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DH101 Preclinical SciencesErgonomics
Nield Book CH 1&2Wilkins CH7
Lisa Mayo, RDH, BSDHStaci Janous, RDH, BS
Concorde Career College
Topics To Cover Today
1. Principles of Ergonomics2. Positioning of Clinician (neutral position,
stool)3. Patient Positioning4. Light & Instrument Tray5. Clock Positions6. How To Prevent Injury
OBJECTIVE #1Principles of Ergonomics
Copyright © 2010 by Saunders, an imprint of Elsevier Inc.
4
Principles of Ergonomics
◦Musculoskeletal disorder: condition where parts of the musculoskeletal system (tendons, nerves, muscles) are injured over time
◦Major issues in dentistry due to:1) Fixed/Static working positions2) Excessive use of small muscles3) Tight grips4) Repetitive movements5) Positioning challenges6) Confined working spaces
Nield p.5
Copyright © 2010 by Saunders, an imprint of Elsevier Inc.
5
Principles of Ergonomics
◦Musculoskeletal disorder prevention: ERGONOMICS Applied science concerning the “fit” between people &
their technology Science of making things efficient Ergonomic guidelines exist for dental professionals
Nield p.5
OBJECTIVE #2Positioning of Clinician
Neutral Working Posture
Neutral Working Position◦Whole body functional biomechanics as it
relates to all work activities ◦Without will experience discomfort, pain, and
work-related stress disorders
Nield p.10-12
Neutral Working Posture
Neutral Seated Position◦Neck◦Back◦Torso◦Shoulders◦Upper Arm◦Forearm◦Hand◦Feet Nield p.10-12
What NOT to do!!
Neutral Seated PositionNECK
◦Head tilt 0-20°◦Line from eyes to treatment area vertical as
possible
BACK◦Lean forward slightly from the hips◦Trunk flexion 0-20°
Neutral Seated Position
TORSO◦In line with long axis of body◦Do NOT twist or lean torso
Neutral Seated Position
SHOULDERS◦In HORIZONTAL LINE◦Weight evenly balance when seated◦Do NOT lift shoulders towards ears, hunch
forward, sit with weight on one hip
Neutral Seated Position
Neutral Seated Position
Neutral Seated Position
Forearm and Wrist straight
Neutral Seated Position
FEET◦Flat on Floor◦Create a wide base of support◦Shoulder’s width apart
Neutral Seated Position
Incorrect Feet
Feet right next Feet on top of to one another one another
WORKING DISTANCE
Wilkins p.91
WHICH ONE IS CORRECT?
STOOLPosition buttocks all way back in chairDistribute weight evenly on both hips
Nield p.15
Nield p.15
Adjust LUMBAR DEPTH by moving the backrest closer or farther from the seat pan until the backrest nestles against the lower back
The unsupported lower back tends to straighten rather than maintain a healthy curve
Nield p.16
Adjust LUMBAR HEIGHT by moving backrest up or down until it nestles in the neutral lumbar curve of the lower backHelps support the natural curve of the spine
Nield p.16
Raise tailbone up to establish correct spinal curves
All 3 normal back curves should be present while sitting
Studies show position of the pelvis determines the shape of the spine
Nield p.16
Pull stomach muscles toward the spineSuck in tummy!!Adds stability and decreases strain on back
Nield p.16
Review
Which of the following is not correct positioning for a clinician in neutral position?
A) Shoulders are relaxed and perpendicular with
the hips and floorB) Elbows are held close to the bodyC) Forearms are maintained parallel with the
floorD) Feet are flat on the floor, knees slightly
apart, and weight evenly distributed
Answer
A) Shoulders are relaxed and perpendicular with the hips and floor is the correct answer.
Shoulders are relaxed and parallel with the hips and floor. Elbows are close to the body. Forearms are parallel with the floor. Forearms and wrists are in a straight line. The full body weight is distributed evenly on the seat; there is comfortable space (about 3 inches) between the edge of the seat and the back of the knee. Knees are slightly apart, and feet are flat on the floor.
OBJECTIVE #3Patient Positioning
32
Patient ChairClient-Clinician Positioning FactorsCommonly used client positions are:
1. Upright for interviewing and educating
2. Semisupine/Semi-upright (patients with cardiovascular or respiratory diseases)
3. Supine ideal for patient tx4. Trendelenburg for medical emerg
(syncope). Brain lower then heart
Wilkins p.90
UPRIGHT
SEMI-SUPINE
SUPINE
TRENDELENBURG
Wilkins p.90
Patient Chair
Contraindications for supine position◦Congestive heart disease◦Vertigo◦Emphysema◦Severe asthma◦Sinusitis◦During the third trimester of pregnancy, some
women may be uncomfortable
Patient Chair: Maxillary Arch Tx
Nield p.19
Body◦Pt’s feet should be even with or slightly higher than
the tip of noseChair Back
◦Parallel to the floorHead
◦Top of pt head even with the upper ridge of the headrest
Headrest◦Pt’s head is in chin-up position: nose and chin level
Patient Chair: Maxillary Arch TxNield p.19
Patient Chair: Mandibular Arch Tx
Nield p.20
Body◦Pt’s feet should be even with or slightly higher than the
tip of noseChair Back
◦Slightly raised above the parallel position at 15-20° to the floor
Head◦Top of pt head even with the upper edge of the headrest
Headrest◦Pt’s head is in chin-down position: chin lower than the
nose
Patient Chair: Mandibular Arch Tx
Nield p.20
How to Find Correct Height of Patient Chair for YOU!
