Back Care & Ergonomics

Back Care & ErgonomicsPatient Positioning, Clinician Positioning, Direct and Indirect Vision, Posturedontics, Simple StretchingGood morning everyone! My name is Salem Qahtani and Im a __________ dental hygiene student.

Today well talk about back care and ergonomics. In the lecture given by Dr. _________, weve seen that 64% of dentists and 93% of hygienists suffer from Musculoskeletal pain. So Well focus on taking care of our backs to prevent upper body and back pain. So how do we take care of our backs? Thats what we are going to discuss today. Today, we will look into some important clinical skills such patient positioning, clinician positioning, direct and indirect vision, posturedontics and simple stretching. These skills are very important in preventing upper body and back pain.

1Patient PositioningLets start with a brief discussion about patient positioning. 2Patient PositioningThere are four basic positions that we can use for the delivery of care.

The upright position is the patients position before starting the treatment. It should be at the clinicians eye level when conversing with the patient. At the end of the treatment, the patient is also returned to this position. The second one is the semi-upright or semi-supine position. This is for patients with cardiovascular, respiratory, or vertigo problems. The supine position, on the other hand is the most frequently used position during treatment procedures, In this position, the brain is on the same level as the heart to support circulation. Lastly, in the trendelenburg, the patient starts in the supine position and is then tipped back and down 35 degrees to 45 degrees placing the heart higher than the head. This position is the emergency position used when the patient is approaching syncope

3Patient Positioning

Lets take a closer look at the supine position because this is the most common position during dental treatment. In this position, the body is slightly higher than the tip of the nose to maintain a good blood flow to the head. The top of the head should be placed even with the upper edge of the headrest and the headrest should be aligned so the neck and head are aligned with the torso.

Patient head position is very important because it affects the accessibility of the different areas of the mouthFor example if you want to check the mandibular areas of the mouth, we ask the patient to open his mouth and tilt his chin down. And we will adjust the headrest accordingly.For the maxillary areas, we ask the patient to tilt his chin up and adjust the headrest accordingly.

Patient Head PositionPosition on HeadrestTop of the patients head must be even with end of the headrestMandibular AreasAsk your patient to open mouth and tilt the head downward (chin-down position) Tilt up the HEADRESTMaxillary Areas Ask your patient to open mouth and position the head in neutral position (chin-up position)TiIt down the headrest

4Patient Positioning: Maxillary ArchWhen positioning the patient to treat the maxillary area, the patients feet should be even with or slightly higher than the tip of his orher nose. The chair back should be nearly parallel to the floor for maxillary treatment areas.Meanwhile, the top of the patients head should be even with the upper edge of theheadrest. You can ask the patient to slide up in the chair to assume this position.The headrest on the other hand can be adjusted that the patients head is in a chin-up position, with the patientsnose and chin level. 5Patient Positioning: Mandibular ArchTo treat the mandibular arch, the patient is positioned slightly different from the position to treat maxillary areas. Like in maxillary areas, the feet should be even or slightly higher than the tip of the nose; and the top of the patients head should be even with the upper edge of the However, the chair should be slightly raised above the parallel position at a 1520angle to the floor. Then the headrest is slightly raised so that the patients head is in a chin-down position,with the patients chin lower than the nose. 6Clinician PositioningThis time lets look at how we can position ourselves as the clinician. Proper positioning is very important to avoid musculoskeletal disorders. 7Musculoskeletal DisordersLets digress for a while to talk about musculoskeletal disorders.

So what are musculoskeletal disorders? These are conditions where parts of the musculoskeletal system are injured over time especially when the part is repeatedly overused.The most commonly affected parts are our hands, wrists, elbows, neck, and shoulders.

8Risk factors for MSDs (TENTATIVE)What are the risk factors for these MSDs? We have fixed working position,

Now lets look at some common MSDs.

