*****ERGONOMICS IN DENTISTRY. pptx******

ERGONOMICS IN DENTISTRY.pptx

1. Ergonomics in dentistry Dr. Sushmita Rane MDS III Seminar 11 17/1/2024

2. Contents: Introduction Definition Ergonomic Design Goals Musculoskeletal Disorders Application of ergonomics in dentistry Four handed Dentistry Conclusion References

3. INTRODUCTION " Look after your body Jim Rohn says, "It's the only place where you reside” . Dental professionals are susceptible to a variety of occupational diseases and disorders, the most frequent of which being Musculoskeletal Disorders (MSDs), which can cause longterm harm. The most prevalent injuries are to the wrists, elbows, shoulders, neck, and back and spine, according to research.

4. Ergonomics is derived from two Greek words: Ergon, which means "labour," and Nomo’s, which means "principles or laws”. It is a method of working smarter by providing tools, equipment, and workstations that allow practitioners to operate as efficiently and safely as possible. Ergonomic design improves productivity, reduces injuries, and increases worker happiness. The International Ergonomics Association (IEA) defines ergonomics (or human factors) as “the scientific discipline concerned with the understanding of the interactions among humans and other elements of a system, and the profession that applies theoretical principles, data and methods to design, in order to optimize human well-being and overall system performance.”

5. WHAT BAD POSTURE CAN CAUSE ? The potential to develop musculoskeletal disorders is higher when one disregards good ergonomic principles. In doing so, dentists are at risk of compromising their technical expertise during procedures. This can lead to a limitation of certain procedures, potential career shortening, and, in the worst case, possible career-ending injuries.

6. The surveys below show that the main complaints are neck and lower back pain. It has also been noted that female dentists appear to have a higher incidence of upper body complaints than their male counterparts.

7. Ergonomic Design goals

8. Consequences of poor design Discomfort Chronic pain Accidents Injuries Fatigue Increased Errors Work related Musculoskeletal Disorders: -Lower back pain -Tendinitis -Epicondylitis -Carpel tunnel syndrome

9. Musculosk eletal Disorders (MSDS)–description and widespread “Work-related musculoskeletal illnesses with a chronic progressive development involves ligaments, spinal discs, muscles, cartilage, nerves, joints and tendons known as Repetitive Motion Injuries/RMI or Cumulative Trauma Disorders/CTD. World’s 2 nd leading cause of disability

10. WHY WE SHOULD CARE ? As per an audit of the worldwide dental writing, around 65% of dental specialists experience outer muscle manifestations like agony, uneasiness, practical hindrance, and expanded labour duration. According to a Bureau of Labour analysis, dental hygienists scored first among all professions in terms of the number of instances of carpel tunnel syndrome per 1,000 employees.

11. Risk factors 1)Long periods of difficult postures 2) If procedure performed repeatedly and over a lengthy period of time 3) Poor lighting when the back is bent or twisted Exercising for long periods of time above shoulder height when sitting in a forwardly bent and rotated position

12. Risk Factors for MSDs Dental Procedures Repititive motions Scaling and polishing Awkward Posture Handling of Objects with the back bent/ twisted Static Posture Static neck, back and shoulders Forceful exertions Tooth extraction Duration Grasping small instruments for prolonged periods Contact Stresses Repeated contacts with hard or sharp objects Vibration Prolonged use of vibrating hand tools

13. STATIC POSTURES Researchers have found that even 30 degrees of forward shoulder flexion or abduction can cause a significant impairment in blood circulation within the shoulder / neck region Static gripping for durations exceeding 20 minutes was also noted during instrumentation tasks within dental practice.

14. FORCE Researchers have suggested that excessive use of a pinch gripping is the greatest contributing risk factor in the development of MSDs among dental practitioners. REPETITIVE MOVEMENTS Highly repetitive tasks like endodontic procedures can lead to fatigue, tissue damage and discomfort.

15. Clinical features of musculoskeletal disor ders Signs Symptoms

16. Classification of MSDs Neural diseases Ulnar neuropathy, Carpal tunnel syndrome. Diseases of the neck Cervical Spondylosis, Tension Neck Syndrome, cervical disc disease, Brachial plexus compression. Diseases of the shoulder Trapezius myalgia, Rotator cuff tendonitis, Rotator cuff tears, and adhesive capsulitis. Diseases of the Forearm, Elbow and Wrist De Quervains disease, Tendonitis, Tenosynovitis, Epicondylitis. Hand-Arm vibration syndrome Reynaud’s disease Diseases of the back Lower Back Pain (LBP), Upper back pain.

