ADHA Access July 2012 : Page 16
Figure 3, a and b. An ergonomic dental cushion (Crescent Products) will increase patient tolerance to being reclined when treating the upper arch, and facilitate proper positioning (left). Reverse the cushion for treating the lower arch (right). (Photo ©2010 from “Positioning for Success” DVD) plane (Figure 3, a and b). This angle is most easily attained with double-articulating headrests by angling the headrest upward into the patient’s occiput. On flat headrests, use a contoured dental pillow with the large end under the patient’s neck to angle the head back and chin higher. Then adjust the height of the patient chair so forearms are parallel to the floor or sloping 10 degrees upward. 24 Whether using flat or double-articulating headrests, contoured memory foam cervical support cushions such as those by Crescent will make the patient much more tolerant to reclining. (To view a video of patient positioning in dental hygiene, go to www.posturedontics.com/ hidden-pages/hygienepositioning.php.) 3) Select the Right Loupes. Since neck pain is significantly as -sociated with working with a forward head posture of 20 degrees or more, I consider it mandatory that dental hygienists wear well-designed ergonomic loupes for a long and healthy career. 25,26 Many schools are now recognizing the postural benefit of loupes and mandating their use. 27 It is important to realize that poorly designed loupes can actually cause neck pain. Therefore, it is imperative to understand the three ergonomic criteria to select loupes that will benefit your health: properly measure working distance, steep Figure 4. New, light-declination angle, and large frames that weight flip-up style sit low on the cheeks. The most important loupes rival the weight 28 of through-the-lens style of these criteria is declination angle. The declination angle is how steeply the loupes loupes and allow for the most neutral, upright are angled downward toward the work head postures. (Surgitel area. A good declination angle will allow Micro250 loupes shown). the clinician to work with a more upright, neutral neck posture (less than 20 degrees of forward neck posture). Flip-up style loupes tend to have a better declination angle than through-the-lens models (Figure 4), but have not been as popular among hygienists due to their weight. Fortunately, new lighter-weight flip-up models are now available (such as Surgitel Micro250) that rival the weight of through-the-lens models and enable excellent working posture. 4) 12 O’Clock Access. The 12 o’clock position allows the dental hygienist the most neutral posture. Since a majority of the hygienist’s treatment should be from this position, it is critical to enable access in this position. There should be at least 22 inches’ clearance between the end of the headrest (reclined position) and the counter. If there is less, try swiveling the patient chair using the foot lever at the base of the chair. If this still does not enable enough room for easy access in the 12 o’clock position, consider also sliding the patient chair (toward the foot of the patient) until the required space criteria is met. If an electrical box is blocking the pedestal of the chair and keeping it from sliding, contact the dental supplier who installed the chair. 5) Retrofit Older Operator Stools. The benefits of a tilting seat on your operator stool are numerous. A flat seat tends to cause your pelvis to roll backward, which flattens your lumbar spine and can predispose it to injury. 11,29-30 Sitting with your thighs sloping slightly downward places the pelvis in a more neutral position and helps you maintain your lum-bar curve with less muscular effort. 24,31-32 You can retrofit your non-tilting operator stool with an ergonomic wedge cushion to gain the ergonomic benefits of a tilting seat pan for a fraction of the cost of a new stool (Figure 5). Sitting on the air-filled cushion also helps strengthen core stabiliz-ing muscles, a key to prevent-ing low back pain. Operator stools that are Figure 5. A non-tilting operator stool too tall or too short can wreak can be retrofitted with a wedge-shaped air filled cushion to attain a havoc on your spinal health. safer working posture. If, at the lowest adjustment, you cannot sit all the way back on the seat, but are forced to perch on the edge of the seat, you should consider ordering a short cylinder from the manufacturer. On the other hand, if, at the highest adjustment, your thighs are still parallel to the floor, and not sloping slightly downward, you should request a tall cylinder. Most manufacturers will swap these out at no cost if the stool is fairly new. 6) Lefties and Special Delivery. Perhaps the most challenging ergonomic scenario is a left-handed hygienist working in a right-handed operatory (or vice-versa!). Lefties should look for a dental practice that has treatment rooms designed for left-handed clinicians or equipment that is ambidextrous. Over-the-patient delivery systems can usually convert from right to left-handedness. Counter-mounted and built-in side deliveries can pose a problem when encountered by a left-hander. Ultrasonics that are located in right-sided all-in-one units may also be problematic for left-handed users. Insufficient or poorly located instrument trays in the operatory can cause excessive reaching and twisting to one side. Possibilities for ret-rofitting the operatory for a leftie and bringing equipment into closer proximity include a pole-mounted extension arm shelf (picture) or a mobile cart, if operatory space allows (Figure 6). Figure 6. A pole-mounted extension arm shelf can bring equipment into closer proximity and improve ergonomics for left-handed hygienists. 7) See the light. Shadowing of the tooth surface can lead to contorted, leaning postures. The light source in the operatory should parallel the dental hygienist’s line of sight as closely as possible to prevent shadowing (Figure 7). 33 This means the light should be placed slightly behind and to one side of the hygienist’s head. However, many overhead lights (especially those mounted on old ceiling tracks and pole-mounted models) do not extend far enough to accommodate this guideline. In this case, hygienists may purchase their own head-mounted light to prevent shadowing. Many hygienists find that head-16 JUL 2012 access
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