9Common Musculoskeletal Disorders for Healthcare ProvidersHere are some common MSDs for healthcare providers like us. We have the thoracic outlet syndrom, the rotator cuff tendinitis, the pronator syndrome, the extensor wad strain, the carpal tunnel syndrome, the ulnar nerve entrapment, tenosynovitis and tendinitis. 10Common Musculoskeletal Disorders for Healthcare ProvidersLets take a closer look at one of the most common MSDs. The carpal tunnel. When we repeatedly bend the hand up, down, or from side to side at the wrist and continuously pinch-gripping an instrument without resting the muscles, we get the carpal tunnel syndrome. However, just poor posture can result to this syndrome.

Its symptoms are Numbness, pain, and tingling in the thumb, index,and middle fingers

11Prevention of MSDsNow, how can we prevent MSDs? We can do it through ergonomics and postural and positional factors.

12ErgonomicsSo ergonomics tells us what to do and what not to do. First we need to maintain a neutral, balanced body position then change patients chair and dental equipment to complete periodontal instrumentation.Then we use neutral spine position to maintain the natural curve of the spine.

It also tells us not to position ourselves or our equipment uncomfortably just so we could finish the job. We should also keep in mind that IT IS NOT OK to keep an awkward position even for just 15 minutes.

13Neutral PositioningIn the neutral head position, the line from the eyes to the treatment area should be as near to vertical as possible. We should avoid tipping our head too forward or tilting to one side. The back should be slightly leaning fowrward from the hips with the trunk flexing from 0 to 20 degrees. We should always avoid curving our backs. The neutral torso position is when the torso is in line with the long axis of the body. We avoid leaning to one side or twisting our torso. The shoulders should be in horizontal line with the weight evenly balanced when seated. We shouldnt lift them up towards our ears, hunch forward or sit with one hip. 14Neutral PositioningThe upper arm, in the neutral position, should hang parallel to the long axis of the torso with the elbows at waist level held ONLY slightly away. The elbow abduction should not be more than 20 degrees nor should the elbows be held above the waist level. Meanwhile, the forearm should be held parallel to the floor. When raising or lowering the forearm, we should pivot it at the elbow joint. AS much as possible, we should avoid forming angles between the forearm and upper arm that are lower that 60 degrees. Lastly, the little finger-side of the palm should always be slightly slower than the thumb-side with the wrist aligned to the15Clinician and Equipment PositionNow, lets look at the steps in assuming the neutral position. First, we adjust the height of the clinician chair to establish a 90 degree hip angle. Then we lower the patient chair until the tip of the patients nose is below the clinicians waist level. Always remember that the elbow angle should be at 90 degrees when the fingers are touching the patients teeth. A common error made by most clinicians is that the patient is too high in relation to the clinician.We should also remember that we must NEVER pace our legs under the back of the patients chair.

Now heres a technique we can use: we sit alongside the patient while placing our arms on our sides. Then we cross it at the waist level. Then we should adjust our chair so that the patients mouth is below the elbow point.

16Clinician and Equipment PositionEarlier, we looked into how we can position the patient when accessing the mandibular and the maxillary areas. This time, lets see how we can position the equipment to access these areas. For the mandibular teeth, the dental light should be placed directly and as far above the patients head. The bracket table, on the other hand is positioned as low as possible to easily view the instruments. Meanwhile, we adjust the patients chair so that the elbow angle is 90 degrees when the finger are resting on mandibular teeth.

For the maxillary teeth, the dental light is positioned above patients chest and as far away from patients face. Then we tilt the light so the light beams shine into patients mouth at an angle. The patient chair is lowered until the elbow angle is 90 degrees when fingers rest on maxillary teeth

17Clinician and Equipment PositioningSequence for PositioningSo lets take a quick look on the sequence for positioning . First is ME: We assume clock position for the treatment areaNext is MY PATIENT: We establish the patient chair and head positionThen, MY EQUIPMENT is positioned properly. We adjust the unit light. Pause and self-check the clinician, patient and the equipment positionNext is MY NONDOMINANT HAND. Finally, my dominant hand. 18Clock Positions for Right-handed clinicianSo here are some illustrations showing the different clock positions for a right handed clinician. We have the8 oclock, 9 oclock, 10 oclock, and12 oclock

19Clock Positions for Left-handed ClinicianAnd here are some illustrations showing the different clock positions for a left handed clinician. We have the 4 oclock3 oclock, 2 to 1 oclock, and the 12 oclock