17. WRIST The safest position for the wrist is a straight or neutral position. Special care should be used to avoid bending the wrist downwards (flexion) or outwards (ulnar deviation).

18. Carpel Tunnel Syndrome ( CTS) CTS occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.

19. Researchers have highlighted that one of the predictors for the high prevalence of Carpel Tunnel Syndrome among dentists was their longer clinical period of repetitive movements Tendonitis of the Wrist  Tendonitis of the wrist is accompanied by pain, swelling and inflammation on the thumb side of the wrist, and is made worse with grasping and twisting activities . People with this disorder have often noted an occasional “catching” or snapping when moving their thumb.

20. Guyon’s Syndrome The Compression occurs in this space at the base of the palm. It is commonly caused by repetitive wrist flexing or excessive pressure on palm. It is characterized by pain, weakness, numbness, tingling & burning in the little finger and part of the ring finger.

21. DeQuervain’s Tenosynovitis This disorder is characterized by pain and swelling in the thumb and wrist area when grasping, pinching, twisting, and a decreased range of motion of thumb with pain. This include synovial sheath swelling, thickening of tendons at base of thumb Causes- repeated trauma or twisting hand/wrist motions.

22. Epicondylitis These Injuries typically occur at either the inside of the elbow, referred to as Medial Epicondylitis (golfer’s elbow), or outside of the elbow, known as Lateral Epicondylitis (tennis elbow).

23. Shoulders Rounding the shoulders can compress nerves, arteries, and veins that supply the arm and hand, leading to upper extremity symptoms.

24. Trapezius myalgia Trapezius myalgia (TM) is  the complaint of pain, stiffness, and tightness of the upper trapezius muscle . It is characterised by acute or persistent neck-shoulder pain.  trapezius myalgia is  caused by static, prolonged elevation of the shoulders, mental stress, infrequent breaks, and poor head posture .

25. Rotator Cuff Tear  The rotator cuff (RC) is a group of 4 muscles; supraspinatus, infraspinatus, teres minor and subscapularis. The Rotator cuff muscle assists with both gross and fine motor control of the arm. Research has shown that clinicians who work without properly fitted loupes lean their neck forward in an unsupported position 85% of the time , creating tremendous stress on the neck and shoulder musculature.

26. Neck Pain and discomfort are the most common complaints reported in the neck/shoulder region amongst dental professionals. The slight inward curve of the neck balances the head on the spine. Holding the head forward disturbs this balance, straining the joints and the muscles of the neck and upper back. This posture also causes compression of the nerves and blood vessels as they exit the neck, leading to symptoms in the arm and hand.

27. Cervical Spondylosis  This disorder is characterized by intermittent/chronic neck and shoulder pain or stiffness, headaches, hand and arm pain, numbness, tingling, and clumsiness. Possible causes include age-related spinal disc degeneration leading to nerve compression and spinal cord damage, arthritis, and time spent with the neck in sustained awkward postures.

28. The main risk factors associated with dental work are the sustained awkward postures and poor seating. Most individuals with low back pain do not simply injure their back in one incident but rather gradually over time.

29. Disc Problems In a seated posture the pressure in the lumbar discs increases by 50% During bending (forward flexion) and twisting (rotation) motions of the spine, the pressure on the lumbar discs increases by 200%.

30. Sciatica It is characterized by pain in the lower back radiating to legs, causing leg weakness, numbness, or tingling. It is commonly caused by bulging, prolapsed or herniated discs compressing a spinal nerve root and is worsened with prolonged sitting or excessive bending and lifting .

31. Interv ention and prevention Maintaining a proper posture and symmetry requires a strong connection between the dentist and the intraoral working zone. Ergonomics should be considered while building instruments and planning workspaces, as well as in clinical practise. It is always recommended to leave 35–40 cm between the working field and the dentist’s eyes

32. Maintaining an upright posture should be a priority at all times. The following are characteristics of a balanced posture: •Respect for body symmetry and a straight back. •Avoid a forward tilt of the body by placing your arms along your body. •The operator's feet are symmetrically positioned Posture Instrument selection When employing devices with dull or blunt edges, extra force is necessary. The adoption of lightweight and durable mechanical hand pieces should be advocated

33. Shadow-free illumination is provided by the parallel alignment of the light beam in the observing direction, which improves job quality Magnification and lighting Dentist micr o breaks Moving the muscular workload from one location to another should be done on a regular basis. A dentist can take a break on the chair side and stretch.

