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CHAIR POSITION

Presented by—Hemam Shankar Singh

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CONTENTS1. INTRODUCTION2. CHAIR AND PATIENT POSITIONS

UPRIGHT POSITION ALMOST SUPINE RECLINED 45 DEGREE

3. OPERATING POSITION RIGHT FRONT POSITION (7 O'CLOCK) RIGHT POSITION (9 O'CLOCK) RIGHT REAR POSITION (11 O'CLOCK) DIRECT REAR POSITION (12 O'CLOCK)

4. CONSIDERATIONS FOR DENTISTS WHILE DOING PATIENT5. SEQUENCE FOR PRACTICING POSITIONING

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INTRODUCTION

CHAIR AND PATIENT POSITIONS ARE IMPORTANT CONSIDERATIONS. MODERN DENTAL CHAIRS ARE DESIGNED TO PROVIDE TOTAL BODY SUPPORT IN ANY CHAIR POSITION.

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INTRODUCTION• CHAIR POSITION IS A VERY IMPORTANT ASPECT IN THE

SUCCESS OF A DENTAL TREATMENT.• THE CORRECT POSITIONING HELPS THE OPERATOR TO

HAVE A GOOD VISIBILITY AND ACCESSIBILITY OF THE ORAL CAVITY

• PROPER POSITIONING OF THE PATIENT AND THE OPERATOR, ILLUMINATION AND RETRACTION FOR OPTIMAL VISIBILITY ARE THE FUNDAMENTAL PRE-REQUISITES TO PROPER DENTAL TREATMENT

• IF OPERATOR MAINTAINS PROPER POSITION AND POSTURE DURING TREATMENT, THE OPERATOR IS LESS LIKELY TO GET STRAIN, FATIGUE, BE MORE EFFICIENT AND LESS CHANCES OF GETTING MUSCULOSKELETAL DISORDERS.

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FOLLOWING POINTS SHOULD BE KEPT IN MIND IN RELATION TO DENTAL CHAIR:

IT SHOULD BE ABLE TO PROVIDE COMFORT TO THE PATIENT IT SHOULD BE ABLE TO PROVIDE TOTAL BODY SUPPORT HEADREST OF CHAIR SHOULD BE ATTACHED FOR SUPPORTING PATIENT'S CHIN AND REDUCING STRAIN ON

CHIN MUSCLES IT SHOULD BE ABLE TO PROVIDE MAXIMUM WORKING AREA TO THE OPERATOR IT SHOULD BE PLACED AT THE CONVENIENT LOCATION WITH

ADJUSTABLE CONTROL SWITCHES FOOT SWITCHES ARE PREFERRED TO IMPROVE INFECTION

CONTROL

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PATIENT POSITIONS• VL

• PATIENT SHOULD BE SEATED SO THAT ALL HIS BODY PARTS ARE WELL SUPPORTED.

• THE PATIENT'S HEAD SHOULD ALWAYS BE SUPPORTED BY ADJUSTABLE/ ARTICULATED HEADREST.

• PREFERABLY THE PATIENT'S HEAD SHOULD BE IN LINE WITH HIS BACK .

• THE CHAIR HEIGHT SHOULD BE KEPT LOW, BACKREST SHOULD BE UPRIGHT AND ARMREST SHOULD BE ADJUSTABLE WHILE MAKING THE PATIENT TO SEAT IN THE DENTAL CHAIR.

• NOW, THE CHAIR CAN BE ADJUSTED TO PLACE THE PATIENT IN RECLINING POSITION.

• PATIENT POSITION CAN VARY WITH OPERATOR, TYPE OF PROCEDURE AND AREA OF THE ORAL CAVITY.

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FOR RESTORATIVE DENTAL PROCEDURES, THE MOST PREFERRED OPERATING POSITIONS ARE:

1. UPRIGHT POSITION2. ALMOST SUPINE3. RECLINED 45 DEGREE

THE MOST COMMON PATIENT POSITIONS FOR OPERATIVE DENTISTRY ARE ALMOST SUPINE OR RECLINED 45 DEGREES. THE CHOICE OF PATIENT POSITION VARIES WITH THE OPERATOR, THE TYPE OF PROCEDURE, AND THE AREA OF THE MOUTH INVOLVED IN THE OPERATION.

