INSTITUTE FOR ENVIRONMENT, SAFETY AND OCCUPATIONAL HEALTH RISK ANALYSIS

Ergonomic Applications to
Dental Practice

Ir. Sudiyono Kromodihardjo MSc. PhD

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Overview
What is Ergonomics?
What are the Consequences of Poor
Ergonomics?
What Policies/Standards Address
Ergonomics?
How can Ergonomic Principles Be
Applied to Dental Practice?

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What is Ergonomics?

Job
Characteristics

Human
Capabilities

ERGONOMICS is a way to work smarter--not

harder by designing tools, equipment, work stations
and tasks to fit the job to the worker--NOT the
worker to the job

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Ergonomics
Relationship between humans, the tasks
they perform, and the environment in which
tasks are performed.
Equipment-centered Ergonomics: Human
Adaptation to Requirements of Equipment.
Human-centered Ergonomics: Equipment is
adapted to Requirements of Humans.

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Humans Do Dentistry
Not Equipment
Priority: Human Factors and the Way We Work

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Ergonomic Design Goals

Improve job process by eliminating unnecessary

tasks, steps & effort
Reduce potential for overexertion injury
Minimize mental / physical fatigue potential
Leverage workers skills / knowledge of their
jobs to re-design work to increase their
satisfaction, comfort, morale and fulfillment

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Consequences of Poor Design

Discomfort Chronic Pain
Accidents Injuries
Fatigue Increased Errors
Work-Related Musculoskeletal
Disorders (WMSDs)
Low back pain
Tendonitis
Epicondylitis
Bursitis
Carpal tunnel syndrome

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U.S. Navy Ergo-Injuries

Compensation Cases FY89 - FY97
24,000

Ergonomic Related Cases

Non Ergonomic Related Cases

Number of Cases

20,000
16,000
12,000
8,000
4,000
FY89

FY90

FY91

FY92

FY93

FY94

FY95

FY96

FY97

Non Ergonomic Related Cases Declined

Source: OSHSYS RAW DATA FY 89 to FY 97

Ergonomic - Carpal Tunnel

Syndrome, Chrondromalacia,
Back Strain, Multiple Strain

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?
?

WMSDs in Dentistry

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Studies have shown

75%
of dentists & hygienists suffer
from musculoskeletal disorders
that affect occupational health
& the quality of practice life

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WMSDs in Dentistry
Reasons for Early Retirement Among Dentists
Musculoskeletal Disorders (29.5%)
Cardiovascular Disease (21.2%)
Neurotic Symptoms (16.5%)
Tumors (7.6%)
Diseases of the Nervous System (6.1%)
Source: Burke et al., 1997

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% Reporting

WMSD Symptoms Among

Dentists
80%
70%
60%
50%
40%
30%
20%
10%
0%

Males
Females

Body Part

Source: Finsen et al., 1998

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WMSD Symptoms Among

Dental Hygienists
% Reporting

Dental Hygienists

Dental Assistants

80
70
60
50
40
30
20
10
0
* Diagnosed * Hand-wrist * Shoulder
CTS
pain
pain

* Neck pain

Low Back
pain

* indicates difference is significant

Source: Liss et al., 1995

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Imagine
Dental practice
without the compromise of your health,
the quality of care you provide,
& the quality of practice life you deserve.

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Imagine
Dental practice
free from back, neck & shoulder pain
that afflict so many clinicians every workday.

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Imagine
Reaching your peak performance potential
while you work comfortably,
with energy & enthusiasm left over
at the end of the day.

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What Factors Contribute to WMSDs?

Repetitive motions (e.g., scaling, polishing)

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What Factors Contribute to WMSDs?

Static neck, back, and shoulder postures

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What Factors Contribute to WMSDs?

Grasping small instruments for prolonged periods

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What Factors Contribute to WMSDs?

Prolonged use of vibrating hand tools

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Applying Ergonomics Principles

to Dental Work
Tools/Instruments
Workstations
Work Practices

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Ergonomics in Dentistry
Tool/Instrument Design
Goals: Reduce force exertion;
Maintain hand/wrist in neutral posture
Considerations:
Overall shape/size
Handle shape/size
Weight
Balance
Maneuverability
Ease of operation
Ease of maintenance

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Ergonomics in Dentistry
Hand Instruments
Look for:
Hollow or resin
handles
Round, knurled or
compressible handles
Carbon steel
construction (for
instruments with sharp
edges)

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Ergonomics in Dentistry
Automatic Handpieces
Look for:
Lightweight, balanced
models (cordless preferred)
Sufficient power
Built-in light sources
Angled vs. straight-shank
Pliable, lightweight hoses
Swivel mechanisms
Easy activation
Easy maintenance

