I J C D C. Indian Journal of Comprehensive Dental Care IMPORTANT CHAPTER IN ORTHODONTICS : ERGONOMICS JAN- JUNE 2018 VOL 8 ISSUE 1

Transcription

1 I J C D C IMPORTANT CHAPTER IN ORTHODONTICS : ERGONOMICS ABSTRACT Orthodontists are commonly exposed to a variety of occupational hazards such as musculoskeletal disorders which can limit the quality of work provided by the dental professional towards their patients and ultimately affect the long term health of the orthodontist. The traditional methodology for prevention and management of dental related musculoskeletal pain was to adopt a proper sitting posture, reduce large scale movements and perform periodic stretching. Proper ergonomic design is crucial to prevent repetitive strain injuries, which can develop over time and can lead to long-term disability. Ergonomics is concerned with the 'compatibility' between people and their work. It takes account of the worker's capabilities and limitations in seeking to confirm that tasks, equipments and the environment suits each worker. This article provides alternatives that should be considered by the practioner to improve his or her work environment and daily practice to reduce the risk of musculoskeletal disorders and improve the quality of care towards the patient JAN- JUNE 2018 VOL 8 ISSUE 1 Indian Journal of Comprehensive Dental Care 1. Shilpa Gupta 2. Tahira Kaur Bawa 3. Gurleen Kaur 4. Darshpreet Kaur 1. M. D. S., R e a d e r, D e p a r t m e n t o f O r t h o d o n t i c s a n d D e n t o f a c i a l Orthopaedics, Sri Guru Ram Das Institute 2. M. D. S. S t u d e n t, D e p a r t m e n t o f O r t h o d o n t i c s a n d D e n t o f a c i a l Orthopaedics, Sri Guru Ram Das Institute 3. B.D.S, Ex-Intern, Sri Guru Ram Das Institute 4. B.D.S, Ex-Intern, Sri Guru Ram Das Institute /Date of Submission : Date of Acceptance : Corresponding author: Name: Dr. Shilpa Gupta Reader, Dept of Orthodontics and Dentofacial Orthopaedics Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar id. drshilpagupta@gmail.com Improper ergonomic design can lead to repetitive strain injuries, which can develop over time and can lead to long- term disability. Some of the signs and symptoms of musculoskeletal disorders include:- INTRODUCTION In Greek, Ergo means work and Nomos, means natural laws or systems. The international ergonomics association has defined ergonomics (or human factors) as the scientific discipline concerned with the understanding of interactions among humans and other elements of a system and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. Musculoskeletal pain can affect the dentist's performance in several ways, which include limiting the number of patients seen per day, decreasing fine motor dexterity and 2 hampering dentists-patient rapport. Because of the narrow work area, performance of dental treatment results in a very inflexible work posture and ultimately affect the quality of care. Not only this, stress on muscles and joints can lead to more serious conditions over time. Surveys of Dental Professionals reveal that more that 60 percent of dentists and hygienists experience often debilitating muscle and joint pain as a result of their work. One of the main goals of ergonomics in dentistry is to lessen the amount of physical and mental stress that sometimes happens day to day in a dental practice. Applying ergonomics to the practice of dentistry will not only provide safety benefits but also improve performance objectives through greater productivity. SIGNS AND SYMPTOMS OF MUSCULOSKETAL DISORDERS a) Upper & lower backache b) Rotator cuff tendinitis c) Brachial nerve compression, tension neck Indian Journal of Comprehensive Dental Care 1123

2 Postural Awareness Techniques Maintaining a low back curve Using magnification systems Adjusting operating chair properly Avoiding static postures Positioning Strategies Alternating between standing and sitting Reposition the feet Positioning patients at the proper height Avoiding twisting Periodic Breaks and Stretching Chair side directional stretching Stretching during micro breaks Releasing trigger points syndrome, cervical spondylitis Considerations to be kept in mind are- d) Ulnar nerve entrapment Overall shape/size e) Carpel tunnel syndrome Handle shape/size f) Tenosynovitis Weight g) Tendinitis Balance ETIOLOGY Manoeuvrability The primary occupational risk factors for musculoskeletal Ease of operation disorders include:- Ease of maintenance 1. Awkward posture In case of hand instruments, look for- 2. Improper adjustment of equipment Hollow or resin handles 3. Infrequent breaks Round, knurled or compressible handles 4. Repetitive movements Carbon steel construction (for sharp instruments) STRATEGIES FOR REDUCING ERGONOMIC PROBLEMS IN While buying automatic hand pieces for your operatory, look DENTISTRY for- VARIOUS INTERVENTIONS FOR CONSIDERATION IN THE DENTAL PRACTICE Lightweight, balanced models 1. EQUIPMENT AND INSTRUMENT DESIGN:- Dentists Power should be sufficient should consider the ergonomic ramifications of the purchase Built-in light sources and be aware about the 'ergonomic designed' ones. Angled versus straight shank Indian Journal of Comprehensive Dental Care 1124