CHAIR POSITIONS

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UPRIGHT POSITIONTHIS IS THE INITIAL POSITION OF CHAIR FROM WHICH FURTHER ADJUSTMENTS ARE MADE

Chair position

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ALMOST SUPINE• IN THIS , CHAIR POSITION IS SUCH THAT HEAD, KNEES AND FEET ARE APPROX. AT SAME LEVEL• PATIENT’S HEAD SHOULD NOT BE LOWER THAN FEET EXCEPT IN CASE OF SYNCOPAL ATTACK

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REECLINED 45 DEGREESIN THIS POSITION , CHAIR IS RECLINED AT 45 DEGREEMANDIBULAR OCCLUSAL SURFACE ARE ALMOST 45 DEGREE TO THE FLOOR

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OPERATING POSITIONSONCE THE PATIENT HAS BEEN COMFORTABLY POSITIONED, THE DENTIST AND THE ASSISTANT SHOULD SIT THEMSELVES IN THE PROPER POSITIONS FOR TREATMENT.

USUALLY SITTING POSITION IS PREFERRED IN MODERM DENTISTRY TO RELIEVE STRESS ON OPERATOR'S LEG AND SUPPORT THE OPERATOR'S BACK.

THE LEVEL OF TEETH BEING TREATED SHOULD BE PLACED AT SAME LEVEL AS THE LEVEL OF OPERATOR'S ELBOW.

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FOR BETTER UNDERSTANDING, SITTING POSITIONS OF OPERATOR ARE RELATED TO A CLOCK. IN THIS CLOCK CONCEPT, AN IMAGINARY CIRCLE IS DRAWN OVER THE DENTAL CHAIR, KEEPING THE PATIENT'S HEAD AT THE CENTER OF THE CIRCLE.

THEN THE NUMBERING TO CIRCLE IS GIVEN SIMILAR TO A CLOCK WITH THE TOP OF THE CIRCLE AT 12 O'CLOCK.

ACCORDINGLY THE OPERATOR'S POSITIONS (RIGHT HANDED OPERATOR) 7 O'CLOCK, 9 O'CLOCK, 11 O'CLOCK, AND 12 O'CLOCKLEFT HANDED OPERATOR'S POSITIONS , 5 O'CLOCK, 3 O'CLOCK AND 1 O'CLOCK .

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RIGHT FRONT POSITION (7 O'CLOCK) 1. IT HELPS IN EXAMINATION OF THE

PATIENT2. WORKING AREAS INCLUDE:

a) MANDIBULAR ANTERIORb) MANDIBULAR POSTERIOR

TEETH (RIGHT SIDE)c) MAXILLARY ANTERIOR TEETH

3. TO INCREASE THE EASE AND VISIBILITY, THE PATIENT'S HEAD MAY BE TURNED TOWARDS THE OPERATOR.

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RIGHT POSITION (9 O'CLOCK) 1. IN THIS POSITION, DENTIST SITS

EXACTLY RIGHT TO THE PATIENT2. WORKING AREAS INCLUDE:

a) FACIAL SURFACES OF MAXILLARY RIGHT POSTERIOR TEETH

b) FACIAL SURFACES OF MANDIBULAR RIGHT POSTERIOR TEETH

c) OCCLUSAL SURFACES OF MANDIBULAR RIGHT POSTERIOR TEETH.

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RIGHT REAR POSITION (11 O'CLOCK) 1. IN THIS POSITION, DENTIST SITS BEHIND

AND SLIGHTLY TO THE RIGHT OF THE PATIENT AND THE LEFT ARM IS POSITIONED AROUND PATIENT'S HEAD

2. THIS IS PREFERRED POSITION FOR MOST OF DENTAL PROCEDURES

3. MOST AREAS OF MOUTH ARE ACCESSIBLE FROM THIS POSITION EITHER USING DIRECT OR INDIRECT VISION

4. WORKING AREAS INCLUDE:a) PALATAL AND INCISAL (OCCLUSAL)

SURFACES OF MAXILLARY TEETHb) MANDIBULAR TEETH (DIRECT VISION).

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DIRECT REAR POSITION (12 O'CLOCK) 1. DENTIST SITS DIRECTLY BEHIND THE

PATIENT AND LOOKS DOWN OVER THE PATIENT'S HEAD DURING PROCEDURE.