34. to allow for adequate recovery time and to avoid muscular fatigue. Develop a patient difficulty rating scale to ensure difficult treatment Scheduling It ensures that personnel are well informed about workplace hazards and are able to selfvolunteer in identifying and minimising potential hazards Dental personnel training

35. S ome aspects of a faulty w or k station set-up The dentist’s seat is either excessively high or excessively low. There is no proper support in a dentist's chair. The equipment table is incorrectly positioned. The lighting is inadequate for the work. Table/work surface edges are sharp and uncomfortable. The workplace is damp and cold. Ventilation makes workspace cold.

36. Applications of ergonomics in dentistry Dentist position Assistant position Patient position Lighting & magnification Examination and control instruments Direct & Indirect Working instruments

37. Patient Chair Positioning the oral cavity above heart level will increase the rate of shoulder fatigue. Positioning the oral cavity below the recommended height will result in non-neutral working postures including over declination of the head, forward and/or lateral bending of the torso, and inability of the clinician to access free movement in the clock positions.

38. Operator chair Saddle stool -provides optimal seating allowing for proper positioning of the spine and the pelvis . The angle of seat allows for proper balance of core muscles and allows for the maintenance of normal curvature without the use of a backrest and without placing stress on the lower spine

39. Ideal posture of oral health professional THE HEAD To be inclined slightly forward, oriented over the shoulders. The interpupillary line is aligned horizontally not more than 15 to 20 degrees. TORSO The longitudinal axis of the torso is upright . It promotes the natural curves of the spine.

40. 7’o clock position Torso Position : Sit facing the patient with your hip in line with the patient’s upper arm. Leg Position : Your thighs should rest against the side of the patient chair.

41. 9’o Clock Position Torso Position. Sit facing the side of the patient’s head. The midline of your torso is even with the patient’s mouth. Leg Position. Your legs may be in either of two acceptable positions: (1) straddling the patient chair or (2) underneath the headrest of the patient chair.

42. 11’o clock position Torso Position. Sit at the top right corner of the headrest; the midline of your torso is even with the temple region of the patient’s head. Leg Position. Your legs should straddle the corner of the headrest.

43. Direct rear position Here the dentist sits directly behind the patient and looks down over the patient’s head This position is mainly used only working on lingual surfaces of the mandibular anterior teeth, lingual surfaces of maxillary anterior teeth

44. UPPER ARMS, ELBOWS and SHOULDERS Arms relaxed at one’s side due to the force of gravity. The elbows close to the side and the forearm is in front of the body parallel to the floor. WRISTS Should be kept in a neutral position with the wrists straight. THE FINGERTIPS Should be held at the treatment point, at a height that is comfortable and affords a clear view of the procedure being performed.

45. SEATED POSTURE Seating height at knee height; hips slightly higher than the knees; tilt the operator stool slightly downward. THE FEET To be flat on the floor. The lower legs are in a vertical position. Consider comfortable shoes and clothing to ease body movement. RHEOSTAT POSITIONING Place it close to the operator so that the knee is at about a 90 to 100 degree angle.

46. Position of the patient A deliberate patient position should be determined according to the dentist’s natural posture and his or her reference point, which allows the clinician to achieve optimal performance without any physical burden. Exceptional cases: Treating patients in an upright position Occasionally, it may be necessary to treat a patient while in an upright position, for example during certain procedures. elderly patients complex medical histories (hypotension, vertigo) P regnancy

47. Patient’s position for Maxillary Arch Feet even with or slightly higher than the tip of his/her nose Chair back nearly parallel to the floor Patient’s Head even with the upper edge of the headrest . headrest the patient’s head is in chin up position

48. Patient’s position for Mandibular Arch Feet even with or slightly higher than the tip of his/her nose Chair back slightly raised at a 15-2 0° angle to the floor Patient’s Head even with the upper edge of the headrest Headrest Raised slightly that the patient’s head is in a chin down position

