Easy ergonomics

Jo Douglas-Boyd explains the importance of physical comfort and safety.

Ergonomics is, in essence, the interaction between man and machine. Derived from the Greek ergo (work) and nomos (laws), this roughly translates to the science of work.
The term ergonomics became a high profile buzzword in the 1970s but was typically used out of context, usually by over exuberant furniture salespeople. Today, ‘ergonomics’ is recognised and advocated by many occupational health organisations. It is widely accepted that more employment days are lost due to minor back injuries, sustained or aggravated in the working environment, than to any other ailment. With workplace/workspace design of such high importance to the blue chips, why should it be any less important in the dental treatment room?

Comfort assessment
There are four significant areas of interest with regard to assessing the comfort of a working position and environment in the treatment room:
Reach. If, during a procedure, dentists need to reach further than a class three movement (from the elbow), what they are reaching for is most likely in the wrong place.
Repetition. Dentists should consider the repetitive actions they perform - is there another way of carrying them out? Could their techniques maintain effectiveness with a slight modification or variation to their style, grip, stance or position?
Loading. Also to be considered is the weight of something a dentist may be holding, or the effective load of the head and torso as it deviates away from the neutral/centred position. Another impact here is the amount of time that this load is held.
Lighting. With around 24,000 lux in the light pattern of a good quality operating light and no more than 1,000 lux around the worktops in the typical treatment room, the opportunity for eyestrain is enormous.
Discomfort in the lower back, neck, shoulders, fingers and wrists, headaches and eyestrain are all too common among the dental team. However, it is perfectly feasible to mitigate, and sometimes even eliminate, all of these occupational hazards. Several studies and practices can be looked into to help dental professionals become more ergonomic in the workplace.

The five Ps
As with any good project or system, remember the five Ps and success will prevail: Previous Planning Prevents Poor Performance. Dentists should take time out of their schedule to discuss issues as a team, and then instigate action based on the outcome. The workplace environment should improve as a result. Those who just pay lip service to the five Ps may end up reaching for the telephone number of the nearest chiropractor.
Although most UK dental practices have adopted the tray system for the delivery of hand instruments to the work site, few have adopted the tub system. Tubs complete the planned approach to a procedure and also ensure that all the relevant materials are within the reach of the assistant, thereby negating unnecessary reaching or stretching. This enables the assistant to remain permanently at the chairside during a given procedure, being more involved in its process and smooth operation. Infection control issues are also addressed with this practice, as the requirement to rummage around in drawers with a potentially contaminated (gloved) hand is eliminated.
Proper placement and planning of the tub and tray system with the procedures and day’s appointments, will enable the assistant to pass instruments and materials to the dentist safely and efficiently. With the practice of four-handed dentistry, this increases the assistant’s engagement and minimises (in most cases eliminates) uncomfortable reach and unnecessary movement by both dentist and assistant.
It is important to note at this point that the ergonomics of dental treatment room design is not meant to ‘pigeon-hole’ the dentist in the corner of a room for the whole day – quite the contrary. The aim is to ensure that during a procedure the dental team is comfortable and efficient. Once the procedure is complete, it is recommended to move about and stretch.

Rapid upper limb assessment Developed in 1993 by McAtammy and Corlett, rapid upper limb assessment (RULA) is a survey method for ergonomic investigations of workplaces where employment-related upper limb disorders are reported. RULA is a screening tool that assesses biomechanical and postural loading on the whole body, with particular attention to the neck, trunk and upper limbs. Although studies have not yet been specifically conducted in the dental treatment room, reliability studies have been conducted using RULA on groups of computer users and sewing machine operators.
A RULA assessment requires little time to complete and the scoring generates an action list that indicates the level of intervention required to reduce the risks of injury due to physical loading on the operator. RULA is intended for use as part of a broader ergonomic study.
Most dentists replace their treatment room equipment every ten to 15 years and it could, therefore, be argued that they are not experts in this process. Most quality dental equipment specialists are involved with more than 30 treatment room refurbishments every year, so they have wide ranging knowledge. Referral is almost always the optimum method of selecting a suitable business partner – dentists can learn from others’ experiences.
If dentists do not feel that ergonomic design is the highest priority in any refurbishment proposal on offer, they should question it. Not all dental equipment manufacturers appreciate the importance and nuances of truly ergonomic treatment room design.

Useful websites:
International Ergonomics Association: www.iea.cc
European Society of Dental Ergonomics: www.esde.org (in progress)
RULA tool: www.ergonomics.co.uk/Rula/Ergo/
UCLA Occupational Health Department: www.ergonomics.ucla.edu/

Planning makes perfect

Work with the experts for a successful practice refurbishment.

