ADHA Access July 2012 : Page 15
with specific chairside stretches and movement strategies in the operatory. Ischemic muscles are especially susceptible to the develop -ment of painful trigger points (painful nodules within the muscle), 15 which are worsened with asymmetrical postures and mental stress. When pressed, trigger points may cause local pain or refer pain to a distant part of the body. 15,16 Because trigger points don’t allow the muscle fibers to contract or relax, they effectively limit mobility and create stress on joints. 17 Dental hygienists should learn which trigger points they are prone to developing and how to avoid the associated postures. Disc degeneration also can result from prolonged static postures. 18 Movement is required to nourish the nucleus inside the spinal disc. 19 Under static sustained pressures, nutrition to the disc is diminished and degenerative changes can occur, placing the disc at an increased risk for injury. 18 When knowledgeable of the etiology of these pain syndromes, dental hygienists can make wise choices regarding work environment modifications, equipment adjustment, patient positioning and exer -cise. Hygienists working in more than one office setting may incorpo -rate numerous economical ergonomic modifications to help them work more efficiently, productively and comfortably. • Tight spaces. Since it has no backrest, the saddle stool allows the easiest access in tight, confined operatory settings (espe -cially at 12 o’clock). In addition, since it places the pelvis in a neutral position, as in standing, it reduces spinal disc pressure and also decreases the need for a backrest. 21 • Side-sitting at nine o’clock. This is an all-too-common positioning strategy among hygienists and can also cause the most struc -tural damage in the shoulders, hips, neck, back and arms. 22 The saddle stool allows the hygienist to directly face the patient in the nine o’clock position, minimizing unsafe side-sitting postures. I often hear hygienists complain that the dentist won’t buy them a good ergonomic stool or loupes. So they endure years of poor posture and the resultant pain. It is incumbent upon hygienists to take the initiative for their own health, rather than wait for the dentist to buy them an ergonomic stool and loupes. A one-time investment in a good stool or loupes can go a long way in benefitting the hygienist’s health. (To view a video on ergonomic adjustment and use of the saddle stool in dental hygiene, go to www.posturedontics.com/hidden-pages/ stoolvideos.php.) ‘Ergonomizing’ Your Operatory/Operatories Based on research and on outcome studies from the author’s dental ergonomic consultations, the following interventions for dental hygienists are organized starting with the most important and effec -tive ones. These can easily be implemented in multiple operatories or offices: 1) Saddle up. The benefits of saddle stools in dental hygiene are numerous. The stools are lightweight, portable and easily adjustable and can solve a multitude of ergonomic problems. • Sharing stools. Often, hygienists will need to share a stool with other team members. Readjusting a traditional stool is time-con -suming and cumbersome. A saddle stool can be easily adjusted with one lever and lends itself easily to multiple users. • Chicken-winging or elevating the shoulders is one of the primary problems leading to neck and shoulder pain among dental hygienists. It occurs when the patient chair will not adjust low enough, when hygienists with short torsos are forced to work with their arms lifted to the sides, or simply due to positioning the patient too high. 1,11,20 The saddle stool solves this problem by placing the hygienist halfway between standing and sitting, which increases the hip angle up to 135 degrees. This allows lower positioning of the patient (forearm parallel to the floor or sloping 10 degrees upward) and a more relaxed shoulder pos -ture (Figure 1). Figure 2. Poor positioning aids, such as sleeping pillows and ‘dog bone’ cushions, force the patient’s head forward and down. This creates an ergonomic nightmare when treating the upper arch. Figure 1. A saddle stool solves a multitude of ergonomic problems and can easily be transported from one office to another. 2) Proper Patient Positioning. Poorly positioned patients can cause the worst leaning, twisting and reaching postures. Ideally, the patient should be positioned supine for treating the upper arch and semi-supine for the lower arch. However, in the real world—and es -pecially among traveling hygienists—time constraints and practicality usually prevent such luxuries. Therefore, it is recommended that the chair back be positioned so it is elevated 10 to 15 degrees from the floor. Proper orientation of the occlusal plane can then be achieved using a contoured dental neck cushion for treating the upper and lower arches. Ensure that the posi -tioning aid is not too large, or it will be counterproductive, forcing the patient’s head forward and down when treating the upper arch. Many “dog-bone” and tempurpedic pillows I have seen in operatories cause such positioning (Figure 2). After reclining the chair, ask the patient to scoot to the end of the headrest. This is especially important if using a flat headrest—reach -ing or leaning over the “dead” headrest space can lead to a myriad of musculoskeletal dysfunctions. 23 Often, this is not done in deference to the patient’s comfort—their spinal curves may not align properly with the patient chair support when scooted up all the way to the end of a headrest. This is easily resolved with dental ergonomic cushions that support the patient’s neck, low back and knees. When treating the upper arch, adjust the headrest so the occlusal plane of the upper jaw is about 15 to 20 degrees backward in relation to the vertical plane. You can check for proper positioning from the side, using an instrument handle to visualize the angle of the occlusal access JUL 2012 15
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