49. DIRECT AND INDIRECT VISUALIZATION In order to maintain a properly balanced, upright posture, it is important to balance direct visualization with indirect visualization using the dental mirror. In order to widen the view without compromising good posture, the dentist should ask the patient to place the head on the headrest and adjust it accordingly to allow easier access, depending on which surface they are working. HARMONIZING POSTURE AND VISION

50. MIRROR A systematic mirror technique is necessary because practitioners tend to assume unnatural and improper posture when trying to check difficult-to-see and impossible-to-see regions. LIGHTING The light beam of the operating light must be perpendicular to the working mandibular plane or to the working maxilla plane to be fully effective. Dental handpieces with an integrated light source are ideal for illumination

51. Principles of Magnifying Loupes to be used as Intervention for MSDs In terms of ergonomics it is allowing the dentist to work in comfort zone with proper posture, reducing the eye strain and reducing the chair side time as well Steps used in magnification are as follows:

52. With increase in magnification, the field of view gets decreased. Normally magnification of 2x–2.5x is used in dental practice and also recommended for new users. Field of view The depth of field refers to the ability of the loupes to focus on both near and far field of interest without changing the position of the dentist. Depth of view

53. Declination (Viewing) Angle The lesser the viewing angle, greater the need for the dentist to tilt the neck and view the object. It is ergonomically important to make sure that this angle is correct for the dentist in order to minimize strain on the neck, back and shoulders.

54. ERGONOMICS BENEFITS OF LOUPES IN MSDS Burton and Bridgeman in their study focused on the working distance between the clinician and field of interest and implemented that by using loupes the working distance can be kept at a comfortable constant position securing up right posture of the dentist throughout the working life of the dental practitioner An Australian survey suggested that dental hygienists who wear loupes are less likely to have any neck and shoulder, wrist/hand, or upper back pain than those not wearing loupes. Using magnifying loupes, the field of vision becomes so clear that gripping of the instruments for longer period of time is avoidable

55. Plessas A (2018) systematic review where the role of ergonomic saddle seats and magnification loupes in preventing MSDs are analyzed in which four studies on loupes as intervention are mentioned, improving the quality of dental care professionals and dental students in terms of working posture, pace of work that ultimately results in accuracy of diagnosis and detection.

56. MAGNIFICATION BY LOUPES AND MICROSCOPE While using either loupes or a microscope, there should be an optimal distance from the dentist’s eyes to the patient’s mouth to ensure clear vision, good focus and ideal posture.

57. CHOICE OF INSTRUMENTS EXAMINATION AND CONTROL INSTRUMENTS Instruments with a large diameter (10 mm), textured handle, and a light weight (15 grams) require the least amount of muscle load and pinch force. Consider alternating tools with different diameter sizes to reduce the duration of prolonged pinch gripping. Silicone instrument handles A round handle, compared to a hexagon handle will reduce muscle force and compression. Favor gloves of proper size and fit

58. Finger Rests  Instruments should be held in a light, pen-like grip, using a fulcrum (finger rest) either intra-orally or extra-orally. The use of 2-finger rests has shown musculoskeletal advantages when performing scaling procedures. When researchers examined three different finger positions (no rest, 1-finger rest, and 2-finger rests) they found significant reductions in thumb pinch forces and muscle activity when using rests.

59. Equipment Layout   Dental equipment should be located in a manner which allows you to maintain a neutral working posture. Frequently used items such as the syringe, hand piece, saliva ejector and high volume evacuator should be positioned so they are within a normal horizontal reach which is the arc created while sweeping the forearm

60. Ambidexterity The majority of people prefer the use of their dominant hand when performing manual operations. It is recommended that individuals attempt to use alternate hands throughout the workday, whenever possible. Although this may not be practical for certain precision tasks, it is possible to alternate hands when performing accessory tasks, such as reaching for tools or supplies.

61. Er gonomics in dentistry: ad vanc es and str ategies F OUR-HANDED DENTISTRY It is a method in which the dentist and subordinate work together to execute procedures that are designed with the patient's best interests in mind. In a four-handed dentistry arrangement, proper use of a dental auxiliary's extra pair of hands is widely recognised as an optimum manner of providing dental services.

