Dental chair, patient and operator position

a small overview on on operator, assistant and patient position while attending a patient on dental chair.

1. DENTAL CHAIR, PATIENT AND OPERATOR POSITION Made by Jatin Suresh TY BDS Batch-F Roll Number - 76 DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTIA

2. Introduction The dental chair, patient and operator position are important because: A patient who is comfortably seated in a dental chair with right posture is going to experience less muscular strain, less fatigue, and is more cooperative during the procedure. If operator maintains proper position and posture during treatment, the operator is less likely to get strained, fatigued, be more efficient and has less chances of getting musculoskeletal disorders. Most of the dental procedures can be completed while sitting.

3. Points To Be Kept In Mind In Relation To The Dental Chair it should be able to provide comfort to the patient. It should be able to provide total body support during working. Headrest of chair should be attached for supporting patient’s chin and for reducing strain on chin muscles. It should be able to provide maximum working area to the operator. It should be placed in convenient location with adjustable control switches. Foot switches are preferred to improve infection control. It is always preferable to have programmable operating position.

4. Dental Chair And Operator Positions Modern dental chairs are designed to provide total body support and comfort in any position. The patient should be seated in such a way that all his body parts are well supported. Patient’s head should be in line with his back irrespective of the fact that patient is reclined or parallel to the floor. Common positions for dental procedures: Upright position Almost supine Reclined at 45 º to the floor

5. Upright position This is the initial position of chair from which adjustments are made.

6. Almost supine Patient’s head, knees and feet are approximately at the same position. Patient is almost in lying down position as the name suggests. Patient’s head should not be lower than feet except in case of syncopal attack.

7. Reclined at 45 º In this position chair is reclined at 45 º. Mandibular occlusal surfaces are almost at 45 º to the floor.

8. Operating Position Accurate operating positions are essential while doing a procedure so as to increase the efficiency and to decrease the physical strain. Position of the patient depends on the type of procedure. Once the patient has been seated properly the operator and the assistant should sit in the proper position for the treatment. usually sitting position is preferred in modern dentistry to relive stress on the operator’s leg and support operator’s back. Level of the teeth being treated should be same as that of operator's elbow. For better understanding, sitting positions of operator are related to a clock, keeping the patient’s head at the center of the circle. The numbering is given as similar as that to a clock with top of the circle at 12 o’clock. Accordingly the operator’s position can be: For right handed operator- 7 o’clock, 9 o’clock, 11 o’clock and 12 o’clock. For left handed operator- 5 o’clock, 3 o’clock and 1 o’clock.

9. Right front position (7 o’clock) Helps in examination of the patient. Working areas include- Mandibular anteriors Mandibular posterior teeth (right side) Maxillary anterior teeth To increase the ease and visibility, the patient’s head may be turned towards the operator.

10. Right Position (9 o’clock) In this position, dentist sits exactly right to the patient Working areas include- Facial surfaces of maxillary right posterior teeth Facial surfaces of mandibular right posterior teeth Occlusal surface of mandibular right posterior teeth

11. Right rear position (11 o’clock) In this position, dentist sits behind and slightly to the right of the patient and the left arm is positioned around the patient’s head. This is the preferred position for most of the dental procedures. Most areas of the mouth are accessible from this position either using direct or indirect vision. Working areas include- Palatal, incisal and occlusal surfaces of maxillary teeth. Mandibular teeth by direct vision.

12. Direct rear position (12 o’clock) in this position, dentist sits directly behind the patient and looks down over the patient’s head during procedure. Working areas are lingual surfaces of mandibular teeth. This position has limited application.

13. Considerations For Dentists While Doing Cases While doing work in the maxillary arch, the maxillary occlusal surfaces should be oriented perpendicular to the floor. While working in the mandibular arch, the mandibular occlusal surfaces should be oriented at 45 º to the floor. Patient’s head can be rotated backward, forward or side to side by the operator for better visibility and convenience. Dentist should not sacrifice good operating position as it will sabotage visibility, accessibility and efficiency. Maintain proper distance from the patient while working. This will result in increased cooperation and confidence from the patient. Dentist should avoid/minimize body contact with the patient. Dentist should not rest forearms on the patient’s shoulders and hands on the face. Dentist should not use patient’s chest as an instrument trolley. The operator should leave left hands free so as to use it for retraction using mouth mirror or fingers of the left hand. Operator should keep changing position if procedure is of long duration to decrease fatigue and strain on muscles.

14. Operating Stool Many types of operating stools are commercially available. An operation stool should have features like: It should have casters for mobility and easy movement. Be sturdy and well balanced. Have seat which is well padded with cushion. Have adjustable backrest to provide full support to the dentist. Nowadays stools having backrest with curved extensions that provide additional back support are also available.

15. Sitting Arrangement Of Operator And Assistant The dentist should sit on the middle of the cushion rather than the edges. The dentist should sit on the stool such that: Spinal column is straight or slightly bent taking the advantage of the backrest. Thighs should be kept parallel to the floor Lower legs are kept perpendicular to the floor. The patient should be lowered to a position that keeps the concerned site as close to the dentist’s elbow level. When the patient is properly positioned the dentist’s eyes should be 14 to 16 inches from the treatment site. Assistant should sit as close as possible to the back of the patient’s chair with feet directed towards the head of the chair. Stool height of the assistant should be 4 to 5 inches above dentist’s eye level. The assistant should sit in an erect posture with feet firmly placed on top of the foot supporting ring at the base of the assistant chair. The instrument tray should be placed towards the head of the patient’s chair, and should be positioned in a such a manner that it allows easy access to instruments and materials . Above positions can be adjusted according to specific needs

16. Zones Of Working Area Working area is divided into four zones: Operator’s zone (lies between 7 o’clock and 12 o’clock) Assistant’s zone (lies between 2 o’clock and 4 o’clock) Static zone (lies between 12 o’clock and 2 o'clock) Transfer zone (lies between 4 o’clock and 7 o’clock) Instrument exchange zone Efficient exchange of instruments between the operator and the assistant is fundamental to have an efficient and stress free dental practice. All the instruments and materials are kept in the assistant’s zone. Transfer of materials and instruments between the assistant and operator should occur in the transfer zone which is below the patient’s chin and above the chest. Static zone This is a non traffic area and can be used to place other equipments . Heavy or dangerous objects should always be passed from this zone.

17. Instrument Exchange Instrument transfer should be accomplished by minimum motion involving movements of only fingers, wrist and elbow. Assistant should be ready when signaled by the dentist for passing the next instrument and receive the used one in a smooth motion. Instruments should be arranged in an orderly fashion for comfortable exchange. As a rule, instruments should be set from left to right in order of their use. After use, they should be returned to their original positions in case they are needed again.

18. Magnification Magnification of the working area is an important aspect of restorative procedures for increasing visibility and efficiency. Several types of magnification devices are available: Loupes Surgical microscope Bifocal eyeglasses Advantages Increase the visibility of working area. Minute and delicate procedures can easily be carried out. Increase the operator’s efficiency and success outcome. Helps in maintaining good posture as using magnification maintains constant working distance. Provides protection to eye from injury.

19. References Textbook of operative dentistry 3 rd edition by Nisha Garg and Amit Garg.

20. THANK YOU