1. Assume neutral seated position2. Sit next to patient with forearms crossed at
your waist3. Position chair for maxillary or mandibular
work4. Position pt’s head for treatment (chin-up or
down)5. When pt opens mouth, should be below the
point of your elbow
Nield p.25-26
ReviewWhy should the patient remain seated in the upright
position for a couple of minutes after being reclined?A) To allow the patient to receive postoperative instructionsB) To allow all the patients saliva to flow back into the mouth and be expectorated before the patient leaves the operatoryC) To avoid possible postural hypotensionD) There is no reason for the patient to remain seated after treatment
Answer
C) To avoid possible postural hypotension is the correct answer.
As the blood flows away from the brain upon being placed in an upright position after being reclined for a period of time, the blood pressure may drop and the patient may experience syncope, or fainting.
OBJECTIVE #4Light & Instrument Tray
Vision: Lighting
Can focus beam of lightLight should be in arm’s reach
Lighting Maxillary Arch
Ranges from directly over the oral cavity to a position over the patient’s neck
Light beam is perpendicular to floor◦ 60-45° angle to floor
Patient Chin-Up position
Nield p.23
Lighting Mandibular Arch
Positioned directly over the oral cavityPatient in chin-down positionLight beam directly perpendicular to the floor
Nield p.23
Wilkins p.93
Loupes and LightingLoupes magnify field of visionMany loupe’s now sold with light
illuminators
Nield p.28-33
Instrument Tray
Within reach of your dominant handToo high = stress on body
Instrument Tray
Can be next to patient (our clinic)Can be on top of patient
Handpieces and Cords
Handpieces◦Ergonomic design features are smaller, lighter
better fitted to RDH handsCords
◦Improper management can cause drag on hands, wrist, arm
◦Straight better then curly
What’s Wrong with this Picture?DH Student
OBJECTIVE #5Clock Positions
Clock Positions for Instrumentation
Clinician moves around patient while performing instrumentation
Goal: correct positioning of patient and clinician facilitates neutral positioning and optimal visual field = decreases fatigue and strain
Clock positions help us know where to sit while we work on different areas of the mouth
Patients move heads to help us see (turn toward/away from me)
Nield Book – CH2
Copyright © 2010 by Saunders, an imprint of Elsevier Inc.
63
Clock PositionsRIGHT-HANDED CLINICIAN
1. 8 O’clock2. 9 O’clock3. 10-11 O’clock4. 12 O’clock
Clock PositionsLEFT-HANDED CLINICIAN
1. 3 O’clock2. 4 O’clock3. 1-2 O’clock4. 12 O’clock
Clock PositionsRIGHT-HANDED CLINICIAN
8 O’clock◦Torso: face patient with hips in line
with patient’s upper arm◦Leg: thighs rest against side of patient
chair◦Arm: slightly away from your sides◦Line of Vision: straight ahead into pt
mouth
Clock PositionsRIGHT-HANDED CLINICIAN
9 O’clock◦Torso: face side of pt’s head.
Midline of torso even w/ pt mouth◦Leg
1. Straddle patient chair (BEST)2. Underneath headrest
◦Arm: Lower half of RT arm in alignment w/pt shoulder. LF hand/wrist over region of pt RT eye
◦Line of Vision: straight down into pt mouth
Clock PositionsRIGHT-HANDED CLINICIAN
10-11 O’clock◦Torso: Sit top RT corner of
headrest, midline torso even w/temple region of pt head
◦Leg: straddle corner of headrest◦Arm: RT hand directly across
corner of pt mouth. LF hand & wrist above pt nose & forehead
◦Line of Vision: straight down into pt mouth
Clock PositionsRIGHT-HANDED CLINICIAN
12 O’clock◦Torso: Sit behind pt head◦Leg: straddle headrest◦Arm: Wrist & hand above
region of pt ears/cheeks◦Line of Vision: straight down
into pt’s mouth
Clock PositionsLEFT-HANDED CLINICIAN
1. 4 O’clock2. 3 O’clock3. 1-2 O’clock4. 12 O’clock
Clock PositionsLEFT-HANDED CLINICIAN
4 O’clock◦Torso: Hips in line w/pt upper
arm◦Leg: Thighs rest against side
of pt chair◦Arm: Arms slightly away from
sides. Lower LF arm over pt chest. Side of RT hand rests in area of pt RT cheekbone
◦Line of Vision: straight ahead into pt mouth
Clock PositionsLEFT-HANDED CLINICIAN
3 O’clock◦ Torso: Face pt head, midline torso
even w/pt mouth◦ Leg
1. Straddle patient chair (BEST)2. Underneath headrest
◦ Arm: Lower half of LF arm in alignment w/pt shoulder. RT hand/wrist over region of pt LF eye
◦ Hand: RT hand in area of pt LF cheekbone. Fingertips LF hand on pm teeth of mandibular LF posterior sextant
◦ Line of Vision: straight down into pt’s mouth
Clock PositionsLEFT-HANDED CLINICIAN
1 O’clock◦Torso: Sit top corner of headrest,
midline torso even w/ temple of pt head
◦Leg: straddle corner of headrest◦Arm: LF hand directly across corner
of pt mouth, RT hand & wrist above pt nose & forehead
◦Line of Vision: straight down into pt mouth
Clock PositionsLEFT-HANDED CLINICIAN
12 O’clock◦Torso: Sit behind pt head◦Leg: straddle headrest◦Arm: Wrist & hand above region
of pt ears/cheeks◦Line of Vision: straight down
into pt mouth
OBJECTIVE #6How To Prevent Injury
Nield p.81-83
79
Physical ExerciseStrengthening ExercisesPerforme regularly to repair, build &
maintain healthy musculoskeletal system
Dexterity Development
Strength-Training for back, shoulders, hands, wrists, fingers, arms
Squeezing therapy putty/soft ball◦Purpose: develop strength & control
Stretching
Purposes◦Before & After Work
Rubber band on finger joints
WILKINS & NEILD VIDEO
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