62. The following requirements must be completed in order to practise proper four-handed dentistry

63. Zones of activity: The work area surrounding the patient is divided into 4 "activity-zones“ To detect activity zones, the patient's face is utilised to simulate the face of a clock. The four activity zones are Operator’s zone Assistant’s zone Static zone Transfer zone

64. Strategies to ensure effective four handed dentistry TEAMWORK To effectively implement the concepts of true four handed dentistry each member of the dental team must assume individual as well as team responsibilities. The team must be aware of each other’s needs, recognize the needs to reposition the patient and operating team.

65. Strategies for the operator The dentist/ Operator should develop standardized routine for basic dental procedures Develop a non verbal signal denoting a need to exchange an instrument. When necessary give advance distinct verbal direction to communicate a need for a different instrument or material. The dentist/ operator must be willing to accept input from the assistant when it is noted that chair positions need to be adjusted. Avoid twisting and turning to reach instruments

66. When in practice the dental assistant should change burs in the handpiece and maintain a ready position for delivery of the handpiece Remove debris from the instruments before returning them to the preset tray. Maintain a clean work area at all times. Communication between the operator and the assistant is vital to successfully implement the concepts of four handed Dentistry

67. Strategies for the assistant Develop a thorough understanding of the procedure. Recognize the patient’s needs. Anticipate the operator’s needs and recognize any change in the procedure. Be seated as close to the patient as possible with legs parallel to the long axis of the patient’s body.

68. All these principles allow the practisioner to work smarter and not harder. When practiced properly, four-handed dentistry results in less fatigue, less burnout, fewer physical challenges, greater productivity, and greater job satisfaction for both dentists and assistants. Patients also appreciate receiving the undivided attention of a well-coordinated dental team and have a much more comfortable clinical experience when treated by a team, rather than by an individual.

69. Stretching Frequent stretch breaks can prevent detrimental physiological changes that can develop while working in static or awkward postures. In an attempt to prevent injury from occurring to muscles and other tissues, dental professionals should allow for rest periods to replenish and nourish stressed structures. If breaks are too far apart, the rate of damage could exceed the rate of repair and eventually lead to the breakdown of tissue.

70. Researchers suggest that dental professionals try to lean back on their stool at least four times during each treatment session as well as spend three to five minutes stretching for every patient seen throughout the day

71. Also, Take a break from activities and focus eyes at a distance for 20 seconds to relieve eyestrain caused by focusing hard on one depth of vision for extended periods of time. If there is neck stiffness, rotate your head in a comfortable range of motion from forward and backward, right and left. Shoulder rolling can help stretch fatigued shoulder muscles from holding an oral evacuator, tools ,

72. conclusion High productivity, injury prevention, and greater patient satisfaction are all benefits of successful ergonomics in the dental operatory. MSDs can be avoided by following some fundamental principles and maintaining a healthy posture. Regular continuing dental education seminars and lectures should be promoted to raise awareness among dental practitioners. Four-handed dentistry should be used on a regular basis to promote efficiency and convenience.

73. References ERGONOMICS AND POSTURE GUIDELINES FOR ORAL HEALTH PROFESSIONALS Content developed by Health and Safety Task Team (T. Caruso, D. Ilhan, M. Ishida, J.M. Laffont ) ©2021 FDI World Dental Federation. Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in dentistry. Int J Clin Pediatr Dent. 2014 Jan;7(1):30-4. doi : 10.5005/jp-journals-10005-1229. Epub 2014 Apr 26. PMID: 25206234; PMCID: PMC4144062. Dushyant Datkar , Akash Sibal , Bhairavi Kale, Ergonomics in Dentistry: A Review, J Res Med Dent Sci, 2022, 10 (7): 087-091. Sachdeva A, Bhateja S, Arora G. Ergonomics in dentistry: A comprehensive review. J Dent Res 2020;7:32-5.

74. Harpreet Kaur ,Vandana A. Pant ,Vandana Gupta “Magnification in Dental Ergonomics – A Comprehensive Review” Advances in Bioscience and Clinical Medicine Volume: 10 Issue: 1 January 31, 2022. ERGONOMICS IN DENTAL PRACTICE Shah A.F. et al., Int J Dent Health Sci 2014; 1(1): 68-78. Rajvanshi , et al.: A Review on Ergonomics in Dentistry: International Journal of Scientific Study | September 2015 | Vol 3 | Issue 6 Shipra Gupta. Ergonomic applications to dental practice. Indian Journal of Dental Research,22(6),2011

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