it is the study of designing equipment
and devices that fit the human body and its
cognitive abilities. The two terms "human
factors" and "ergonomics" are essentially
synonymous.
 Merriam-Webster Dictionary
• 1
• : an applied science concerned with designing
and arranging things people use so that the
people and things interact most efficiently and
safely —called also biotechnology, human
engineering, human factors
• 2
• : the design characteristics of an object resulting
especially from the application of the science of
ergonomics
 “Fitting the Job to the Worker”
Basic ERGONOMIC principles:
1. Reduce Musculoskeletal Disorders
2. Reduce wasteful motions
3. Decrease fatigue
4. Increase productivity
5. Increase time efficiency
6. Decrease rate of errors in job
 Bones
Spinal column-33 total vertebrae Skeletal system- 206 bones
Muscles
• There are 639 (640)
muscles in the human
body
• There are three types of
muscles: visceral
(smooth), cardiac, and
skeletal.
• Skeletal -voluntary
moving muscles.
Lymphatic System
• There are between 400
and 700 lymph nodes
and vessels in the body.
• They are the body’s
“trash collectors” .
• The lymphatic vessels
move one way- from
distal to heart.
 Q: How does this all go together?????
Q: Why does it matter????
• Nutrient Pathway Disorders occur due to static
and or awkward postures, force, repetition,
vibration and contact stress.
• The above systems are blocked, inhibited or
stressed to the point of skin break down,
muscle atrophy, paralysis and/or neurological
deficits.
• Other involved system- Cardiopulmonary
 Genetic or Congenital Risk vs. Other
Health Issues
• Age
• History of Heart Disease
• History of Diabetes
• Gender
• Compliance of worker
• Skeletal disorders
(scoliosis)
• Overweight
• Lack of sleep/rest (6 hrs
or less of sleep per CDC)
• Poor diet
• Poor habits (i.e.
smoking)
• Poor endurance, flexibility
strength

CANNOT CHANGE CAN CHANGE!!!

 #1 Risk factor
• Force of grip or pinch
during cleanings
• Examples: holding
scaling tools, polishing,
flossing
Force Risk Factor
#2 Risk factor
• Prolonged vibration of
tools
• Examples: hand piece
• Study from Journal of
Professional Excellence
Dimensions of Dental
Hygiene.
 #3 Risk factor
• Awkward Postures
• Examples: General
cleaning and especially
cleaning the upper
teeth.
• Reference page: Study
completed by
Marquette University-
Feb. 2005 Journal of
California Dental
Association.
More Awkward Postures
#4 Risk Factor
• Repetition of tasks
• Examples: (2 hours or
more of the same motion
without break), patient
who has not had prior
dental care and has
excessive build up.
• Study in Journal of
Occupational and
Environmental Medicine
June 2005. Vol. 47 Issue 6
 #5 Risk Factor
• Contact Stress
• Examples: the pressure
against the palm
applied by tools or the
pressure applied to the
posterior aspect of the
leg or knee (popliteal)
while seated
 Contact Stress
Operatory Chair hydrolics had failed- had to sit like this for 35 mins!!!!
 Warning Signs of MSD’s
• Decreased strength with gripping instruments
• Decreased Range of Motion (ROM) in the
turning of head to side or reaching arms over
head, behind back or back of head.
• Numbness or tingling in fingers, elbow or
neck.
• Over sensitivity on the posterior surface of the
forearm and boney aspects of elbow.
Top MSD’s For Dental Professionals
• Carpal Tunnel- numbness, pain in hand/wrist, and
forearm. Wake up with stiff hands
• Chronic Low Back Pain- tight feeling, burning, and
aching of lower back muscles.
• Trapezius Myalgia- pain, tenderness and trigger points
on upper traps.
• Rotator Cuff Impingment- pain in shoulder when
reaching overhead.
• Lateral Epicondylitis (tennis elbow)- pain at elbow,
especially when gripping and lifting combined.
• Tension neck syndrome- pain in shoulders and neck
due to stress and constant elevation of shoulders.
 Other Contributing Risk Factors
• Stressful working environment- Type A
personality- perfectionist- less tolerable to
change- hurried- impatient- competitive
• Poor lighting
• Lack of space
• Older equipment
• Broken equipment
 What to do
now???
As Hygienist you teach your patients
daily prevention is the key to good
dental health.
 Proper Body Mechanics
General Rules
1. Push, Don’t Pull.
2. Lift With Your Legs.
3. 90, 90, 90. (More Like 100,100,100.)
4. Keep Spine Aligned.
5. Limit Twisting or Bending at Waist.
6. Change Positions Often!!!!
7. Keep Neutral Hand/Shoulder positions.
Specific Positioning for Hygienist
by Patricia Nunn RDH, MS from Dimensions March 2004
Aligning the Spine
 90, 90, 90
Pay attention to slumping
postures, in sitting or standing 100, 100, 100 for hygienist
Pictures and descriptions by Patricia Nunn RDH, MS in March
2004 Dimensions “Preventive Positioning”
Push, Don’t Pull
Limit Bending and Twisting at Waist
 Keep Changing Positions
• Sit to stand often
• Stand while charting if you have been sitting
for a long time.
• Go for a walk during lunch even if it is for 10
minutes. Walk the stairs 5 times.
• Complete “Ergo Break” stretches or “Chairside
Stretches”. (see last pages for graphics)
Lift With Your Legs
 WHAT DO YOU SEE???
Cleaning room and tools Check out angle of neck & knees
 ANYTHING WRONG HERE???
This hygienist is working on a
Charting and X-ray station child; what are risk factors?
WHAT IS THE “RISK FACTOR”??

