When one thinks of ergonomics, one thinks of keeping the correct posture but often do we forget that the equipment we use to work with affects that. Studies have shown that over 60 percent of dentists suffer from neck and back pain.  Incorrect use of that equipment can cause a forward leaning posture and excessive reaching with the arms which results in movement dysfunction and shoulder joint or lower-back problems. When you spend over 2000 hours a year looking at oral cavities, it is important consider some tips to avoid this.

Rear-delivery systems accommodate all clinical instruments behind the patient. It is the least expensive option and keeps the equipment out of view of the patient, which decreases anxiety. It works well when true four-handed dentistry is practiced but is not recommanded for two-handed operations as it provoques extensive reaching, leaning or twisting of the torso, which can contribute to low-back pain. Side-delivery systems require less trunk-twisting than rear delivery for the doctor to retrieve instruments. But you must remember to squarely face the system when changing burs, rather than sustaining a twisted posture. One problem I see with some dentists who use side delivery is the tendency to “lock” themselves into one working position relative to the patient. This tends to overwork and fatigue certain areas of the body and can lead to pain. Also correct height of the side-delivery system is paramount to preventing shoulder pain and injury because the instruments and handpieces should be no higher than elbow level.  In case of over-the-patient delivery systems, the arm extends over the chest of the patient, so handpieces and other instruments are within easy reach for both dentist and assistant, minimizing excessive reaching or shift of vision. If you are smaller, the system may require repeated upward reaching at the shoulder when seated, an ergonomic risk factor for shoulder pain. And for the assistant’s health, don’t position the system too far down the patient’s stomach, since this will cause your assistant to have to twist to retrieve instruments. Some people prefer over-the-head delivery. They allow the operator the ability to practice from the 7 o’clock to 1 o’clock positions. Supplies are in a good position for assistant access, while handpieces are more accessible than rear-delivery layouts, reducing the ergonomic challenges when in two-hand function. Additionally, when properly configured, they convert from right- to left-hand function rapidly.

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But don’t forget: the best practice with any delivery system is to change positions as frequently as possible, depending on the tooth surface being treated, in order not to lock yourself in one position and prevent future pain. Some other things you can do to correct your posture while working are using good loupes and adequate lightening to decrease the extent to which your neck is held forward and flexed down, positioning the patient’s head at a level that gives you good access to the oral cavity and always try to hold your elbows at a 90 degree or less flexion. And of course take a break in between difficult cases.

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