Back Care & Ergonomics

Patient Positioning, Clinician Positioning, Direct and Indirect

Vision, Posturedontics, Simple Stretching
Patient Positioning
Patient Positioning
Upright
initial and final
position;
at eye level when
conversing with
patient;
Semi-upright/
semi-supine
For patients w/
cardiovascular,
respiratory, or
vertigo problems
between the
upright and full
supine positions.
Supine
brain is on the
same level as the
heart.
for support of the
circulation;
used mostly for
treatment
procedures.
Trendelenburg
in the supine
position and
tipped back and
down 35 degrees
to 45 degrees
heart is higher
than the head.
emergency
position used
when the patient
is approaching
syncope
Patient Positioning
Supine Position in Detail
Body
Slightly higher than the tip of the nose
Maintains good blood flow to the head
Head
Top of head should be even with upper edge of headrest
Headrest
Should be aligned so the neck and head are aligned with the torso
Patient Positioning: Maxillary Arch
Positioning for the Maxillary Arch
BODY: feet should be even with or slightly higher
than the tip of his or her nose.
CHAIR BACK: nearly parallel to floor
HEAD: even with the upper edge of headrest
HEADREST: adjust to position the head in chin-up
position
Patient Positioning: Mandibular Arch
Positioning for the Mandibular Arch
BODY: feet should be even with or slightly higher than
the tip of his or her nose.
HEAD: even with the upper edge of headrest
CHAIR BACK: slightly raised above parallel position
(15-20 degrees)
HEADREST: slightly raise the headrest chin-down
position
Clinician Positioning
Musculoskeletal Disorders
Musculoskeletal
injuries resulting
from REPEATED
OVERUSE.
Hands, wrists
elbows, neck,
shoulders
Risk factors for MSDs (TENTATIVE)
MSDs
Fixed
working
position
Excessive
use of
small
muscles
Tight Grips
Repetitive
movements
Positioning
challenges
Confined
working
space
Equipment
limitation
Common Musculoskeletal Disorders for
Healthcare Providers
Thoracic
Outlet
Syndrome
Rotator Cuff
Tendinitis
Pronator
Syndrome
Extensor
Wad Strain
Carpal
Tunnel
Syndrome
Ulnar Nerve
Entrapment
Tenosynovitis Tendinitis
Common Musculoskeletal Disorders for
Healthcare Providers
Carpal Tunnel Syndrome
Wrist and hand disorder caused by
compression of median nerve within carpal
tunnel of the wrist.
SYMPTOMS: Numbness, pain, and tingling
in the thumb, index, and middle fingers
Prevention of MSDs
Ergonomics
Postural
and
positional
factors
PREVENTION
of MSDs
Ergonomics
Do
Maintain a neutral, balanced body
position then change patients chair and
dental equipment to complete
periodontal instrumentation.
Use neutral spine position to maintain
the natural curve of the spine
Donts
Dont change body position or
equipment in an uncomfortable or
painful manner just to get the job done.
Dont have a mindset that its acceptable
to assume an uncomfortable position
just for 15 minutes.
Neutral Positioning
Neutral Neck
Position
Neutral Back
Position
Neutral Torso
Position
Neutral
Shoulder
Position
Neutral Positioning
Neutral Upper
Arm Position
Neutral Forearm
Position
Neutral Hand
Position
Clinician and Equipment Position
Neutral Position in Relation to
Patient
Adjust the height of the clinician chair to
establish 90 degrees hip angle
Lower patient chair until tip of patients nose is
below the clinicians waist level.
Elbow angle: 90 degrees when fingers are
touching patients teeth
COMMON ERROR: patient is too high in
relation to the clinician
AVOID placing legs under the back of the
patients chair.
EASY TECHNIQUE
Sit alongside the patient while placing arms
on the sides and crossed at waist.
Patients mouth below the elbow
point.
Clinician and Equipment Position
Position for Mandibular Teeth
Dental Light place directly and as far above
patients head.
Bracket Table position as low as possible to
easily view the instruments
Patient Chair position so that elbow angle is 90
degrees when fingers rest on mandibular teeth.
Position for Maxillary Teeth
Dental Light position above patients chest. And
as far away from patients face. Tilt light so light
beams shine into patients mouth at an angle.
Patient Chair lower entire chair until elbow angle
is 90 degrees when fingers rest on maxillary teeth
Clinician and Equipment Positioning
Sequence for
Positioning
ME: Assume clock
position for the
treatment area
MY PATIENT:
Establish patient
chair and head
position
MY EQUIPMENT:
Adjust the unit
light. Pause and
self-check the
clinician, patient
and the equipment
position
MY
NONDOMINANT
HAND
MY DOMINANT
HAND:
Clock Positions for Right-handed clinician
8 oclock
9 oclock
10 oclock
12 oclock
Clock Positions for Left-handed Clinician
4 oclock
3 oclock
2 to 1 oclock
12 oclock
Positioning Summary for Left-Handed
Clinician
Positioning Summary for Right-Handed
Clinician
Exercise
1. See and check each
photo for clinician,
patient and
equipment position.
2. For incorrect
positioning element,
describe how the
problem could be
corrected.
Photo 1
Photo 2
Photo 3
Direct and Indirect Vision
Indirect Vision
Observation of reflected image in order to
visualize the lingual of mandibular posteriors,
distal of maxillary posteriors, etc. (Fehrenbach,
2009)
Definition
Reduced risk for MSDs due to minimization of
the clinician's musculoskeletal discomfort since
it allows for the maintenance of neutral position
Advantage
Simple Stretching and
Posturedontics
Simple Stretching
Increasing blood flow to muscles
Increasing production of joint synovial
fluid
maintains normal range of motion
creates a relaxation response
identifies tight muscles prone to injury
addresses the negative effects
of static, awkward postures by:
Chairside Stretching
Elbow at 90 degrees and
shoulder height. Gently
pull arm across front of
body with opposite arm.
Look over shoulder being
stretched. Hold two to four
breath cycles.
Legs in tripod position,
bend to your left side,
resting left elbow on left
knee. Stretch right arm
overhead and look at the
ceiling. Hold for two to four
breath cycles.
Clasp fingers together
behind occiput and slowly
extend the upper back.
Look toward ceiling and
press the elbows outward
to stretch the chest.
Stretching During Microbreaks
Anchor right hand
behind your back
or chair. Slowly
bring left ear
toward left armpit.
Hold two to four
breath cycles.
How to Stretch Safely
Position your body at
the starting position.
Take a deep breath
Slowly exhale as you
gradually intensify the
stretch up to a point of
mild tension or
discomfort
Hold the stretch for two
to four breathing cycles
(10 to 20 seconds)
Release the stretch
slowly come back to
neutral position. Repeat
the stretch, if time
allows.
Try on both sides and
determine which one is
the tightest.
Perform the directional
stretch primarily toward
the tightest side
throughout the workday,
Place stretching charts
that are visible from the
chairside.
Never stretch in a
painful range.
Posturedontics
Healthy spine
requires flexibility.
To achieve a healthy
spine we should
encourage
movement in all
directions.
Overusing one area
limits movement and
affects other areas
affecting blood flow
and oxygenation.
Posturedontics
Posturedontics
Daily
Functional
Exercises
A preventive strategy
for all dental personnel.
Designed to create
functional movement
patterns
Focus on muscles with
occupational demands
Encourage full range of
movements for joints
Support the natural
curves of the spine
Can be done during
clinical hours; chairside
between patients; at
home
Posturedontics
Posturedontics
Posturedontics
Posturedontics
Posturedontics
Review
Clinical Case