• Dentist and assistant

 Attention: Anyone with prior history
of illness or injury!!!
-As with all exercise programs, if you have any
cardiac, respiratory, or orthopedic problems,
consult your physician first!!! Do not begin any new
exercise without his/her approval.
-The following exercises are considered low stress
and low impact. However, the holding of positions
without proper breathing CAN raise your blood
pressure. Again, please consult your doctor first.
-Always begin any exercise with 10 minutes or more
of slow stretching of all muscle groups.
-Always count out loud to assist proper breathing.
 A quote from Ben Franklin

“An ounce of
prevention is worth a
pound of cure.”
ERGO BREAK
 Exercises for Life
CORE EXERCISES
1. Paraspinal Squeeze- Stomach in, back and
up. While sitting, standing or lying down. Goal:
to hold for 30 seconds and be able to talk during
the exercise! Repeat 10- 20 times in a day.
2. Side lying leg lifts- In side lying on floor, lift
both feet off floor as high as you are able
(without straining) and hold for 10 seconds.
Goal 30 seconds. Repeat 5 times, 3days/wk.
 Cont. Core Exercises
3. Large ball exercises- Sit on ball with feet
supported on floor or hooked under the bed.
Cross arms on chest and lean back until muscles
in stomach contract. Hold and deep breathe for
10-30 seconds. Return to neutral, rest if needed
and repeat 5-10 times. Do 3 times wkly.
4. Any Yoga class will do. Start with beginners. It is
harder than it looks!!!!
5. Plank- Fully extend body on floor, raise to “push
up” position and hold for 20-30 seconds. Rest
and repeat up to 10 times. 3x’s a wk.
 Neck- Stretches
1. No “Turtle Neck” Please- while driving or
sitting in a chair. Look straight ahead (no
tucking chin) and push head back into head rest.
That is what it’s for!! Hold for 5 seconds, repeat
up to 20 times. Note: if you do this in the car,
only do it during the red lights please!!!!! Set
your mirrors while in this position to keep your
head in proper position during driving. You
wont be able to see out mirrors if you start to
slouch.
 Neck/Pec Stretches
• Upper trap/levator stretch- While sitting
place on hand behind back (over lower back).
Next, slowly turn head away from arm that is
behind until stretch is felt. For greater stretch,
slowly look down. Hold for 10 secs, slowly
return to neutral. Repeat up to 5 times. Do
each side. Warning: DO NOT COMPLETE THIS
STRETCH IF YOU HAVE ANY NECK INJURIES,
SPINAL STENOSIS, BULGING/HERNIATED DISC
OR CAROTID ARTERY BLOCKAGE.
 Legs
1. The “Sonicare” Squat- During the two minutes you
brush your teeth you can bend slightly at the knees
and hold. Be sure to breath comfortably. Don’t
worry about holding it the entire 2 minutes the first
go around. Two minutes is your goal. Repeat twice
daily (and floss!!!!)
2. Take the stairs or park further from building. Not a
problem if you don’t have a BLUE lot parking pass!!
Every little bit helps.
3. Piriformis Stretch- Laying or standing. Watch
demo.
 Legs
3. Lunges- Slow and
steady without weights to
start. Make sure the knee
of the leg stepping
forward never goes
beyond the foot on the
floor. Can add weights
(2lb.-5lb.)as you tolerate,
20 reps each side without
any soreness next day.
 Shoulder/Arms
1. Corner Push ups- Stand
in a corner, place arms on
opposite walls at shoulder
height and at comfortable
distance apart. Slowly bend
elbows, while keeping head
in neutral until scapula’s
touch. Hold for 10 sec,
return to start, and repeat
x’s 20. 3x’s wkly. (Hold
longer for stretch, less reps.
2. Bench press- Lying on
floor or firm bed with knees
bent comfortably. Grasp rod
with both hands (mop or
broom) and lift straight up
toward ceiling. This should
be slow and smooth. Once
fully extended hold for
count of 10, return to start
and repeat x’s 20. 3x’s wkly.
 Arms/Shoulders
3. Ball or balloon toss-
Can play with the kids for
15 minutes hitting a beach
ball or balloon in the air.
To make it harder add 1lb.
wrist weights. Any task
completed with arms
above the shoulders is
two times as stressful on