2. WORKING AREAS ARE LINGUAL SURFACES OF MANDIBULAR TEETH.

3. THIS POSITION HAS LIMITED APPLICATION.

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RIGHT HANDED OPERATOR—3 PREFERRED POSITIONS

LEFT HANDED OPERATOR—3 PREFERRED POSITIONS

7 O’CLOCK 5 O’CLOCK

9 O’CLOCK 3 O’CLOCK

11 O’CLOCK 1 O’CLOCK

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1. WHILE DOING WORK IN MAXILLARY ARCH, MAXILLARY OCCLUSAL SURFACES SHOULD BE PERPENDICULAR TO THE FLOOR.

2. IN MANDIBULAR ARCH, MANDIBULAR OCCLUSAL SURFACE SHOULD BE ORIENTED 45° TO THE FLOOR.

3. PATIENT'S HEAD CAN BE ROTATED BACKWARD OR FORWARD OR FROM SIDE TO SIDE FOR OPERATORS EASE AND VISIBILITY WHILE DOING WORK.

4. MAINTAIN PROPER WORKING DISTANCE DURING DENTAL PROCEDURE. THIS WILL LEAD TO INCREASE COOPERATION AND CONFIDENCE AMONG THE PATIENT.

5. OPERATOR SHOULD NOT REST FOREARMS ON THE PATIENT'S SHOULDERS AND HANDS ON THE FACE OF THE PATIENT.

CONSIDERATIONS WHILE DOING PATIENT

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6. DENTIST SHOULD NOT USE PATIENT'S CHEST AS A INSTRUMENT TROLLEY.

7. THE OPERATOR SHOULD LEAVE LEFT HAND FREE DURING MOST OF DENTAL PROCEDURES FOR RETRACTION USING MOUTH MIRRORS OR FINGERS OF LEFT HAND.

8. OPERATOR SHOULD KEEP CHANGING POSITION IF PROCEDURE IS OF LONG DURATION TO DECREASE THE MUSCLE STRAIN AND FATIGUE.

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FOR SUCCESSFUL INSTRUMENTATION, IT IS IMPORTANT TO PROCEED IN A STEP-BY-STEP MANNER. A USEFUL SAYING TO HELP YOU REMEMBER THE STEP-BY-STEP APPROACH IS “ME, MY PATIENT, MY LIGHT, MY NON-DOMINANT HAND, MY DOMINANT HAND.”

SEQUENCE FOR PRACTICING POSITIONING

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SEQUENCE FOR ESTABLISHING POSITION

1 ME.ASSUME THE CLOCK POSITION FOR THE TREATMENT AREA

2 MY PATIENT.ESTABLISH PATIENT CHAIR AND HEAD POSITION.

3MY EQUIPMENT.ADJUST THE UNIT LIGHT. PAUSE AND SELF-CHECK THE CLINICIAN, PATIENT, AND EQUIPMENT POSITION.

4MY NONDOMINANT HAND.PLACE THE FINGERTIPS OF MY NONDOMINANT HAND AS SHOWN IN THE ILLUSTRATION FOR THE CLOCK POSITION.

5MY DOMINANT HAND.PLACE THE FINGERTIPS OF MY DOMINANT HAND AS SHOWN IN THE ILLUSTRATION FOR THE CLOCK POSITION.

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• WHEN WORKING ON ANTERIOR SEXTANTS, YOUR LEFT HAND (NON-DOMINANT HAND) AND YOUR RIGHT HAND (DOMINANT HAND) ARE POSITIONED ON OPPOSITE SIDES OF THE PATIENT’S MOUTH.

• ANTERIOR SURFACES TOWARD MY NON-DOMINANT HAND—THE COLORED ANTERIOR SURFACES IN THIS ILLUSTRATION.

• ANTERIOR SURFACES AWAY FROM MY NON-DOMINANT HAND—THE WHITE ANTERIOR SURFACES IN THIS ILLUSTRATION.

POSITIONING TERMINOLOGY

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POSTERIOR ASPECTS FACING TOWARD ME—THE COLORED POSTERIOR SURFACES IN THIS ILLUSTRATION.

• MAXILLARY RIGHT POSTERIOR SEXTANT, FACIAL SURFACES• MAXILLARY LEFT POSTERIOR SEXTANT, LINGUAL SURFACES• MANDIBULAR RIGHT POSTERIOR SEXTANT, FACIAL SURFACES• MANDIBULAR LEFT POSTERIOR SEXTANT, LINGUAL SURFACES

POSITIONING TERMINOLOGY

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POSTERIOR ASPECTS FACING AWAY FROM ME—THE COLORED POSTERIOR SURFACES IN THIS ILLUSTRATION.

