Dentists are at high risk for musculoskeletal disorders due to the nature of their work. The good news is that is by following some simple design rules, such problems can be avoided. Sue Nelson discusses dental ergonomics
Well-planned ergonomics are the key to a comfortable, functional practice space that keeps staff happy and injury-free, and puts patients at ease. But it’s important to take a holistic approach.
Engineered for safety
Dentists are particularly prone to occupational health and safety issues due to their constant exposure to blood and body fluids such as saliva, an array of fixed and moveable equipment that can present tripping and other hazards, and the injuries caused by the countless repetitive movements they need to make to carry out procedures.
In addition, a lot of dentists suffer from musculoskeletal disorders and must give up practice because of poor posture, caused by hunching over patients for long periods. It’s clear that the workspace needs to be carefully planned.
“Everything has to cater to this demanding environment,” says David Petrikas, a consultant to dental equipment manufacturer, A-dec, “from the stools the dentists and assistants use, to the patient chair, the equipment, the cabinetry and work surfaces, to the surgery and sterilisation room layout.
“The likes of hands-free cupboard doors and taps can help, as can ‘pass-through’ and double-sided cabinetry, and even cabinetry with lead-lined doors to house the X-ray machine to shield radiation.”
Surface areas in a dental practice need to be kept clutter-free and clean. “Filling the working zone with clutter and stock leads to a very uncomfortable and inefficient operation,” says Ronnie Earl of Optima Healthcare. “Invest in overhead storage, correct dispensing methods and a well-organised drawer system.”
Architect Sam Russell of Create Dental adds: “Health and safety risks that we’d be looking to avoid through design would be things like minimising twisting in surgeries by having everything easily in reach for both the dentist and the dental assistants, especially with repetitive movements for things they regularly need to use. It’s just smart design.”
On the level
The ergonomics of disability access have changed the way dental practices are planned. “Requirements have progressed over the years,” says Russell. “We look at the circulation spaces of the corridors and part of that is the reception area.”
The popular-culture cliché of the formidable, uninviting dental surgery is long gone. “High reception counters are less popular now—there’s a preference for a seated desk height,” says Russell. “We think about the space underneath, ensuring it allows a person in a wheel-chair to get close to the counter and to feel comfortable and welcome. It’s also a more comfortable space for able−bodied people to sit down and debrief at reception, to look over their treatment plans and book in for their next consult.
“These sorts of spaces can be cleverly and ergonomically designed to welcome all people into spaces and make everybody feel comfortable.”
Less is more
While access areas should be roomy and able to accommodate a diverse patient base including wheelchair users, the workspace itself should be well-organised, compact and accessible.
“So, often we think that a nice big dental surgery would be ideal and feel so good to work in,” says Ronnie Earl. “However, there is only so much space that can actually be used effectively. When we try to use the large space, we position everything so far from the working zone that, in operation, we are constantly straining ourselves.”
Sam Russell agrees: “It’s important not to put regularly used items down too low or up too high. We’ll design storage areas so that, rather than having floor-to-ceiling overheads, we just cut them off at a certain point so people can’t overextend themselves. It’s just not an option to do so.”
Let there be light
Dentists need strong colour-corrective lighting to ensure colour matching on shades of teeth, and there is, of course, very bright task-lighting coming off chairs in surgeries. Natural light can help balance the discomfort of this lighting for patients and staff, who are exposed to it for long periods. “The two biggest ways to improve the quality of space are ceiling height and natural light,” says Russell. “If there’s any way to maximise ceiling height or get in as much natural light as possible, that’s the way to go.
“You can make otherwise quite boxy spaces feel light and airy. It’s not about having direct windows to outside—there are other smart ways you can do that such as through borrowed light, where you use internal glazing to bring in as much light from the windows you do have through to the spaces that aren’t directly linked to the windows. Consider skylights to bring natural light into otherwise dark areas, and try to accommodate natural ventilation where possible.
“We try to make surgeries into peaceful areas using a small private courtyard or a water feature to help patients relax into the space,” adds Russell. “This is in stark contrast to the dental surgeries of old.”
Retrofitting old houses as practices can be tricky and costly, but the end result can be a useful, well-designed space that is enjoyed by staff and patients alike. It’s important to go into the project with your eyes open, and to consider ergonomics carefully.
“Commercial and purpose-built properties are not as expensive as old houses to fit out, because they typically come with car parks and disability access,” says Russell. “If you’re converting from a house, you may incur enormous civil works for the car park and drainage and upgrades to the services you’ll require. You’ll need to consider disability access—installing ramps, widening of corridors and doorways—and fireproofing external walls and load-bearing floors.
“It can be difficult when you’re knocking out walls and dealing with heritage overlays and very old structures, but you can meet all the requirements and get a nostalgic quality of space to the clinic that you just can’t get in commercial places. And just because it’s an old house doesn’t mean you can’t get a lot of natural light.”
Listen to others
Remember your team when setting up an ergonomically sound practice. “They too have had experience in different environments and will have invaluable feedback and suggestions,” says Ronnie Earl.
“I’ve found that different dentists practise in different ways, so it’s about understanding how dentists use their space and designing accordingly,” he adds. “It’s so important to consider how they’re likely to use the space and minimise any potential risk.”
Given the high stakes of dental practice health and safety, it’s also vital to speak to an expert—someone who has had experience setting up practice for other dental professionals.