the heart. Take breaks as
needed.
4. Tricep/Sawing logs-
Start with 15oz can of
food or a bottle of water
in one hand. Lean onto
table with other hand for
support. Move hand with
bottle back and forth from
floor to ceiling in a
“sawing motion”, slowly
repeat 20 times. 3x’s wkly.
 Aerobic Exercise
• Walking is the best low impact aerobic
exercise. You can do it anywhere. Make sure
you keep a swift pace (WHERE’S THE FIRE) and
swing your arms forward and back. When
they come forward you should bend slightly at
elbow. This works biceps and triceps.
• Low impact aerobics, Swiss ball, Pilates and
low impact circuit training are all good.
 AT HOME
• You only work 8-10 hours a day. Pay attention to
what you do OFF the clock. House cleaning tasks,
cooking, washing dishes and yard work.
• Also, what type of pillow do you have? When
was the last time you bought a new one? Is it
contoured? What type of sleeper are you- side,
stomach, back with arms above?????
• What type of mattress do you have? 1/3 of your
life is spent in bed
• Watch time spent on laptops and other devices.
 Recommended Equipment
Saddle Stool Loupes
 Recommended Equipment
• Blue Boa Suction System
• Tools with VERA system
• Ultrasonic tools
• Other Magnification systems- procedure scope, surgical
operating microscopes, generic magnification lenses
• Seat cushions which give a slight forward tilt. For
example: Fit-Sit found online at ergonomic-
products.com. You sit ¾ of your day. Swiss ball stools
and those with adjustable arm rest and backs are also
wonderful. Trade with others at lunch.
 Recommended Techniques
• Use the 12 o’clock method- over the head.
• Use your mirror for upper teeth cleaning.
• Change sides or positions often, if possible.
• Position the patient to better suit you- get your stool
set for you first, then adjust patient to elbow height.
• Take Ergo Breaks after every cleaning. Should only
take 2 minutes tops.
• Arrange tools within 16” of center, at the most 24”
for less used tools. Adjust height of tray at elbow
height.
 Bibliography and Reference Resources
• OSHA.gov - This is the official website for the Occupational Safety and Health
Administration. Search Ergonomics and it will bring up a variety of tools to
assess you office, work and home. Search Ergonomics for Dental Professionals
for a list of potential risks and ADA/OSHA Alliance explaining their joint effort
to educate those in the Dental Industry on safe working conditions and
technical knowledge in the area of Ergonomics.
• NIOSH.gov – The National Institute of Occupational Safety & Health.
• CDC.gov – The Centers for Disease Control and Prevention. Search
Ergonomics. They have over 1300 results. Yet the first one on the list is
Musculoskeletal Disorders and Ergonomics Programs and Guidelines. Must be
a hot topic!
• Ergonomicsimplified.com – free evaluation tools and equipment.
• Ehs.uky.edu – Home page of UK Environmental Health and Safety. Search
Ergonomics.
• Backschoolofatlanta.com - variety of classes, books & listings of professional
Ergonomic specialist (just like Mrs. Clark- look for her name )
 Continue of Bibliography and
Reference Resources
• Karwowski W., Marras W. The Occupational Ergonomics
Handbook. Flordia: CRC Press LLC 1999:1765-66
• Murphy, D. (Ed.), 1998, Ergonomics and the Dental Care
Worker, Washington, D.C.: American Public Health
Association.
• Matiyakon W.,McNitt-Gray J. The Journal of Professional
Excellence Dimensions of Dental Hygiene. Preventing Shoulder
Injury. January 2007;5(1)16-18.
• Nunn P. The Journal of Professional Excellence Dimensions of
Dental Hygiene. Preventive Positioning. March 2004;2(3):12-
14,16,18-19.
Continue of Bibiography and Reference
Resources
• McKenzie, R. Treat Your Own Neck (Back). 3rd
ed. New Zealand: Spinal Publications 1997.
• Murphy, D. Ergonomics and the Dental Care
Worker. Washington: American Public Health
Assoc. 1998
• Valachi, B. Practice Dentistry Pain Free.
Evidence-Based Strategies to Prevent Pain and
Extend Your Career. Portland, OR:
Posturedontics Press. 2008.