ERGONOMICS IN RESTORATIVE DENTISTRY

BY

prof Christopher ikeokwu udoye

STUDY OBJECTIVES
By the end of the lecture, the student will be able to:
•Be familiar with the field of ergonomics

•Identify risk factors and stressful individual behaviors which

lead to injuries.

•Learn how to apply preventive strategies, including good

posture and positioning.

•Be conversant with key epidemiological indices of

Musculoskeletal Disorders (MSDs).

•Independently operate ergonomically

MODEL QUESTIONS
1. What is ergonomics? How would you apply Ergonomic
principles in your Practice as a Dental Officer manning a
Cottage Dental Clinic at Akwanga Local Government Area,
Plateau State.

2. What is a Dental Workstation? Write a concise essay on

Ergonomic Guidelines for a Dental Workstation.
 DEFINITION
•In Greek, ‘Ergo’, means work and, ‘Nomos’, means natural
laws or systems. Aptly, ergonomics is an applied science
concerned with designing and arranging materials people use
so that work can be done most efficiently and comfortably.
INTRODUCTION
•Restorative Dentists and Endodontists world over, have
been challenged by issues related to MSDs.
•This mainly occurs due to awkward postures in the work
areas.
•Occupational related disorders are on the rise daily and
one amongst them is MSDs, due to improper ergonomics.
•Knowledge of ergonomics is thus of great value in
preventing ill health and injury from work.
GOALS OF ERGONOMICS
•Reducing the risk of MSDs
•Increasing productivity
•Increasing safety
•Improving quality of life
•Decreasing fatigue and errors
EPIDEMIOLOGY
i.Prevalence:
•7% of dentists develop MSDs
•93% are without
ii. MSDs Distribution pattern
•10%: shoulder, elbow and hand
•30%: Neck
•60%: Back
•Amongst all professions, Nurses are at highest risk (WHO)
PATTERN OF DISTRIBUTION CONTD
RESULT AMONG 130 DENTISTS STUDIED

•82.8% of dentists were at high risk

•Distribution: neck-55.9% and shoulder- 43.8%

•Significant relationship bw MSD risk and number of patients

per week, and work hours per week

•However, relationship bw MSD and gender, experience and

BMI were not proven in the study.
SIGNS AND SYMPTOMS OF MSDs
i. Signs
• Reduced range of movement
• Loss of normal sensation
• Reduced grip strength
• Loss of normal movement
• Loss of co ordination
ii. Symptoms
• Excessive fatigue in the shoulder and neck
• Tingling, burning, or other pains in the arms
• Weak grip, cramping of hands
• Clumsiness & dropping of objects
• Hypersensitivity in hands and fingers
MECHANISM AND RISK FACTORS OF MSD
i. Risk factors
• Stress
• Poor flexibility
• Improper positioning
• Infrequent breaks
• Repetitive movements
• Weak postural muscle
• Prolonged awkward posture
• Improperly adjusted equipment
MECHANISM
• Prolonged static posture
Mechanism Contd
•Muscle ischemia/necrosis/imbalances
•Hypermobile joints
•Spinal disc herniation and degeneration
•Neck and shoulder injury
•Carpal Tunnel syndrome
•Low back pain
•Psychosocial factors
PREVENTION OF MSDs
i. Good posture
ii. Proper equipment layout
TIPS FOR GOOD POSTURE
•Maintain an erect posture
•Use adjustable chair with lumbar, thoracic and arm
support.
•Work close to your body
•Minimize excessive wrist movement
•Avoid excessive finger movement
•Adjust your chair height and patient’s chair to a
comfortable level
•Consider horizontal patient positioning
•Check placement of the adjustable light
•Check the temperature of the room
PROPER EQUIPMENT LAYOUT
•Dental equipment should be located in a manner which
allows a neutral working posture and reduce postural
deviation while working.
ADVANTAGES OF ERGONOMIC PRINCIPLE IN WORK PLACE
•Lower MSD injury rates
•Working smarter and not harder
•Improved product quality, bc of lower errors.
•Reduced absenteeism, bc of minimal fatigue and MSD
problems
•Lower costs as workers’ compensation and other
payments for illness go down
•Improved worker safety, comfort and morale, and
reduced fatigue
 FURTHER METHODS OF KEEPING MSD RISK AT BAY-WORK SCHEDULE
•Incorporate brief stretch break periods bw patients ( SEE NEXT
2 SLIDES FOR REQUIRED STRETCH BREAKS)

•Difficult treatment sessions should not be performed

consecutively

•Increase treatment time for more difficult patients

•Alternate heavy and light calculus patients throughout the

day.

