CDA Essentials 2019 • Volume 6 • Issue 3

32 | 2019 | Issue 3 I ssues and P eople W hy is ergonomics a persistent challenge in dentistry? Ergonomics is the relationship between humans and their environment, between people and their work. In clinical dentistry, the presumption used to be that back, neck and shoulder problems for dentists, hygienists and assistants, were simply a given if you practised dentistry. We’ve come a long way. But unfortunately, equipment is still being chosen, installed and utilized in ways that are based on old conventions. Clinics are complex environments; we have a combination of equipment designed by different manufacturers, designed for use in a physical space that may be different from the space where it’s installed. Add to that the complexity of personnel working together, whether it’s in serial fashion (when operatories are used on different days by different clinicians) or simultaneously. It means that all clinicians in the practice—dentists, hygienists and assistants—have to troubleshoot the manner in which they work. That can be challenging for people who are often driven by a sense of urgency. W hat factors should the dentist in this particular scenario consider? A key point is that the entire dental team needs to be open- minded about changes involving ergonomic optimization within a practice. It needs to be a cooperative venture. I’ve done ergonomic consultations for practices in which the dentist refused to make changes when the hygienists or assistants have had problems with the equipment. I’ve also seen it the other way around when the dentist was convinced that the assistants needed to make changes, but then the assistants say they don’t think they could work that way. H ow should the dental assistant in this scenario address the issue? It’s important for people to take responsibility for their health and enlighten themselves about ergonomics. It needs to be an ongoing discussion within the dental team because our knowledge base changes and factors within practices change. It’s important that communication goes both ways. I know for some practices and some people it can be problematic to raise issues because there is the employer-employee relationship that’s continually shadowing the conversations, but this is about health— health of the dentists, and of the employees, and the health of the patients. H ow should the assistant in this scenario properly position to work with the dentist? The primary factor that affects an optimal working relationship between the dentist and the assistant is related to vantage. This depends, in part, on how close the axes of their upper bodies align with access to the oral cavity, and their position relative to each other. A useful rule of thumb is that the dental assistant should sit about 5 to 6 inches higher—eye to eye—than the dentist. Sadly, many pieces of furniture used by assistants are still not readily height adjustable. And many of them do not have an adjustable-height foot platform. I go into many offices where the foot ring for the assistants has a simple mechanical tightener that has often been discarded, or if it does move up and down, it doesn’t lock its position very well. An important consideration, for both the dentist and assistant, is their relationship to their optimal control point, which is where their hands should be positioned and the zone where the patient’s oral cavity should be positioned. The optimal control point is roughly at the clinician’s heart height and in the midsagittal plane of the clinician’s body. Some people still incorrectly work with their forearms parallel to the floor because axioms from the past, when dentists first started sitting down to practise, dictated that thighs and forearms should be parallel to the floor. We now know that this created many problems in terms of circulation in the legs and low back pain, which required firm lumbar supports for prevention. Frankly, for both dentist and assistant stools, arguments can be made for no lumbar support. If the seat can be adjusted easily to a proper range of seating heights, the back of the stool is simply a handle to move the chair around; it’s not actually supporting the lumbar region of the clinician’s back, nor should it be. • Healthy Workplace Series •