CDA Essentials 2019 • Volume 6 • Issue 3

33 Issue 3 | 2019 | I ssues and P eople W hat other factors should the dentist consider here? Sometimes when problems arise like the one described in the scenario, it can be prevented by something as simple as the dentist and assistant having a conversation about permission to make contact. But it’s a conversation that alarmingly few dentists and assistants have. However, if the assistant’s torso is an extra 4 inches away from the oral cavity access, it creates an inefficiency. In an optimized situation, the assistant is going to make some lateral contact, probably of his or her knee or thigh, with the side of the patient chair or with the knee or thigh of the dentist. If the assistant has to lean forward, even leaning on the stool’s belly band (which is very common practice) that’s a problem and we need to talk about it. Having a conversation about permission to make contact shifts the dynamic of how the dentist and assistant work together. A re there other situations where physical contact is needed for optimal positioning? People make presumptions about the need for personal space, with either their clinical partner or patient, and so avoid making contact to stabilize their position. Things can take a sideways turn because of that presumption. For example, one of the ways intraoral mirrors are misused when retracting tissue is they are held in a way such that there is no stabilization of the mirror-holding hand with the patient’s head. This leaves the non-dominant arm hovering, and fatigue can set in and negatively affect the clinician’s shoulder and neck comfort. Why do people avoid touching the patient to stabilize their position? Because they were taught that to touch the patient’s face, forehead, or zygoma is a violation of the patient’s personal space. It’s one of the most common and misunderstood situations in clinical dentistry, dental hygiene, and dental assisting. But making physical contact is necessary to make sure that you are stabilized and can control your movements in a position that is as safe as it can possibly be. A s employers, what obligation do dentists have to address employee concerns related to ergonomics? My opinion is that dentists, as employers, have an obligation to themselves and to the people with whom they work to provide equipment that can be optimized ergonomically. Of course, that’s assuming that they own the practice and can make appropriate equipment and layout assessments as to operatory ergonomic optimization to the best of their knowledge and ability. Associates would have to advocate for more ergonomically effective situations. H ow can dental teams learn more about clinical ergonomics for their particular situations? Are ergonomics assessments an option? Unfortunately, there are few consultants in Canada who can assess clinical ergonomics in dental practices impartially. By that I mean consultants who have working knowledge of the issues but aren’t invested in sales of particular products. But educational resources are more plentiful than they have been in previous years. Much clinician knowledge about clinical ergonomics can be achieved through self- education. At the University of British Columbia I helped develop a study module resource on dental ergonomics (dentistry.ubc.ca/ergo ) , along with Dr. Susanne Sunell, who is a dental hygienist and educational consultant, and Maggie Wen, MSc, RDH, a dental hygienist with expertise in clinical ergonomics. An eight-part video series on dental ergonomics was produced for CDA Oasis (starting with Part 1: oasisdiscussions.ca/2015/02/27/dce ) . H ow can a dentist be ergonomically sound without breaking the bank? This question assumes that you have to buy all new equipment in order to be ergonomically sound. Most modern equipment can be made to work for us, but it has to be set up and utilized with some level of ergonomic sophistication. That can be the challenge. If anything needs to be changed in most modern offices, it would be focused on minor equipment layouts, changes which can make the difference between uncomfortable ergonomic compromises and comfortable, efficient practice. I f the dentist makes significant changes to adapt the work space to make it more ergonomically optimal, what will happen when new staff members are added to the team? Every time you change personnel or equipment, it changes part of that complex operatory. But if you have modified the clinical setting to be optimized ergonomically, either by replacing or relocating or shifting equipment in some way, then that will work for people who recognize the opportunity to fundamentally improve their clinical practices. a • Healthy Workplace Series •