Ergonomic guidelines to prevent pain and extend your career

I have measured hygienist’s head postures improve up to 15 degrees with this technique alone. A correctly placed contoured dental neck cushion will improve patient comfort and increase tolerance to this positioning when used with either flat and double-articulating headrests. In fact, I have found that once patients are positioned with these cushions, they tend to request them for future visits! (See photo below)

View the hygienist positioning video shown in Bethany’s RDH UOR lecture: Positioning for Success in Dental Hygiene. (5 minutes)Headrest type DOES matter!
Flat or double-articulating headrest--is there an ergonomic consideration for either? The answer is a resounding YES, especially when treating the upper arch. Double-articulating headrests can be angled up into the occiput to gain optimal view of the upper arch (See photo below).

This is an important concept when treating patients who may not tolerate full supine--the double-articulating headrest can be angled backward to compensate for the lack of recline to get the arch in a better position. Flat headrests make it more difficult to get the occlusal plane of the upper arch angled optimally backward. Most flat headrests come with a horseshoe or magnetic headrest, which generally do not support the cervical spine adequately. The best positioning for the upper arch, using a flat headrest, can be attained using a cervical support cushion from Crescent Products with the large end under the neck (See photo below).

But, even then, with flat headrests, the occlusal plane cannot approach the desired 10-20 degree backward angle for optimal viewing and posture. These contoured cushions work well for hygiene treatment and can allow for ergonomic positioning throughout the treatment without re-adjusting the patient chair. The cushion can simply be reversed (large end behind the patient's head) when treating the lower arch.Geriatric Patients and Patients Who Can't Recline Fully
A common problem among elderly patients is supporting their kyphotic head posture. An osteo pillow (Crescent Products) is a larger cushion that supports the elderly forward head posture and makes the patient more tolerant to reclining. For those patients who cannot tolerate even a semi-supine position, consider a saddle stool, (View saddle stool article) which will enable closer positioning to the patient while still supporting the operator. If the patient must be treated from a standing position, it is imperative to raise the patient to a height which promotes the least bending and/or leaning. Downsize your Backrest!
Patient chairs with wide backrests cause strenuous leaning and reaching postures to reach the oral cavity in the 8-9 o’clock positions. Did you know that you can retrofit some patient chairs with a narrower backrest to gain closer positioning? For instance, the A-dec 500 chair can be retrofitted with a much narrower "pedo" backrest to get you 3-4 inches closer to the oral cavity. This modification is especially important in hygiene, where the 9 o’clock position is frequently used when treating the right lower posterior quadrant.

Bethany Valachi, PT, MS, CEAS, is a physical therapist, dental ergonomic consultant and author of the book, “Practice Dentistry Pain-Free.” She is CEO of Posturedontics® and clinical instructor of ergonomics at OHSU School of Dentistry in Portland, OR. She offers additional education on her website at www.posturedontics.com.