Ergonomics in medicine, dentistry: the basics of organizing the workplace of a dentist

To do their job safely and efficiently, dentists use certain laws.

Knowledge of the ergonomic foundations of workplace organization is necessary for both interns and novice specialists, as well as experienced dentists.

What is ergonomics?

First, you need to understand what ergonomics is in medicine. It is a separate section in applied medicine that focuses on working conditions in order to optimize the workflow. The term was introduced in 1949, it literally means the law of work, equipment. A lot of scientific, diploma works and abstracts have been written on this topic.

Discipline is necessary to adapt a job, a workplace. The main task is to effectively and safely fulfill the duties of a medical worker in relation to himself, employees, and the patient.

Ergonomics includes the following issues:

• optimization of working conditions in the workplace;
• development of the position of the doctor and the patient;
• development of the optimal position and distance to tools and equipment;
• development of algorithms for the movement of medical workers.

Failure to comply with these rules leads to excessive efforts and body movements, which leads to overstrain of the body. Special attention is paid to the organization of the workplace.

Physical moments are taken into account, depending on the specifics of the work - body tension, the ability to maintain position and posture, optimal visual and auditory capabilities.

Ergonomics challenges in dentistry

Using this section in dentistry, the following tasks are solved:

1. Providing a comfortable working environment for the dentist and his assistant. This point implies the correct use of equipment, hand tools and their balancing. The latter moment helps to increase tactile sensitivity and reduces hand tension. To reduce risks occupational diseases, in particular, carpal syndrome, the correct diameter of the handle in hand instruments is selected, the angular inclination handpieces. All devices used by the dentist must comply with ergonomic requirements.
2. Correct equipment placement. The correct arrangement of the office and the organization of the place reduces the burden on the doctor and his assistant by reducing unnecessary movements and manipulations.
3. Creation of comfortable conditions for staff. This includes optimal lighting, minimization of radiation, noise and vibration from vacuums and compressors, creation of interior lighting suitable for the specifics of the doctor's work. The optimal comfort zone for the specialist, support staff and patient is determined. For example, in offices where the shades of the teeth are identified - the walls, the ceiling should not be bright. This also applies to additional items (wall clock, painting, sofa).

Four basic concepts

There are 4 basic concepts of workplace organization. Each of them describes the optimal position of the doctor and his assistant, the placement of the instruments:

• №1. It is basic. It implies the placement of instruments on the table to the right of the patient.
• №2. The instruments are placed behind the patient's headrest.
• №3. The accessories are placed to the left of the patient (assistant's side) and move over the head.
• №4. The instrumentation is located on the right near the headrest of the chair.

The 4 basic positions of the dental assistant's tools are also taken into account:

1. Position number 1 - the set of the assistant is located to the left of the chair.
2. Position # 2 - behind the headrest of the patient's seat.
3. Position number 3 - to the left of the headrest.

Note! The concepts and provisions listed are based on the four-handed principle.

Ergonomics in the dental office

Special attention is paid to the organization of the place and working positions of the dentist. The main equipment for the office is considered to be 2 chairs - a doctor and his assistant, dental unit, storage furniture sterile materials, tools. All this should be located so that the work is comfortable, the movements are not constrained.

Doctor's position

Patient examination, treatment and tooth extraction should be performed in a comfortable working position. The upper body in this position is not supported by the arms or the back of the chair. Support is provided only if the doctor is in a non-working position. In the wrong position, tension increases, which subsequently adversely affects the muscle tissue.

The work of a specialist is performed while sitting and standing, depending on the specifics of the intervention. While sitting, long manipulations are carried out, which require precise and accurate movements. In a standing position, they perform short work and manipulations that require certain efforts.

The following professional guidelines are used to help reduce stress:

1. The back is kept straight, not twisted. The pelvis can be tilted slightly forward.
2. The top flexes up to 20 degrees forward. Lateral and deep forward bends have negative health effects.
3. The angle of inclination of the head in relation to the body (upper part) is no more than 20-25 degrees.
4. Hands are not tense, hang close to the body, shoulders are straight and relaxed.
5. Feet are completely flat on the floor, slightly spaced but close together. When placed symmetrically, the optimal balance is determined. Violation of ergonomic rules - legs are placed on a work table support or on a patient chair. In this position, balance is disturbed, and the doctor may fall.
6. In a sitting position, the legs should be perpendicular to the floor, the angle at the knee joint should be 90-110 degrees.

