Why poor posture can be a real pain in the neck

Dentistry just doesn’t lend itself to good posture, which means it does lend itself to a host of ergonomic strains and injuries.

But with proper instruction and practice, you and your staff can correct bad habits that are likely to increase injuries and lower productivity.

An ergonomic hazard is defined by the Occupational Safety and Health Administration (OSHA) as “a physical factor within the environment that harms the musculoskeletal system.” Ergonomic hazards include repetitive movement, workplace/job/task design, uncomfortable workstation height and poor body positioning.

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Symptoms of musculoskeletal disorders (MSDs), according to the OSHA, include pain, numbness, tingling, stiff joints, difficulty moving, muscle loss and sometimes even paralysis.

A report by the USAF Dental Evaluation and Consultation Service notes that for dentists and their assistants, particular stressors include: sustained or awkward positions, forceful hand exertions, vibrating operational devices and the precision required of the work.

To avoid these types of stressors, an International Journal of Clinical Pediatric Dentistry article recommends:

• Using an adjustable chair with lumbar, thoracic and arm support

• Working close to your body

• Minimizing excessive wrist movements

• Avoiding excessive finger movements

• Alternating work positions between sitting, standing and side-of-patient

• Adjusting the height of your chair and the patient's chair to a comfortable level

• Considering horizontal patient positioning

When working with patients, your goal should be a neutral posture, one in which the joints are not bent and the spine is aligned and not twisted.

While you’re much more likely to be sitting, rather than standing when working, that certainly doesn’t prevent sustained, awkward positions, notes Dr. Regina Pope-Ford, an assistant professor at Bradley University in Phoenix.

When Pope-Ford evaluated 12 dentists as they worked on a patient simulator performing tooth extractions, mirror checks and cavity preparations with a handpiece, she found that the dentists stood less than 10 to 15 percent of the time with patients.

And while standing may cause back disorders, sitting may result in neck injuries. She found that most of the dentists she studied exceeded recommended levels of muscle contraction for static postures.

What you can do

One solution, according to Pope-Ford, may be for dentists to “mix it up” and change positions throughout the day.

According to an International Journal of Clinical Pediatric Dentistry article, supine positioning of the patient in the chair is usually the most effective way to maintain neutral posture. “The chair should be raised so the operator's thighs can freely turn beneath the patient's chair. Clearance around the patient's head should at least allow unimpeded operator access from the 7 to 12:30 o’clock position, for right-handed operators.”

“For most intraoral access sites, the maxillary plane should be extended 7° beyond the vertical. For treating the maxillary second and third molars, the maxillary plane should be 25° beyond the vertical. For the mandibular anterior teeth, bring the patients chin down so the maxillary plane is 8°ahead of the vertical,” according to the article.

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There is currently no industry standard for an “ergonomic instrument” to help protect you from hand and wrist injuries, according to the journal article. It’s recommended that you consider using automatic instruments instead of manual hand instruments.

Be also sure to use properly sharpened instruments to reduce excessive force: “When working edges are sharp, the instrument performs more of the work; when the edges are dulled, additional operator force is required to achieve the same result.”

Handpieces should be as light as possible and well balanced. Hose length should be as short as possible, because extra hose length adds weight, according to the article. “Avoid retractable or coiled hoses. The tension in the hose is transferred to the wrist and arm as the hose is stretched. Ideally, a pliable hose with a swivel mechanism in the barrel of the handpiece so that it can rotate with minimal effort should be used." 

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Dental equipment and instruments should be centered on the dental assistant. From an ergonomic viewpoint, over-the-head and over-the-patient delivery systems better allow the dental assistant to access the handpieces.

“With difficult patients and procedures, alter the sequence of the tasks to be performed, whenever possible. For example, in order to increase task rotation, instead of scaling the entire mouth, then polishing all the teeth followed by flossing, consider doing these tasks a quadrant at a time,” the article states.

Finally, it helps to alternate easy cases with difficult cases throughout the day and to allow buffer periods that accommodate emergency patients or extra time for difficult procedures.