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Ergonomic Applications to Dental Practice

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Ergonomic Applications to Dental Practice

  1. 1. Ergonomic Applications to Dental Practice dr shabeel pn www.hi-dentfinishingschool.blogspot.com
  2. 2. Overview <ul><li>What is Ergonomics? </li></ul><ul><li>What are the Consequences of Poor Ergonomics? </li></ul><ul><li>What Policies/Standards Address Ergonomics? </li></ul><ul><li>How can Ergonomic Principles Be Applied to Dental Practice? </li></ul>
  3. 3. What is Ergonomics? Job Characteristics Human Capabilities <ul><li>ERGONOMICS is a way to work smarter--not harder by designing tools, equipment, work stations and tasks to fit the job to the worker --NOT the worker to the job </li></ul>
  4. 4. Ergonomics is Not New Early emphasis: Improving pilot performance via optimal layout / type of controls & displays <ul><li>Recent interest: Improving comfort, health & productivity via workstation design </li></ul><ul><ul><li>--Lighting & Temperature </li></ul></ul><ul><ul><li>--Tools </li></ul></ul><ul><ul><li>--Process (Heights, reaches, weights) </li></ul></ul>
  5. 5. Application of Ergonomics in Design Tools Workstations Work methods Environments
  6. 6. Ergonomic Design Goals <ul><li>Improve job process by eliminating unnecessary tasks, steps & effort </li></ul><ul><li>Reduce potential for overexertion injury </li></ul><ul><li>Minimize mental / physical fatigue potential </li></ul><ul><li>Leverage workers’ skills / knowledge of their jobs to re-design work to increase their satisfaction, comfort, morale and fulfillment </li></ul>
  7. 7. Consequences of Poor Design <ul><li>Discomfort  Chronic Pain </li></ul><ul><li>Accidents  Injuries </li></ul><ul><li>Fatigue  Increased Errors </li></ul><ul><li>Work-Related Musculoskeletal Disorders (WMSDs) </li></ul><ul><ul><ul><li>Low back pain </li></ul></ul></ul><ul><ul><ul><li>Tendonitis </li></ul></ul></ul><ul><ul><ul><li>Epicondylitis </li></ul></ul></ul><ul><ul><ul><li>Bursitis </li></ul></ul></ul><ul><ul><ul><li>Carpal tunnel syndrome </li></ul></ul></ul>
  8. 8. U.S. Navy Ergo-Injuries Source: OSHSYS RAW DATA FY 89 to FY 97 Non Ergonomic Related Cases Declined Ergonomic - Carpal Tunnel Syndrome, Chrondromalacia, Back Strain, Multiple Strain
  9. 9. WMSDs in Dentistry ?  ? ? ? ? ? ? ? ? ? ? ? ? ?
  10. 10. WMSDs in Dentistry Reasons for Early Retirement Among Dentists <ul><li>Musculoskeletal Disorders (29.5%) </li></ul><ul><li>Cardiovascular Disease (21.2%) </li></ul><ul><li>Neurotic Symptoms (16.5%) </li></ul><ul><li>Tumors (7.6%) </li></ul><ul><li>Diseases of the Nervous System (6.1%) </li></ul>Source: Burke et al., 1997
  11. 11. WMSD Symptoms Among Dentists Source: Finsen et al., 1998
  12. 12. WMSD Symptoms Among Dental Hygienists Source: Liss et al., 1995 * indicates difference is significant
  13. 13. What Factors Contribute to WMSDs? <ul><li>Repetitive motions (e.g., scaling, polishing) </li></ul>
  14. 14. What Factors Contribute to WMSDs? <ul><li>Static neck, back, and shoulder postures </li></ul>
  15. 15. What Factors Contribute to WMSDs? <ul><li>Grasping small instruments for prolonged periods </li></ul>
  16. 16. What Factors Contribute to WMSDs? <ul><li>Prolonged use of vibrating hand tools </li></ul>
  17. 17. Ergonomics Standard Setting Activities <ul><li>OSHA </li></ul><ul><li>ANSI </li></ul><ul><li>DoD </li></ul>
  18. 18. OSHA Ergonomics Standard History <ul><li>Draft ergonomics standard released in Feb 99 </li></ul><ul><li>Final Rule issued in late 2000 </li></ul><ul><li>Repealed by Congress & The President in 2001 </li></ul><ul><li>Renewed efforts underway to “re-invent” a version more palatable to new administration & industry </li></ul>