The dentist's chair deserves special attention. The specialist spends more than half of his working time on it. The position is selected in accordance with anthropometric characteristics. Correct seat height and backrest tilt affects circulation, posture health. Before work, it is necessary to adjust the height of the chair so that the inner thigh is tightly placed on the seat, and the feet are completely and tightly attached to the floor.

The chair must meet the following criteria:

• the presence of wheels for free movement;
• five supports for stability;
• the ability to adjust the height level;
• the size of the seat ranges from 34-51 cm;
• the fabric that covers the chair must be breathable;
• the front edge of the seat is flat and rounded;
• average seat length in accordance with anthropometric data - 30-40 cm;
• the angular relationship between the back and the seat is 85-95 degrees.

The assistant's chair should be 10-12 cm higher for a better view. The back of the chair rotates 360 degrees around the perimeter. This provides support for the helper's body in any direction.

Patient position

The position of the patient also plays an important role in terms of ergonomics. This determines how well the dentist gains access to the teeth, as well as the quality of follow-up. The doctor's hands during operations with the correct placement of the object of treatment should not rise above the waist.

The working area should be at such a distance and position that the dentist does not make unnecessary dodgy movements, stretching and bending the back during the procedure. Better when the patient is lower.

Suitable positioning of the patient in the dental seat - lying / reclining. The body should be relaxed at all points of contact with the chair. The best ergonomic position is sinusoidal. With this design of the chair, the knees are in line with the head, the angle of inclination between the back and the seat does not change, and the inclination of the headrest can be adjusted.

The presented position creates favorable conditions for the implementation of long-term events, relieves tension from the client's muscles. The swallowing reflex is also blocked. The patient's head turns back and forth can be changed by 20 degrees, and to the side - by 45 degrees.

Attention should be paid to the distance between the dentist and the object of treatment. The optimal distance is 35-40 cm for a specialist with good eyesight. The patient assumes a position in which the doctor's desk is just above the body.

The lamp should be far from the eyes and at the same time within the reach of the doctor.

For interventions in the lower jaw, it is located above the head of the object of treatment - with this placement, the rays purposefully fall on the required area.

The chair should be lowered all the way down to the level of the dentist's elbows. When working with the upper jaw, the equipment and chair are in a changed position. The lamp is located above the chest, the rays are directed at an angle.

Note! It will take time for the doctor to develop the correct ergonomic posture. To check your position, you can use a simple method. It is necessary to fold the arms across the waist. The subject's nose should be at the level of the doctor's elbows.

Rational exchange of tools between doctor and assistant

For the best performance, the actions between the doctor and the assistant are coordinated. The movement of tools should be clear, fast, according to a previously worked out scheme. In dental practice, two principles of rational transmission are used - these are the methods of parallel and rotational replacement.

Parallel replacement method

Algorithm for the parallel replacement method:

1. The doctor removes one instrument from the working area (hereinafter “I1”) and waits for the second instrument (hereinafter “I2”).
2. The assistant holds the I2 by the non-working surface with his left hand and transfers it in such a way that the specialist makes a comfortable grip.
3. In the transfer area, tools I1, I2 are parallel to each other, vertically, the working surface looks down.
4. The assistant with the left little finger makes a grip of I1 for the inoperative part, after a firm grip, the doctor releases I1.
5. Then the assistant transfers I2, and removes I1.

Four-handed work, video:

Rotary swap method

This method is similar to the previous one in the initial stages. Only the last steps are different. Before performing the transfer I2, the assistant rotates the hand with the instrument 12 degrees. When doing this, the working surface of the tool must point upwards.

Working effectively with an assistant - a few tips:

Basic grip and fixation

Another point to pay attention to is the basic grip and fixation of working tools. The correct technique makes it possible to regulate and control the accuracy of manipulation and the strength of the application.

Basic provisions of the basic grip and fixation:

1. The hand is fixed in such a position in which the wrist is straight, the fingers are relaxed. In professional terminology, such a pose is called a "sleeping hand".
2. The tool is placed on the inner-lateral part of the 2 and 3 phalanges of the index finger of the working hand.
3. At the level of the 3rd phalanx, the instrument is fixed with the index and thumb.
4. The tool slides until it comes into contact with the third finger. He moves at the expense of the 1st, 2nd, 3rd fingers of the working hand in relation to the fulcrum.

Note! In practice, it is often not always possible to treat a patient in ideal ergonomic conditions. Based on his own experience, the doctor individually determines which ergonomic style suits him.

Presentation on Ergonomics in Dentistry: