dental Chair position

ideal chair position of dentist and the patient

1. CHAIR POSITION Presented by— Hemam Shankar Singh 1

2. CONTENTS INTRODUCTION CHAIR AND PATIENT POSITIONS UPRIGHT POSITION ALMOST SUPINE RECLINED 45 DEGREE OPERATING POSITION RIGHT FRONT POSITION (7 O'CLOCK) RIGHT POSITION (9 O'CLOCK) RIGHT REAR POSITION (11 O'CLOCK) DIRECT REAR POSITION (12 O'CLOCK) CONSIDERATIONS FOR DENTISTS WHILE DOING PATIENT SEQUENCE FOR PRACTICING POSITIONING 2

3. INTRODUCTION CHAIR AND PATIENT POSITIONS ARE IMPORTANT CONSIDERATIONS. MODERN DENTAL CHAIRS ARE DESIGNED TO PROVIDE TOTAL BODY SUPPORT IN ANY CHAIR POSITION. 3

4. INTRODUCTION CHAIR POSITION IS A VERY IMPORTANT ASPECT IN THE SUCCESS OF A DENTAL TREATMENT. THE CORRECT POSITIONING HELPS THE OPERATOR TO HAVE A GOOD VISIBILITY AND ACCESSIBILITY OF THE ORAL CAVITY PROPER POSITIONING OF THE PATIENT AND THE OPERATOR, ILLUMINATION AND RETRACTION FOR OPTIMAL VISIBILITY ARE THE FUNDAMENTAL PRE-REQUISITES TO PROPER DENTAL TREATMENT IF OPERATOR MAINTAINS PROPER POSITION AND POSTURE DURING TREATMENT, THE OPERATOR IS LESS LIKELY TO GET STRAIN, FATIGUE, BE MORE EFFICIENT AND LESS CHANCES OF GETTING MUSCULOSKELETAL DISORDERS. 4

5. FOLLOWING POINTS SHOULD BE KEPT IN MIND IN RELATION TO DENTAL CHAIR: IT SHOULD BE ABLE TO PROVIDE COMFORT TO THE PATIENT IT SHOULD BE ABLE TO PROVIDE TOTAL BODY SUPPORT HEADREST OF CHAIR SHOULD BE ATTACHED FOR SUPPORTING PATIENT'S CHIN AND REDUCING STRAIN ON CHIN MUSCLES IT SHOULD BE ABLE TO PROVIDE MAXIMUM WORKING AREA TO THE OPERATOR IT SHOULD BE PLACED AT THE CONVENIENT LOCATION WITH ADJUSTABLE CONTROL SWITCHES FOOT SWITCHES ARE PREFERRED TO IMPROVE INFECTION CONTROL 5

6. PATIENT POSITIONS VL PATIENT SHOULD BE SEATED SO THAT ALL HIS BODY PARTS ARE WELL SUPPORTED. THE PATIENT'S HEAD SHOULD ALWAYS BE SUPPORTED BY ADJUSTABLE/ ARTICULATED HEADREST. PREFERABLY THE PATIENT'S HEAD SHOULD BE IN LINE WITH HIS BACK . THE CHAIR HEIGHT SHOULD BE KEPT LOW, BACKREST SHOULD BE UPRIGHT AND ARMREST SHOULD BE ADJUSTABLE WHILE MAKING THE PATIENT TO SEAT IN THE DENTAL CHAIR. NOW, THE CHAIR CAN BE ADJUSTED TO PLACE THE PATIENT IN RECLINING POSITION. PATIENT POSITION CAN VARY WITH OPERATOR, TYPE OF PROCEDURE AND AREA OF THE ORAL CAVITY. 6

7. FOR RESTORATIVE DENTAL PROCEDURES, THE MOST PREFERRED OPERATING POSITIONS ARE: UPRIGHT POSITION ALMOST SUPINE RECLINED 45 DEGREE THE MOST COMMON PATIENT POSITIONS FOR OPERATIVE DENTISTRY ARE ALMOST SUPINE OR RECLINED 45 DEGREES. THE CHOICE OF PATIENT POSITION VARIES WITH THE OPERATOR, THE TYPE OF PROCEDURE, AND THE AREA OF THE MOUTH INVOLVED IN THE OPERATION. CHAIR POSITIONS 7

8. UPRIGHT POSITION THIS IS THE INITIAL POSITION OF CHAIR FROM WHICH FURTHER ADJUSTMENTS ARE MADE Chair position 8

9. ALMOST SUPINE IN THIS , CHAIR POSITION IS SUCH THAT HEAD, KNEES AND FEET ARE APPROX. AT SAME LEVEL PATIENT’S HEAD SHOULD NOT BE LOWER THAN FEET EXCEPT IN CASE OF SYNCOPAL ATTACK 9

10. REECLINED 45 DEGREES IN THIS POSITION , CHAIR IS RECLINED AT 45 DEGREE MANDIBULAR OCCLUSAL SURFACE ARE ALMOST 45 DEGREE TO THE FLOOR 10

11. OPERATING POSITIONS ONCE THE PATIENT HAS BEEN COMFORTABLY POSITIONED, THE DENTIST AND THE ASSISTANT SHOULD SIT THEMSELVES IN THE PROPER POSITIONS FOR TREATMENT. USUALLY SITTING POSITION IS PREFERRED IN MODERM DENTISTRY TO RELIEVE STRESS ON OPERATOR'S LEG AND SUPPORT THE OPERATOR'S BACK. THE LEVEL OF TEETH BEING TREATED SHOULD BE PLACED AT SAME LEVEL AS THE LEVEL OF OPERATOR'S ELBOW. 11

12. FOR BETTER UNDERSTANDING, SITTING POSITIONS OF OPERATOR ARE RELATED TO A CLOCK. IN THIS CLOCK CONCEPT, AN IMAGINARY CIRCLE IS DRAWN OVER THE DENTAL CHAIR, KEEPING THE PATIENT'S HEAD AT THE CENTER OF THE CIRCLE. THEN THE NUMBERING TO CIRCLE IS GIVEN SIMILAR TO A CLOCK WITH THE TOP OF THE CIRCLE AT 12 O'CLOCK. ACCORDINGLY THE OPERATOR'S POSITIONS (RIGHT HANDED OPERATOR) 7 O'CLOCK, 9 O'CLOCK, 11 O'CLOCK, AND 12 O'CLOCK LEFT HANDED OPERATOR'S POSITIONS , 5 O'CLOCK, 3 O'CLOCK AND 1 O'CLOCK . 7 12

13. RIGHT FRONT POSITION (7 O'CLOCK) IT HELPS IN EXAMINATION OF THE PATIENT WORKING AREAS INCLUDE: MANDIBULAR ANTERIOR MANDIBULAR POSTERIOR TEETH (RIGHT SIDE) MAXILLARY ANTERIOR TEETH TO INCREASE THE EASE AND VISIBILITY, THE PATIENT'S HEAD MAY BE TURNED TOWARDS THE OPERATOR. 13

14. 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 SURFACES OF MANDIBULAR RIGHT POSTERIOR TEETH. 14

15. 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 PATIENT'S HEAD THIS IS PREFERRED POSITION FOR MOST OF DENTAL PROCEDURES MOST AREAS OF MOUTH ARE ACCESSIBLE FROM THIS POSITION EITHER USING DIRECT OR INDIRECT VISION WORKING AREAS INCLUDE: PALATAL AND INCISAL (OCCLUSAL) SURFACES OF MAXILLARY TEETH MANDIBULAR TEETH (DIRECT VISION). 15

16. DIRECT REAR POSITION (12 O'CLOCK) 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. 16

17. RIGHT HANDED OPERATOR— 3 PREFERRED POSITIONS LEFT HANDED OPERATOR— 3 PREFERRED POSITIONS 7 O’CLOCK 5 O’CLOCK 9 O’CLOCK 3 O’CLOCK 11 O’CLOCK 1 O’CLOCK 17

18. WHILE DOING WORK IN MAXILLARY ARCH, MAXILLARY OCCLUSAL SURFACES SHOULD BE PERPENDICULAR TO THE FLOOR. IN MANDIBULAR ARCH, MANDIBULAR OCCLUSAL SURFACE SHOULD BE ORIENTED 45° TO THE FLOOR. PATIENT'S HEAD CAN BE ROTATED BACKWARD OR FORWARD OR FROM SIDE TO SIDE FOR OPERATORS EASE AND VISIBILITY WHILE DOING WORK. MAINTAIN PROPER WORKING DISTANCE DURING DENTAL PROCEDURE. THIS WILL LEAD TO INCREASE COOPERATION AND CONFIDENCE AMONG THE PATIENT. OPERATOR SHOULD NOT REST FOREARMS ON THE PATIENT'S SHOULDERS AND HANDS ON THE FACE OF THE PATIENT. CONSIDERATIONS WHILE DOING PATIENT 18

19. 6. DENTIST SHOULD NOT USE PATIENT'S CHEST AS A INSTRUMENT TROLLEY. 7. THE OPERATOR SHOULD LEAVE LEFT HAND FREE DURING MOST OF DENTAL PROCEDURES FOR RETRACTION USING MOUTH MIRRORS OR FINGERS OF LEFT HAND. 8. OPERATOR SHOULD KEEP CHANGING POSITION IF PROCEDURE IS OF LONG DURATION TO DECREASE THE MUSCLE STRAIN AND FATIGUE. 19

20. FOR SUCCESSFUL INSTRUMENTATION, IT IS IMPORTANT TO PROCEED IN A STEP-BY-STEP MANNER. A USEFUL SAYING TO HELP YOU REMEMBER THE STEP-BY-STEP APPROACH IS “ ME, MY PATIENT, MY LIGHT, MY NON-DOMINANT HAND, MY DOMINANT HAND .” SEQUENCE FOR PRACTICING POSITIONING 20

21. SEQUENCE FOR ESTABLISHING POSITION 1 ME. ASSUME THE CLOCK POSITION FOR THE TREATMENT AREA 2 MY PATIENT. ESTABLISH PATIENT CHAIR AND HEAD POSITION. 3 MY EQUIPMENT. ADJUST THE UNIT LIGHT. PAUSE AND SELF-CHECK THE CLINICIAN, PATIENT, AND EQUIPMENT POSITION. 4 MY NONDOMINANT HAND. PLACE THE FINGERTIPS OF MY NONDOMINANT HAND AS SHOWN IN THE ILLUSTRATION FOR THE CLOCK POSITION. 5 MY DOMINANT HAND. PLACE THE FINGERTIPS OF MY DOMINANT HAND AS SHOWN IN THE ILLUSTRATION FOR THE CLOCK POSITION. 21

22. WHEN WORKING ON ANTERIOR SEXTANTS, YOUR LEFT HAND (NON-DOMINANT HAND) AND YOUR RIGHT HAND (DOMINANT HAND) ARE POSITIONED ON OPPOSITE SIDES OF THE PATIENT’S MOUTH. ANTERIOR SURFACES TOWARD MY NON-DOMINANT HAND— THE COLORED ANTERIOR SURFACES IN THIS ILLUSTRATION . ANTERIOR SURFACES AWAY FROM MY NON-DOMINANT HAND— THE WHITE ANTERIOR SURFACES IN THIS ILLUSTRATION . POSITIONING TERMINOLOGY 22

23. POSTERIOR ASPECTS FACING TOWARD ME—THE COLORED POSTERIOR SURFACES IN THIS ILLUSTRATION. • MAXILLARY RIGHT POSTERIOR SEXTANT, FACIAL SURFACES • MAXILLARY LEFT POSTERIOR SEXTANT, LINGUAL SURFACES • MANDIBULAR RIGHT POSTERIOR SEXTANT, FACIAL SURFACES • MANDIBULAR LEFT POSTERIOR SEXTANT, LINGUAL SURFACES POSITIONING TERMINOLOGY 23