A refurbishment is a chance to assess the strengths and
weaknesses of the entire dental practice. It is an opportunity to make improvements and create the ideal environment for staff and patients.
For dentists considering converting to private practice, choosing the right surgery equipment is fundamental. Expert advice is key -it is a good idea to engage in a consultative relationship with a potential supplier, who can ensure that the correct equipment with the right specification is integrated into the overall design.
Dental equipment dealers offer a wealth of practical insights into the latest furnishings to meet individual requirements. It is wise to involve the equipment dealer early on in the design process. A new practice should be planned holistically, with each element developed to make the building and the business function perfectly.
The extent of a refurbishment and its objectives will help to fix an overall budget. For example, is the aim of the refit to expand a practice or is it to provide a more comprehensive service? The objectives will also determine which areas of the building are going to change and those that will remain, from the plumbing to the electrics and the fabric of the architecture.

Try before buying
It is important for dentists to experience different models and configurations in person before making a purchase. They can then be confident about what will suit them and their new working environment. The choice of treatment centre should be based on the needs of the surgery, not the dimensions of the equipment. Patient and staff flows in a practice must also be considered.
Equipment flexibility and choice of configuration are essential. For instance, is it important to have equipment that suits both right and left-handed dentists? Manufacturers such as Takara Belmont, with broad equipment portfolios, can provide these solutions. New treatment centres must also fit in with the look and feel of the refurbished practice. Good suppliers will have a design team to help to ensure that the presentation and delivery of the furniture fully integrates with the surgery.
Avoiding downtime is important for every busy practice and is another area where forward planning is vital. Fitting a refurbishment around quieter periods, such as the summer holidays, will minimise disruption. A practice overhaul will need to run to a time-line so that everything is pre-ordered and delivered on time. All Takara Belmont equipment can be pre-ordered to individual specifications.
Takara Belmont has invested in a new state-of-the-art production centre alongside the London showroom. The new centre has more than doubled the production capacity, which, in turn, will minimise the installation and downtime in surgeries. The company has also created a technical support centre to provide dentists and dealers with improved customer service on all products.

Integrated practice

Brian Whitby explains the concept of the complete treatment centre.

In the modern dental practice, there is a move away from purchasing individual items of equipment and towards the integrated treatment centre (ITC). With this complete working concept, each of the dynamic instruments should be within arm’s reach and the design and configuration should allow a smooth workflow interaction between all team members and the patient.
When choosing equipment, a major consideration is its versatility and ability to offer solutions for all operative needs, including for left and right-handed practitioners. One example of such an all-encompassing concept is the new Anthos Classe R7 system from Cefla Dental Group. Its ergonomic solutions are compatible with all work styles and it is easily adapted to different operating modes.

Delivery system
The dentist’s instrument delivery system is the heart of the ITC. Options include mounted onto the dental chair, over-the-patient, side delivery system, in cart form or as a cabinet mounted module. Chair mounted is rapidly becoming the system of choice, as the ergonomics are more effective and efficient.
With the chair mounted system, there are three basic styles: international, with the dynamic instrument tubings hanging down; continental, with the instruments delivered from a reflex arm system; and side delivery, some of which can also be chair-mounted, thus combining many of the best attributes of chair-mounted units and cart systems.

Patient chair
The foundation of the ITC is the patient chair, which should be fully programmable, stable and comfortable for long procedures, such as crown and bridge preparations and implants. The headrest should be infinitely adjustable to enable the most supportive angle for the patient’s head and neck. Some manufacturers, such as Anthos, produce multi-articulating headrests with pneumatic locking mechanisms to ensure that, once the headrest is positioned correctly, it will stay in place.

Cuspidor and suction
The cuspidor area is one that can be easily overlooked, but it is vital for the dental nurse and has a major impact on patients. The ideal cuspidor should be chair mounted and the spittoon bowl must be easy to clean and made from a suitable material that will retain its looks and function for years. On some models, the bowl can be motorised, so an automatic movement places it where the patient needs it and then after use it moves away to maximise operator space. Suction tubes should be easily accessed and a syringe is essential for the nurse to assist the dentist in operative procedures.

Operating light and stools
The operating light is an essential component of the ITC. Proper illumination of the oral cavity is essential for correct visual diagnosis and avoiding eye strain for dentists and nurses alike. The operating light should have perfectly balanced arms for stability and ideally a three-axis rotation so that it can be moved to maintain proper alignment with the oral cavity.
The dentist’s stool should have at least three adjustment facilities - seat height, backrest height and backrest tilt. The nurse’s stool must be height adjustable with a higher travel than the dentist’s stool so that she/he can see over the top of the dentist’s hands and into the oral cavity to ensure correct placement of the suction cannula.
There are many exciting innovations in dental equipment, but any practice looking to invest should understand that this tends to be a once in every ten years decision. Dentists need to make sure that they analyse their own requirements and specify equipment to suit their needs for today and tomorrow.