  19. 19. OSHA Ergonomics Standard <ul><li>Program-oriented approach </li></ul><ul><li>Based on six elements: </li></ul><ul><ul><li>Management leadership </li></ul></ul><ul><ul><li>Employee participation </li></ul></ul><ul><ul><li>Hazard identification </li></ul></ul><ul><ul><li>Job hazard analysis and control </li></ul></ul><ul><ul><li>Training </li></ul></ul><ul><ul><li>Medical management </li></ul></ul><ul><ul><li>Program evaluation </li></ul></ul><ul><li>Applicable to manufacturing and manual handling operations; workplaces where WMSDs are reported </li></ul>
  20. 20. ANSI Z-365 Control of Cumulative Trauma Disorders <ul><li>Voluntary standard to address work-related musculoskeletal disorders </li></ul><ul><li>Developed by committee of government, labor, business, industry and science representatives (including ADA) </li></ul><ul><li>Draft approved by the Accredited Standards Committee in May 98 </li></ul><ul><li>Public comments under review </li></ul>
  21. 21. Navy/DoD Ergonomics Policy <ul><li>DOD Ergonomics policy memo of 4 Feb 1997 </li></ul><ul><li>OPNAVINST 5100.23E Ergonomics Program Chapter </li></ul><ul><li>Ergonomics program elements integrated into DODI 6055.1, “DoD Occupational Safety and Health Program” </li></ul>
  22. 22. DOD Ergonomics Program Elements Workplace Analysis Hazard Prevention and Control Education and Training Program Evaluation and Review Health Care Management
  23. 23. DOD Ergonomics Working Group Tool Box Level I Ergonomics Methodology Guides Computer Based Ergonomics Training Job Requirements/ Physical Demands Survey Ergonomics Program Management Guidelines Web Site http://chppm-www.apgea.army.mil/ergowg/index.htm
  24. 24. Applying Ergonomics Principles to Dental Work <ul><li>Tools/Instruments </li></ul><ul><li>Workstations </li></ul><ul><li>Work Practices </li></ul>
  25. 25. Ergonomics in Dentistry Tool/Instrument Design <ul><li>Considerations: </li></ul><ul><li>Overall shape/size </li></ul><ul><li>Handle shape/size </li></ul><ul><li>Weight </li></ul><ul><li>Balance </li></ul><ul><li>Maneuverability </li></ul><ul><li>Ease of operation </li></ul><ul><li>Ease of maintenance </li></ul>Goals : Reduce force exertion; Maintain hand/wrist in neutral posture
  26. 26. Ergonomics in Dentistry Hand Instruments <ul><li>Look for: </li></ul><ul><li>Hollow or resin handles </li></ul><ul><li>Round, knurled or compressible handles </li></ul><ul><li>Carbon steel construction (for instruments with sharp edges) </li></ul>
  27. 27. Ergonomics in Dentistry Automatic Handpieces <ul><li>Look for: </li></ul><ul><li>Lightweight, balanced models (cordless preferred) </li></ul><ul><li>Sufficient power </li></ul><ul><li>Built-in light sources </li></ul><ul><li>Angled vs. straight-shank </li></ul><ul><li>Pliable, lightweight hoses </li></ul><ul><li>Swivel mechanisms </li></ul><ul><li>Easy activation </li></ul><ul><li>Easy maintenance </li></ul>
  28. 28. Ergonomics in Dentistry Syringes and Dispensers <ul><li>Look for: </li></ul><ul><li>Adequate lumen size </li></ul><ul><li>Ease in cleaning </li></ul><ul><li>Knurled handles (no finger cut-outs) </li></ul><ul><li>Easy activation and placement </li></ul>
  29. 29. Ergonomics in Dentistry Magnification Systems <ul><li>Consider: </li></ul><ul><li>Working distance </li></ul><ul><li>Depth of field </li></ul><ul><li>Declination angle </li></ul><ul><li>Convergence angle </li></ul><ul><li>Magnification factor </li></ul><ul><li>Lighting needs </li></ul>Goal : Improve neck posture; Provide clearer vision
  30. 30. Ergonomics in Dentistry Workstation Layout <ul><li>Ensure : </li></ul><ul><li>Instruments, materials, medications, etc. are accessible while seated </li></ul><ul><li>Hoses are positioned away from the body </li></ul><ul><li>Set-up can be adapted for different operators </li></ul>