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Ergonomics in Dentistry
Syringes and Dispensers
Look for:
Adequate lumen
size
Ease in cleaning
Knurled handles
(no finger cut-outs)
Easy activation and
placement

Ergonomics in Dentistry

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Magnification Systems
Goal: Improve neck posture; Provide clearer
vision
Consider:
Working distance
Depth of field
Declination angle
Convergence angle
Magnification factor
Lighting needs

Ergonomics in Dentistry

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Workstation Layout
Ensure:
Instruments,
materials, medications,
etc. are accessible while
seated
Hoses are positioned
away from the body
Set-up can be adapted
for different operators

Ergonomics in Dentistry

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Operator Chair
Goal: Promote mobility and patient access;
accommodate different body sizes
Look for:
Stability (5 legged base w/casters)
Lumbar support
Hands-free seat height adjustment
Adjustable foot rests
Adjustable, wrap-around body
support
Seamless upholstery

Ergonomics in Dentistry

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Patient Chair
Goal: Promote patient comfort; maximize
patient access
Look for:
Stability
Pivoting or drop-down arm
rests (for patient ingress/egress)
Supplemental wrist/forearm
support (for operator)
Articulating head rests
Hands-free operation

Ergonomics in Dentistry

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Posture/Positioning
Goal: Avoid static and/or awkward postures
Potential Strategies:
Position patient so that operators elbows are
elevated no more than 30 degrees.
Adjust patient chair when accessing different
quadrants
Alternate between standing and sitting

Ergonomics in Dentistry

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Work Practices
Goal: Maintain neutral posture, reduce force
requirements

Potential Strategies:
Ensure tools are sharpened, well-maintained
Use automatic handpieces instead of manual
instruments where possible
Use full-arm strokes rather than wrist strokes

Ergonomics in Dentistry

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Scheduling
Goal: Provide sufficient recovery time for staff
to avoid chronic muscular fatigue
Potential Strategies:
Increase treatment time for more difficult
patients
Alternate heavy and light calculus patients
within a flexible scheduling system
Vary procedures within the same appointment
Shorten patients recall interval

Ergonomics in Dentistry

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Prosthetics Labs
Naval Station Rota Spain Clinic Case Study: Lab techs
mentioned chronic back, shoulder & neck discomfort / pain
during periodic Industrial Hygiene survey from working at nonadjustable bench in obviously stressful static postures -- with no
forearm support nor bench edge padding

Ergonomics in Dentistry

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Prosthetics Labs
Naval Station Rota Spain Clinic Case Study -- Post intervention
improvements offered by Kavo ergonomic lab benches :
Lab techs affirm GREATLY increased comfort / decrease in back,
shoulder & neck discomfort / pain.

KAVO dental prosthesis lab benches offer ample forearm supports and workpiece
support centering prosthesis directly below technician which optimizes spinal / neck
/ head vertical alignment

Ergonomics in Dentistry

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Prosthetics Labs
Naval Station Rota Spain Clinic Case Study: Lab technicians now
work in optimized ergonomic posture. In addition to forearm
supports and central workpiece support (locally-ventilated for air
contaminant removal !) , the table also has much improved overhead
lighting, a magnifying lens and a drill speed control operated by the
techs right knee

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ERGONOMICS SUMMARY
Good ergonomic design of tools, processes
and furniture DOES improve personnel
comfort, health, morale, productivity and
readiness.
Individual effort as part of a workshop team
is the greatest means of identifying /
improving workplace ergonomic issues.
Its critical to seek prompt medical aid for
symptoms of ergonomic stress / CTDs

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Learn to Prevent or Reduce

Occupational Ailments
By the following

Self-derivation of a natural and comfortable posture for

comprehensive patient care

Positioning of patients to maintain posture and optimize visual and

physical control of intra-oral procedures

Operatory light positioning to provide adequate illumination from

one location with minimal adjustment

Correctly positioning the dental assistant for efficiency and

effectiveness in support of patient care

Positioning all equipment and instrument items in the operatory

proximal to the practitioner and the assistant to reduce unnecessary
exertion and fatigue

Learn to Prevent or Reduce

Occupational Ailments

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continued

Using instrument grips that ensure stabilization and control of

performance

Maximizing the potential of the mirror when direct vision

compromises posture

Selection of magnifying loupes that do not induce

musculoskeletal pain

Selection of equipment designed to optimize a comfortable

working environment

Using 5 movements for control of optimal posture in a 10-step

decision process that assures performance without compromise
of self, patient, or task