• MAXILLARY LEFT POSTERIOR SEXTANT, FACIAL SURFACES• MAXILLARY RIGHT POSTERIOR SEXTANT, LINGUAL SURFACES• MANDIBULAR LEFT POSTERIOR SEXTANT, FACIAL SURFACES• MANDIBULAR RIGHT POSTERIOR SEXTANT, LINGUAL SURFACES

POSITIONING TERMINOLOGY

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ARCH TREATMENT AREA CLOCK POSITION

HEAD POSITION

MANDIBULAR ARCH

ANTERIOR SURFACES TOWARD MY NON-DOMINANT HAND

8–9 SLIGHTLY TOWARD, CHIN DOWN

ANTERIOR SURFACES AWAY FROM MY NON-DOMINANT HAND

12 SLIGHTLY TOWARD, CHIN DOWN

MAXILLARY ARCH

ANTERIOR SURFACES TOWARD MY NON-DOMINANT HAND

8–9 SLIGHTLY TOWARD, CHIN UP

ANTERIOR SURFACES AWAY FROM MY NON DOMINANT HAND

12 SLIGHTLY TOWARD, CHIN UP

MANDIBULAR ARCH

POSTERIOR ASPECTS FACING TOWARD ME (RIGHT FACIAL AND LEFT LINGUAL)

9 SLIGHTLY AWAY, CHIN DOWN

POSTERIOR ASPECTS FACING AWAY FROM ME (RIGHT LINGUAL AND LEFT FACIAL)

10–11 TOWARD, CHIN DOWN

MAXILLARY ARCH

POSTERIOR ASPECTS FACING AWAY FROM ME (RIGHT LINGUAL AND LEFT FACIAL)

10–11 TOWARD, CHIN UP

POSTERIOR ASPECTS FACINGTOWARD ME (RIGHT FACIAL AND LEFT LINGUAL)

9 SLIGHTLY AWAY, CHIN UP

POSITION FOR THE RIGHT-HANDED

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POSITIONING FOR THE ANTERIORAnterior Surfaces TOWARD My Non-dominant Hand

7 TO 9 O’CLOCK (8:00 OPTION SHOWN)TURNED SLIGHTLY TOWARD THE CLINICIANCHIN-DOWN POSITION

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POSITIONING FOR THE ANTERIORAnterior Surfaces TOWARD My Non-dominant Hand

7 TO 9 O’CLOCK (9:00 OPTION SHOWN)TURNED SLIGHTLY TOWARD THE CLINICIANCHIN-UP POSITION

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POSITIONING FOR THE ANTERIORAnterior Surfaces AWAY From My Non-dominant Hand

12 O’CLOCK POSITION TURNED SLIGHTLY TOWARD THE CLINICIANCHIN-DOWN POSITION

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POSITIONING FOR THE ANTERIORAnterior Surfaces AWAY From My Non-dominant Hand

12 O’CLOCK POSITION TURNED SLIGHTLY TOWARD THE CLINICIANCHIN-UP POSITION

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POSITIONING FOR THE POSTERIORPosterior Aspects Facing TOWARD Me

9 O’CLOCK (OPTION 1 FOR 9:00) TURNED SLIGHTLY AWAY FROM THE CLINICIANCHIN-DOWN POSITION

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POSITIONING FOR THE POSTERIORPosterior Aspects Facing TOWARD Me

9 O’CLOCK (OPTION 2 FOR 9:00)TURNED SLIGHTLY AWAY FROM THE CLINICIANCHIN-UP POSITION

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POSITIONING FOR THE POSTERIORPosterior Aspects Facing AWAY From Me

10 TO 11 0’CLOCKTURNED TOWARD THE CLINICIANCHIN-DOWN POSITION

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POSITIONING FOR THE POSTERIORPosterior Aspects Facing AWAY From Me

10 TO 11 0’CLOCKTURNED TOWARD THE CLINICIANCHIN-UP POSITION

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CONCLUSION

Proper use of the chair positions as according to the relative operating areas helps the operator to complete the procedure without delayed. it also reduces the chances of causing musculoskeletal disorders.

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