  31. 31. Ergonomics in Dentistry Operator Chair <ul><li>Look for: </li></ul><ul><li>Stability (5 legged base w/casters) </li></ul><ul><li>Lumbar support </li></ul><ul><li>Hands-free seat height adjustment </li></ul><ul><li>Adjustable foot rests </li></ul><ul><li>Adjustable, wrap-around body support </li></ul><ul><li>Seamless upholstery </li></ul>Goal : Promote mobility and patient access; accommodate different body sizes
  32. 32. Ergonomics in Dentistry Patient Chair <ul><li>Look for : </li></ul><ul><li>Stability </li></ul><ul><li>Pivoting or drop-down arm rests (for patient ingress/egress) </li></ul><ul><li>Supplemental wrist/forearm support (for operator) </li></ul><ul><li>Articulating head rests </li></ul><ul><li>Hands-free operation </li></ul>Goal : Promote patient comfort; maximize patient access
  33. 33. Ergonomics in Dentistry Posture/Positioning <ul><li>Potential Strategies : </li></ul><ul><li>Position patient so that operator’s elbows are elevated no more than 30 degrees. </li></ul><ul><li>Adjust patient chair when accessing different quadrants </li></ul><ul><li>Alternate between standing and sitting </li></ul>Goal : Avoid static and/or awkward postures
  34. 34. Ergonomics in Dentistry Work Practices <ul><li>Goal : Maintain neutral posture, reduce force requirements </li></ul><ul><li>Potential Strategies : </li></ul><ul><li>Ensure tools are sharpened, well-maintained </li></ul><ul><li>Use automatic handpieces instead of manual instruments where possible </li></ul><ul><li>Use full-arm strokes rather than wrist strokes </li></ul>
  35. 35. Ergonomics in Dentistry Scheduling <ul><li>Potential Strategies : </li></ul><ul><li>Increase treatment time for more difficult patients </li></ul><ul><li>Alternate heavy and light calculus patients within a flexible scheduling system </li></ul><ul><li>Vary procedures within the same appointment </li></ul><ul><li>Shorten patient’s recall interval </li></ul>Goal : Provide sufficient recovery time for staff to avoid chronic muscular fatigue
  36. 36. Ergonomics in Dentistry Prosthetics Labs Naval Station Rota Spain Clinic Case Study : Lab techs mentioned chronic back, shoulder & neck discomfort / pain during periodic Industrial Hygiene survey from working at non-adjustable bench in obviously stressful static postures -- with no forearm support nor bench edge padding
  37. 37. Ergonomics in Dentistry Prosthetics Labs Naval Station Rota Spain Clinic Case Study -- Post intervention improvements offered by Kavo ergonomic lab benches : Lab techs affirm GREATLY increased comfort / decrease in back, shoulder & neck discomfort / pain. KAVO dental prosthesis lab benches offer ample forearm supports and workpiece support centering prosthesis directly below technician which optimizes spinal / neck / head vertical alignment
  38. 38. Ergonomics in Dentistry Prosthetics Labs Naval Station Rota Spain Clinic Case Study : Lab technicians now work in optimized ergonomic posture. In addition to forearm supports and central workpiece support (locally-ventilated for air contaminant removal !) , the table also has much improved overhead lighting, a magnifying lens and a drill speed control operated by the tech’s right knee
  39. 39. ERGONOMICS SUMMARY <ul><li>Good ergonomic design of tools, processes and furniture DOES improve personnel comfort, health, morale, productivity and readiness. </li></ul><ul><li>Individual effort as part of a workshop team is the greatest means of identifying / improving workplace ergonomic issues. </li></ul><ul><li>It’s critical to seek prompt medical aid for symptoms of ergonomic stress / CTDs </li></ul>
  40. 40. Need More Information? <ul><li>www.hi-dentfinishingschool.blogspot.com </li></ul>

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