3 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig.7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Neutral neck position Neutral back position Neutral shoulder position Saddle seat correct posture neutralpostion in relation to patient Fig. 13 Fig. 14 Fig. 15 Mandibular arch Fig. 16 Maxillary arch Fig. 17 Fig. 18 Fig. 19 Operator, assistant and patient are comfortably seated in balanced posture Fig. 20 Indian Journal of Comprehensive Dental Care 1125

4 Fig. 21 Fig. 22 Fig. 23 Fig. 24 Pliable, lightweight hoses c) Ergonomic guidelines for operator chair- Swivel mechanisms Stability Easily activated Lumbar support Easy to maintain Hydraulic controls In case of syringes and dispensers, look for- Cylinder height Enough lumen size Hands-free seat height adjustment Easy to clean Adjustable foot rests Knurled handles Adjustable, wrap around body support Easy activation and placement Seamless upholstery Adjustable backrest 2. EARLY TREATMENT OF MUSCULOSKELETAL Tilting seat pan DISORDERS:- Early interventions are important in order to achieve a better result at less cost and inconvenience. Early Textured seat material symptoms in the wrist and hand respond to conservative Correct wheel type medical management that includes rest, icing, non-steroidal Armrests anti-inflammatory drugs and splints. d) Ergonomic guidelines for patient chair- 3. PROPER POSTURE, STOOLS AND PATIENT POSITIONING:- Stability a) General posture in dental practice- Pivoting or drop-down arm rests Patient chair:- a) up right, b) semi reclined, c) fully Wrist/forearm support for operator reclined. Hands free-operation Relationship of the dentist knee to the patient chair: Narrow upper back that allows closer positioning - a) 90 degree, b) >90 degree, c) <90 degree. Swivel function that will allow the chair to rotate in Dentist posture:- a) while standing- flexion posture the operatory either A-O degree or B-35 degree (unfavourable), b) while sitting- flexion posture either A-degree or B-20 degree or 30 Sling or low profile armrests that helps the dentist to degree. work in 8 o'clock-10 o' clock position without hit their knees on a fixed metal arm rest Relationship of dentist to the patient's chair:- a) at sternal level, b) below sternal level, c) above sternal level. Large knobs should be absentas they hit the edge of operator chair, preventing close positioning a) Operator positioning :- 3 Adjustable chair height. b) Patient postioning :- Indian Journal of Comprehensive Dental Care 1126

5 4. LIGHTING:- a) Body stretching exercise For proper lighting and to prevent shadowing, it is b) Neck exercises advised that the operatory light should be parallel to, or within 15 degrees of the operator's line of sight. c) Hand exercises The intensity ratio between dental operating light Hand clenching exercise should not be greater than Wrist bending exercise Fibre-optics adds concentrated light to the operating field. Procedure scope-it facilitates neutral head position and reduced eye fatigue. It makes use of an extra-oral camera that is placed above the patient's mouth, which projects a magnified image of the oral cavity onto a large flat video screen mounted at eye level, allowing the operator to move freely around the patient while visualising the screen. Microscope- it provides near neutral head position with proper adjustment. Indirect viewing of the oral cavity is achieved by the optics in the scope that bends the path of image to almost 90 degrees, allowing an upright posture. Finger strengthening exercise CONCLUSION 5. MAGNIFICATION:- Different visualisation aids used in dentistry are- Dental professionals are prone to unique muscle imbalances and require special exercises and ergonomic interventions to maintain optimal health during the course of their career. It is important to not only know the effective interventions, but also in what sequence to implement them. By making changes in the way we practice via incorporation of some of the suggestions discussed in the article into our regular routine during the work day will prove beneficial for the practitioner, as one will experience less fatigue and pain and will be able to provide quality service to the patients. REFERENCES 1. Sarkar PA, Shigli AL. Ergonomics in general dental practice. People's JSci Res, 2012; 5(1): Loupes- enable working posture of less than 25 degrees of forward head posture. Strength lies between 2x to 2. Chasteen JE. Four handed dentistry in clinical practice. 5x. These are available in 2 styles that is flip ups (front lens St. Louis, CV. Mosby mount) and through-the-lens (fixed mounts). 3. Gupta S. Ergonomic applications to dental practice. 6. FOUR-HANDED DENTISTRY:- Indian Journal of dental research. 1Nov, 2011;22(6):816. Eliminates unnecessary motion 4. Valachi B, Valachi K. Preventing musculoskeletal Decreases twisting and turning movements disorders in clinical dentistry: strategies to address the Decreases long reaches and unbalanced postures mechanisms leading to musculoskeletal disorders. The journal of the American Dental Association. 31Dec, RELIEF EXERCISES:- ;134(12): Indian Journal of Comprehensive Dental Care 1127