•Alternate procedures performed.

ERGONOMIC GUIDELINES FOR A DENTAL WORKSTATION
A. HAND INSTRUMENTS
• Hand instrument with round handle compared to hard edged
hexagonal handle reduced muscular stress and compression of
digital nerve.
• Shallow circumferential grooves and knurling in the instrument
handles provide better friction with fingers, so that less force is
required for the secure grasp without tactile sensation.
• Instrument with sharp edge do better with less effort.
• Instrument handle with large diameter and with lighter weight
reduce the load on muscles.
• Instrument made from carbon steel with tungsten carbide
cutting edges could be more efficient.
• Overused burs and files should be discarded timely.
• Light weight cordless hand pieces with inbuilt light sources are
recommended.
B. AUTOMATIC INSTRUMENTS
•Such instruments like high and low speed hand pieces, belt
driven drills, lasers, ultrasonic scalars and Endo hand piece are
better than manual ones.
C.DENTAL MIRRORS
•Prevents awkward body positioning and helps maintain a
neutral working posture.
•Dull scratched mirror surface can cause strain to the eyes.
•Employ scratch resistant antifogging double sided mouth
mirror and compressed air to improve the clarity of operative
field.
•Mirror to handle angle is set at 45 deg and held in a vertical
manner.
•Handle is made lighter with slight ribbing parallel to the long
axis of the handle to facilitate rotational movements.
D. GLOVES
•Should be of proper size and fit for each operator as it is a
potential contributor to Carpal Tunnel syndrome
E. MAGNIFICATION
•Surgical magnification(fixed microscope, surgical loupes,
etc) can drastically augment the visual competence.
F. DELIVERY SYSTEM
•Practice of 4 handed dentistry maintains a position
around the operating field with limited hand, arm and
body movement.
•From an ergonomic view point, over the head and over
the patient delivery system better allow the Assistant to
access the hand pieces for bur changes and other
operations.
DELVERY SYSTEM CONTD
•Of the available 4 delivery systems of ‘Traditional’, ‘Four
Handed dentistry’, ‘Solo’, and ‘Sit, See & WorK Well’, Four
Handed system is the most ergonomic.
•Focus will be on Four Handed system, and for the records,
Traditional system will be cited first.
A. Traditional delivery system
•In Traditional system, dentists are at the risk of great
disability, bc they often work in static unhealthy postures,
and in some cases even with the units out of sight and reach.
•Traditionally, the unit instruments have been placed to the
left of the chair.
•To reach a unit instrument, the operator must look away
from the area of treatment and turn the body.
TRADITIONAL DELIVERY SYSTEM CONTD
•In doing so, the operator needs to move the hands from
the primary area of work.
•As a result, the focus on the treatment is repeatedly
disrupted.
•The eyes become tired from constant adaptation and
accommodation.
•The Assistant cannot help the dentist change contra
angles and burs, and cannot transfer unit instruments to
the dentist.
•The instrument holders are closed and difficult to clean
and disinfect.
OPERATING CHAIR ERGONOMIC GUIDELINES
GOAL: Promote mobility and patient access, accommodate different
body sizes.
Look for chair with:
•Stability ( 5 legged base)
•Lumbar support
•Hand free seat height adjustment
•Adjustable foot rest
•Adjustable wrap around body support
•Seamless upholstery
•Hydraulic controls
•Cylinder height
•Adjustable back rest
•Tilting seat pan
•Textured seat material
PATIENT CHAIR ERGONOMIC GUIDELINES
GOAL: Promote patient comfort, maximize patient access
Required are:
•Stability
•Pivoting or drop down arm rest (for ingress & egress of
patient)
•Supplemental wrist/forearm support for dentist)
•Articulating head rest
•Hands free operation
•Small thin head rest (Allows for greater leg room)
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