Dental Presentation

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Prevent Repetitive InjuriesErgonomics for a Healthier

You in the Dental Field

According to the U.S. Department of Labor, (OSHA), repetitive strain injuries are the nation's most common and costly occupational health problem.

Source: United States Department of Labor. Repetitive motion results in longest work absences. Available at: www.bls.gov/opub/ted/2004/mar/wk5/art02.htm. Accessed December 19, 2008.

Work related repetitive injuries affect hundreds of thousands of American workers, costing more than $20 billion a year in workers compensation.

Source: United States Department of Labor. Repetitive motion results in longest work absences. Available at: www.bls.gov/opub/ted/2004/mar/wk5/art02.htm. Accessed December 19, 2008.

60 % report upper extremity neuropathy.Stentz , 1994

82% report subjective neck pain. Szelgua, 2002

Ranked 1 when reporting carpal tunnel syndrome per 1000 employees. Tannaka , 1994

The good news is that no matter how much you continuously do a motion, proper posture and an ergonomically sound environment can reduce the risk of serious health problems caused by so much sitting.

Source: http://www.dentistrytoday.com/top-products/4178-posture-chair-posture-perfect-solutions.

What is Ergonomics?

Ergonomics is the scientific engineering of an object or environment intended to maximize productivity, while minimizing fatigue and discomfort.

Anything from the instrument you use or the office you work in can be ergonomically designed to meet this definition.

Source: http://www.kabdental.com/dental-equipment/operatory-packages/beaverstate-dental.htm

•Your back and legs•Your hands•Your head and

When discussing ergonomics and health, there are three areas of your body that are of primary concern. They are:

Proper ergonomics and posture are necessary to prevent potential health problems like:

Source: Ergonomics At Work - The Web Site Where The Solutions Are Comfortable, www.combo.com/ergo.

• Back problems

• Neck and shoulder pain

• Headaches

• Eye strain

• Arm and wrist pain

• TOS

• Fatigue

• Repetitive strain injuries such as Carpal Tunnel Syndrome or tendonitis

• Reduced productivity• Increased errors• Stress• Reduced job satisfaction

Other problems that improper ergonomics, particularly in the workplace, can cause are:

Improving your posture.

First, let’s look at your back. Your back assumes its normal posture based on the shape of the spine. The spine normally has four curves in it.

Poor posture can alter the natural curves of your spine, and cause damage to your discs and nerves.

Pressure• Discs have pressure in

them just like a car tire. • When you lay on your

back, the pressure inside a disc is 25 lbs/sq. inch.

• Standing is 100 lbs. • Sitting jumps to 140 lbs.• Bending from the waist

without bending your knees is 150 lbs.

• Seated slouched is an amazing 200 lbs.

When performing a movement, it is important to maintain the normal curve of your spine; this creates good posture.

Maintaining a neutral posture while sitting may aid dental hygienists in the prevention of work-related musculoskeletal disorders.

The next area to consider is the seated

position.

A good chair will help maintain the proper curves of the spine.

A bad chair can be made into a good chair with a proper tilt and support.

Crossing your legs or sitting on your ankles should be avoided.

Now, let’s take a look at your hands.

Source: Ostrem, T.C. “Balancing Muscle Groups: A Solution to Repetitive Stress Injuries,” Chiropractic Products, May 1997.

Repetitive motions of the hand and wrist can result in a painful pinched nerve in the wrist, known as Carpal Tunnel Syndrome and Tunnel of Guyon.

Outside of Work Causes

• Exercise• Computer or tables• Diseases o Diabetes

These problems can be prevented by simple hand and wrist stretches done every two hours, which we will cover later.

Let us now look at ways to maintain good health for your neck and head.

Having to look up or look down on a repetitive basis can cause injury to your neck. This can cause disc and nerve damage that can result in headaches, neck pain, shoulder pain and fatigue.

“For every inch of Forward Head Posture, it can increase the weight of the head on the spine by an additional 10 pounds." Kapandji, Physiology of Joints, Vol. 3

Here are some very important rules to follow at work:

Try to keep all vital equipment within arms reach. Constant leaning and reaching can add to physical stress on the body.

Because your job requires sitting for long periods of time, you should get up and move around for 5 minutes every hour. You can work while standing up and moving around your area.

When working on patients all day, try to look out a window, or across the room for 10 seconds every 15 minutes.

This will help reduce eye strain.

Arm rests on your chair should be set slightly below the level of your elbows while sitting upright, with your shoulders relaxed.

Sitting Posture

Hip and knee angle.

Hip 125 degree or more.

Knee 135 degree

When sitting there are two angles to consider in the lower extremities..

Sitting Posturewhile working

Both feet should rest squarely on the floor with easy assess to the foot pedal.

To optimize a stool with a seat pan it is best to tilt seat pain forward 5 – 15 degrees. Go beyond 15 degrees may cause the individual to slide forward.

Using a saddle stool moves your pelvic in a more neutral position which requires less muscle force and allows for a better spinal position.

Wear properly fitting gloves.

Source: OSHA and ADA Alliance http://www.ada.org/sections/professionalResources/pdfs/ergonomics_upper__backpain.pdf.

Your wrists should always be in a neutral position when working for

extended periods.

Source: http://www.jdentaled.org/cgi/content/full/69/4/453/F3

Use larger diameter instruments. Also instruments that are light weight, balance, and sharper.Ultrasonic scaler.

Keep equipment in good working order. Improperly maintained equipment can cause you to use unnecessary pressure and extra time when performing certain procedures.

Stabilizing you hand while performing precision work.

If possible, use chair arms to support your upper arm or forearm when doing fine, precision work with your hands.

Pace your work. Try to schedule harder treatment before or after easier treatments.

Wrist should be in neutral position.

Position the patient’s head at a level that gives you access to the oral cavity while being able to hold your shoulders in a relaxed,

neutral position (rather than a hunched up position) and you are able to hold your elbows at about a ninety degree or less flexion.

Position your patient to accommodate you. Don’t be afraid to tilt your patient.

Why loupes?

Help to maintain neck flexion less than 25 degrees.

Why loupes?

• Can flip out of the way•Adjustable declination

angle• Heavier• Narrow field of view

• Larger field of view• Lighter•Does not knock out of

adjustment •More expensive

TTL Flip up

Declination Angle

A larger declination angle significantly reduces forward head posture.

If you follow these guidelines, you will greatly

reduce the amount of physical stress that you put

on your body while at work.

Here are some stretches that you can do at work or at home to help stay relaxed

and healthy.

This stretch is for your shoulders, neck and back:

Back Stretching on Thera-Ball

Lye on your back on the ball while maintaining your arms across your chest.

Allow your arms to fall to the sides.

No Pain Should BeFelt With Stretch.

Bend your head slightly to one shoulder. Rotate your head so that you are looking up toward the ceiling.

Anterior Neck Stretch:

Shrugging your shoulders in circular motions will help the muscles relax.

Front thigh muscles need to be stretched regularly.

Clasp hands behind head and then arch your spine backwards.

Stretching your lower back and glut muscle by placing one foot over the other knee and bend forward at the waist.

These stretches are for your hands and wrists:

Separate your fingers as far as possible. Close fingers together, squeeze. Repeat 3 times with each hand.

Fingers out - Fingers in:

Bend one wrist to extension (upward) using your other hand. Hold position at the end of range of motion for 12 seconds. Repeat with other hand. Repeat all steps to flexion (downward.)

Hand Extension & Flexion:

Questions?

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