Turning a practice into an ergonomic surgery provides positive outcomes—physically, mentally and financially—for practitioners and their staff. By Kerryn Ramsey
Dentists are renowned for suffering from neck, back and arm pain due to the nature of their work. Sitting and leaning over patients while repetitively holding and reaching for instruments invariably leads to physical discomfort that can escalate to long-term physical damage. It can become so bad that some dentists have to cancel patients or miss days from work leading to loss of income and long-term physical and mental health issues. Ergonomics, the process of designing workspaces and workflows to match the user, is a proven way of reducing these types of injuries and disorders.
“An ergonomically designed dental practice with an emphasis on appropriate layout and correct equipment choice will greatly enhance productivity and can significantly prolong the working life of the dental team,” says David Petrikas, who has spent more than a dozen years as a public relations consultant to leading dental equipment manufacturer, A-dec.
“This is especially important in the practice of four-handed dentistry as the positioning of instruments, suction, materials and the assistant’s work surface all impact on the range of movements required to perform procedures efficiently and ergonomically without excessive twisting movements.”
For the past few decades, the layout of dental surgeries has been pretty standard but advances in equipment is changing things. One big change has been the mounting of equipment onto the dental chair. Sam Koranis, managing director of Medifit, says this allows for the dentist and nurse to remain seated with little need to strain or sustain an awkward posture while carrying out their duties.
A-dec’s Petrikas agrees. “Poor ergonomics is often seen in the relationship between the equipment, the patient chair, and the dentist’s and assistant’s stools. Improper positioning in relation to each other can cause disorders ranging from back and neck pain to debilitating musculoskeletal conditions that shorten dentists’ working lives. Many dentists have been able to continue or resume their practice of dentistry simply by switching to a well-designed dental patient chair and a stool that enables correct posture while working.”
A thin flexible backrest is essential in a patient chair. This provides good access to the oral cavity without unnecessary bending of the dentist’s neck or back. Poorly designed patient chairs with thick or stiff backrests makes this access extremely difficult. “The dentist’s and assistant’s stools must also be correctly designed and adjusted to take pressure off the neck and lower back to avoid musculoskeletal injury,” says Petrikas.
Ronnie Earl, project executive at Optima, notes that there are various ergonomic elements that need to be considered in a dental surgery. “The most important thing when setting up a practice is making the health of the dentist the first priority,” he says. “Patient experience is critical but the dentist is working eight- to 10-hour days and generating the income. If they are cramped up in an uncomfortable working environment, it puts their health at risk and leads to inefficient operation. Dentists need to understand how they operate and explore the best methods to achieve those ends. It’s also important to find the most efficient and ergonomic way for their dental assistants and hygienists to operate.”
When designing a surgery, there are many aspects to consider, such as instrument and materials location, equipment selection and positioning, infection control and the operation of the dental assistants. The work environment shouldn’t be damp or cold. Most importantly, it needs to cater to the specific needs of the operator and reflect proven ergonomics.
“An ergonomically designed practice with an emphasis on appropriate layout and correct equipment choice will greatly enhance productivity and can significantly prolong the working life of the dental team.”—David Petrikas, PR consultant, A-dec
“Bench heights are very important as duties are carried out at a seated height,” says Medifit’s Koranis. “Basins and drawers should be accessible to the assisting nurse without the need to leave the seated position. Attention also needs to be placed on the flow from dirty to clean in the steri and lab, particularly where staff are standing and carrying items. Equipment can be designed into the cabinetry to assist in creating a good ergonomic work space.”
It’s also important for the reception area to be ergonomically designed. “Administration staff should not be crammed or utilising 400mm-wide benches where there is no working area,” says Ronnie Earl. “In today’s world, one of the most important issues is having the computers set at the right height and at a comfortable working position.”
When Medifit designs a practice, the team balances all the various elements to provide good ergonomic design. They assess the flow of the practice and how the dentist works in their space, covering both left- and right-handed dentists. They also note how many staff are in an area at any one time and what equipment is being used. Medifit then designs the space around these requirements, always taking into consideration accessibility for clients who may be wheelchair bound, elderly or very young.
“If we are designing for an orthodontist who predominantly sees children, then we would set the height of the brush station to suit the end users,” Koranis explains.
It’s imperative to take into account the interaction between the space and the people who use it. “If we have a particularly tall client then we may raise the height of overhead cupboards to suit,” he adds. “OH&S is a major consideration and it is important to create a practice that avoids undue exertion or strain on the user.”
When running an ergonomic practice, the positive outcomes are physical, mental and financial. Dentists and staff will have less fatigue at the end of the day, as well as experiencing less pain. In addition, a practitioner will be able to provide the quality of service that their patients demand.
The simple fact is that dentists are time-poor, have a challenging work load and often have to deal with emotional patients. Pain and discomfort as a result of bad ergonomics is one more challenge that they and their staff definitely do not need. Unfortunately, it is often difficult for those who work in a practice to see how the ergonomics can be improved. They are simply too close to the problem.
Ronnie Earl notes that the best thing to do is to work with a specialist dental fit-out company that can map the functionality of a practice and make improvements. “It’s a simple matter for a qualified person to provide advice on how to improve the ergonomics of a practice.”
Revamp, remodel and revitalise
Is it time to update your practice? David Petrikas of A-dec reveals the common faults that need to be addressed:
- Thick backrests in patient chairs, which force the operator into a poor working position. Patient chairs need a full range of motion to suit tall or petite operators, and allow for easy patient access and egress from the chair.
- ‘Office-style’ dentists chairs and stools that do not support the correct working position. This leads to pressure on the lower back and/or neck, together with poor blood flow to the legs.
- Poorly positioned work surfaces such as side or rear cabinets that require the assistant to bend, twist or stand up to reach materials during dental procedures.
- Delivery systems that do not support the operator and the type of work performed. A-dec supplies over-the-patient (both Continental and traditional), 12 o’clock and wall-mounted delivery systems. This places dynamic instruments within easy reach or out of the way when not required.