20Positioning Summary for Left-Handed Clinician

Now, here is a table showing the positioning summary for the left handed, 21Positioning Summary for Right-Handed Clinician

And the right handed clinician. These tables show the treatment area, clock position and the patient head position. If you want a copy of this summary, please feel free to download this presentation as it will be posted on the blackboard.22ExerciseSee and check each photo for clinician, patient and equipment position. For incorrect positioning element, describe how the problem could be corrected.Now, lets do an exercise. Here is a photo showing the patients, the clinicians and the equipments positions. Lets analyze this picture and see whether or not they are positioned correctly. If not, lets describe how it can be corrected. 23Direct and Indirect VisionIndirect VisionIndirect vision: observation of reflected image when direct vision is impaired or impractical; visualization of lingual of mandibular posteriors, distal of maxillary posteriors, etc. (Fehrenbach 401)Fehrenbach, Margaret J., Jane Weiner. Saunders Review of Dental Hygiene, 2nd Edition. Saunders Book Company, 2009. VitalBook file.The citation provided is a guideline. Please check each citation for accuracy before use.

http://www.highbeam.com/doc/1G1-314651000.html

25Simple Stretching and PosturedonticsSimple Stretching27Chairside StretchingStretching During MicrobreaksHow to Stretch SafelyPosturedonticsPosturedonticsHealthy spine requires flexibility. To achieve a healthy spine we should encourage movement in all directions. Overusing one area limits movement and affects other areas affecting blood flow and oxygenation. Chronic poor postural habits nerve impingement chronic pain/ injury Daily functional movement exercises for the spine and other joints A preventive strategy for all dental personnel.Designed to create functional movement patternsFocus on muscles with occupational demandsEncourage full range of movements for jointsSupport the natural curves of the spineCan be done during clinical hours; chairside between patients; at home

31PosturedonticsChronic poor postural habits nerve impingement chronic pain/ injury Daily functional movement exercises for the spine and other joints A preventive strategy for all dental personnel.Designed to create functional movement patternsFocus on muscles with occupational demandsEncourage full range of movements for jointsSupport the natural curves of the spineCan be done during clinical hours; chairside between patients; at home

32Posturedontics Daily functional movement exercises for the spine and other joints A preventive strategy for all dental personnel.Designed to create functional movement patternsFocus on muscles with occupational demandsEncourage full range of movements for jointsSupport the natural curves of the spineCan be done during clinical hours; chairside between patients; at home

33Posturedontics

Posturedontics

Posturedontics

Posturedontics

Posturedontics

ReviewClinical Case

Scenario: A dental hygienist is on the first day of his new position at a large dental clinic. Before taking this new position, he was the only dental hygienist for over 10 years at the same small dental practice after graduating top of his class at age 20. He notices that he is unable to put his feet on the floor when he sits on the stool provided for him. He also has trouble instrumenting the lower arch; it just seems there is not enough overhead light, especially on the lingual of the anteriors. He also wants to get closer to his patients; he has forgotten what the effective distance to a patient's mouth is. At the end of the day he notices that his back hurts. He is worried about what this means to his future in his profession.

1.What factors does the dental hygienist need to consider in order to discover why he is having a backache?

2.What could he have done to help with overhead lighting during instrumentation of the mandibular arch, especially the lingual of the anteriors?

3.What is the distance he should have maintained to his patient's mouths? What can he do if this distance seems too far away?

4.If this situation continues for many years without any changes to his way of practice, what could the outcome be for him?

ReferencesDental Economics. (n.d.). Retrieved July 29, 2014, from It's a S-t-r-e-t-c-h: http://www.dentaleconomics.com/articles/print/volume-98/issue-5/columns/preventing-pain-in-dentistry/it39s-a-s-t-r-e-t-c-h.htmlEsther, M. W., & Charlotte, R. (2008). Clinical Practice of Dental Hygiene. Lippincott Williams & Wilkins.Fehrenbach, M. J., & Weiner, J. (2009). Saunders Review of Dental Hygiene. Saunders Book Company.