Scenario: A dental hygienist is on the first day of his new
position at a large dental clinic. Before taking this new
position, he was the only dental hygienist for over 10
years at the same small dental practice after graduating
top of his class at age 20. He notices that he is unable to
put his feet on the floor when he sits on the stool
provided for him. He also has trouble instrumenting the
lower arch; it just seems there is not enough overhead
light, especially on the lingual of the anteriors. He also
wants to get closer to his patients; he has forgotten what
the effective distance to a patient's mouth is. At the end
of the day he notices that his back hurts. He is worried
about what this means to his future in his profession.



1. What factors does the dental
hygienist need to consider in order
to discover why he is having a
backache?

2. What could he have done to help
with overhead lighting during
instrumentation of the mandibular
arch, especially the lingual of the
anteriors?

3. What is the distance he should have
maintained to his patient's mouths?
What can he do if this distance
seems too far away?

4. If this situation continues for many
years without any changes to his
way of practice, what could the
outcome be for him?

References
Dental Economics. (n.d.). Retrieved July 29, 2014,
from It's a S-t-r-e-t-c-h:
http://www.dentaleconomics.com/articles/print/volum
e-98/issue-5/columns/preventing-pain-in-
dentistry/it39s-a-s-t-r-e-t-c-h.html
Esther, M. W., & Charlotte, R. (2008). Clinical Practice
of Dental Hygiene. Lippincott Williams & Wilkins.
Fehrenbach, M. J., & Weiner, J. (2009). Saunders
Review of Dental Hygiene. Saunders Book
Company.