24. POSTERIOR ASPECTS FACING AWAY FROM ME—THE COLORED POSTERIOR SURFACES IN THIS ILLUSTRATION. • MAXILLARY LEFT POSTERIOR SEXTANT, FACIAL SURFACES • MAXILLARY RIGHT POSTERIOR SEXTANT, LINGUAL SURFACES • MANDIBULAR LEFT POSTERIOR SEXTANT, FACIAL SURFACES • MANDIBULAR RIGHT POSTERIOR SEXTANT, LINGUAL SURFACES POSITIONING TERMINOLOGY 24

25. ARCH TREATMENT AREA CLOCK POSITION HEAD POSITION MANDIBULAR ARCH ANTERIOR SURFACES TOWARD MY NON-DOMINANT HAND 8–9 SLIGHTLY TOWARD, CHIN DOWN ANTERIOR SURFACES AWAY FROM MY NON-DOMINANT HAND 12 SLIGHTLY TOWARD, CHIN DOWN MAXILLARY ARCH ANTERIOR SURFACES TOWARD MY NON-DOMINANT HAND 8–9 SLIGHTLY TOWARD, CHIN UP ANTERIOR SURFACES AWAY FROM MY NON DOMINANT HAND 12 SLIGHTLY TOWARD, CHIN UP MANDIBULAR ARCH POSTERIOR ASPECTS FACING TOWARD ME (RIGHT FACIAL AND LEFT LINGUAL) 9 SLIGHTLY AWAY, CHIN DOWN POSTERIOR ASPECTS FACING AWAY FROM ME (RIGHT LINGUAL AND LEFT FACIAL) 10–11 TOWARD, CHIN DOWN MAXILLARY ARCH POSTERIOR ASPECTS FACING AWAY FROM ME (RIGHT LINGUAL AND LEFT FACIAL) 10–11 TOWARD, CHIN UP POSTERIOR ASPECTS FACING TOWARD ME (RIGHT FACIAL AND LEFT LINGUAL) 9 SLIGHTLY AWAY, CHIN UP POSITION FOR THE RIGHT-HANDED 25

26. POSITIONING FOR THE ANTERIOR Anterior Surfaces TOWARD My Non-dominant Hand 7 TO 9 O’CLOCK (8:00 OPTION SHOWN) TURNED SLIGHTLY TOWARD THE CLINICIAN CHIN-DOWN POSITION 26

27. POSITIONING FOR THE ANTERIOR Anterior Surfaces TOWARD My Non-dominant Hand 7 TO 9 O’CLOCK (9:00 OPTION SHOWN) TURNED SLIGHTLY TOWARD THE CLINICIAN CHIN-UP POSITION 27

28. POSITIONING FOR THE ANTERIOR Anterior Surfaces AWAY From My Non-dominant Hand 12 O’CLOCK POSITION TURNED SLIGHTLY TOWARD THE CLINICIAN CHIN-DOWN POSITION 28

29. POSITIONING FOR THE ANTERIOR Anterior Surfaces AWAY From My Non-dominant Hand 12 O’CLOCK POSITION TURNED SLIGHTLY TOWARD THE CLINICIAN CHIN-UP POSITION 29

30. POSITIONING FOR THE POSTERIOR Posterior Aspects Facing TOWARD Me 9 O’CLOCK (OPTION 1 FOR 9:00) TURNED SLIGHTLY AWAY FROM THE CLINICIAN CHIN-DOWN POSITION 30

31. POSITIONING FOR THE POSTERIOR Posterior Aspects Facing TOWARD Me 9 O’CLOCK (OPTION 2 FOR 9:00) TURNED SLIGHTLY AWAY FROM THE CLINICIAN CHIN-UP POSITION 31

32. POSITIONING FOR THE POSTERIOR Posterior Aspects Facing AWAY From Me 10 TO 11 0’CLOCK TURNED TOWARD THE CLINICIAN CHIN-DOWN POSITION 32

33. POSITIONING FOR THE POSTERIOR Posterior Aspects Facing AWAY From Me 10 TO 11 0’CLOCK TURNED TOWARD THE CLINICIAN CHIN-UP POSITION 33

34. CONCLUSION Proper use of the chair positions as according to the relative operating areas helps the operator to complete the procedure without delayed. it also reduces the chances of causing musculoskeletal disorders. 34

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