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 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 32-35

Ergonomics in dentistry: A comprehensive review

1 Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad, Haryana, India
2 Department of Oral Medicine, Manav Rachna Dental College, Faridabad, Haryana, India
3 Department of Public Health Dentistry, Inderprastha Dental College and Hospital, Sahibabad, Uttar Pradesh, India

Date of Submission26-Dec-2019
Date of Acceptance13-Jan-2020
Date of Web Publication28-Mar-2020

Correspondence Address:
Sumit Bhateja
Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_87_19

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Nature of the dental profession and postures assumed by dental surgeons during their professional work has an enormous effect on their body. Dentists nowadays are becoming more prone to musculoskeletal disorders. A well-adapted design of the workplace is a basic requirement for maintaining musculoskeletal health that will in turn enhance work efficiency. The present article discusses the various methods to stabilize the dental operatory to allow the operator to work with comfort, efficiency, and ease.

Keywords: Dentistry, ergonomics, musculoskeletal disorders

How to cite this article:
Sachdeva A, Bhateja S, Arora G. Ergonomics in dentistry: A comprehensive review. J Dent Res Rev 2020;7:32-5

How to cite this URL:
Sachdeva A, Bhateja S, Arora G. Ergonomics in dentistry: A comprehensive review. J Dent Res Rev [serial online] 2020 [cited 2023 Mar 27];7:32-5. Available from: https://www.jdrr.org/text.asp?2020/7/1/32/281510

  Introduction Top

Ergonomics can be defined as an applied science concerned with structuring and organizing things commonly utilized by individuals with the goal that both people and things connect most efficiently and securely.[1] Every occupation has its associated risks and occupational hazards, which ultimately bring ergonomics into the picture. Ergonomics deals with the modification of work as per the requirement of people, rather than accommodating with the existing conditions.

The dental profession requires skillful dental preparations with great precision and control. Muscles used for this purpose are at risk of becoming fatigued and causing discomfort to the dentist. A dentist is known to be the most susceptible to postural problems due to limited access and restricted view which makes them vulnerable to occupational risks. The proper ergonomic design should be given utmost importance to prevent tedious strain injuries which eventually can lead to long-term disability. Ergonomic principles aim to establish a relatively safe and healthy working environment for practitioners which will eventually lead to increased productivity.

Since the past few years, the incidences of musculoskeletal disorders (MSDs) have been on the rise. MSDs have been perceived as a serious cause of concern and received considerable attention from the researchers and health-care professionals.

  Musculoskeletal Disorders Top

MSDs refer to a wide range of inflammatory and degenerative disorders of muscles, tendons, and nerves. These disorders can result in pain and functional impairment affecting many body parts such as the neck, upper and lower back, shoulders, elbows, wrists, and hands.[2] Hill et al. in 2010 reported MSDs to be one of the most common and leading causes for early retirement among dentists.[3] The prevalence of musculoskeletal pain in dentists ranges between 64% and 93% with the back and neck being the most affected regions.[4]

MSDs affect areas such as the neck, back, shoulder, elbow, wrist, and fingers. Early symptoms include decreased strength, pain, swelling, and numbness. Other symptoms may include excessive fatigue in shoulders and neck, weak hand grip, and hypersensitivity in hands and fingers. Sustained awkward postures often lead to stressed and shortened muscles which can become ischemic and exert asymmetrical forces causing misalignment of the spinal column.[5]

Risk factors for musculoskeletal disorders

The risk factors for MSDs among dental professionals include:

  • Prolonged awkward postures: dental personnel undertake awkward positions to obtain an optimal view of the patient's teeth and to coordinate the relative positions between himself and the assistant. An increased amount of stress is placed on the spinal disks when the back is bent or twisted. Furthermore, performing prolonged activities over the shoulder height can be stressful. In addition, the disc pressure increases rapidly when sitting in forwardly bent and rotated positions
  • Repetitive motions: fatigue and muscle strain can be caused if motions are repeated and that too for a prolonged period of time. The longer the period of continuous work, the longer is the rest time period required
  • Inadequate lightning: compromised lightning in the dental operatory can unintentionally lead to unnatural postures.

Apart from the above-mentioned risk factors, few others such as stress, poor flexibility, infrequent breaks, and improper equipment adjustment contribute significantly to MSDs.[4] A study conducted in 2016 found that nearly 44% of dentists were at very high risk of developing MSDs.[6]

Carpal tunnel syndrome (CTS) is one of the nerve-related disorders primarily involving the median nerve of the wrist and can be provoked by exposure to vibration.[7] CTS has been linked with both repetitive and forceful work. There is evidence of an association between CTS and highly repetitive work, alone or in combination with other factors.[4]

Implications of musculoskeletal disorders

MSDs can induce premature fatigue, pain, and a negative attitude toward work. The neck is the most commonly affected due to poorly designed workstations.[8] Possible reasons for the same maybe due to improper vision to the patient's oral cavity. The operator has a tendency to bend into awkward positions, resulting into a deviation from the balanced posture. Furthermore, an incorrect neck position may radiate to the back thus leading to backache. A study conducted in 2018 to evaluate ergonomic postures during routine procedures discovered that none of the operators had a correct neck position.[8] Lower and upper back pain has also been reported by a large fraction of dentists. Lower back pain can be exacerbated by inflexibilities around the hips and pelvis and relative weakness of abdominal and gluteal muscles.[1] Constant flexion and extension motions of the hand and wrist without any rest lead to mechanical stress on the digital nerves. A proper ergonomically designed workplace can ensure abolishment of MSDs.

  Intervention Top

Maintaining a balanced posture and preserving its symmetry are largely dependent on the relationship established between the dentist and the intraoral working area. Ergonomics should be included in the instrument designing, planning of workstations, and should be implemented clinically. It is always recommended that the distance between working field and the dentists eyes should be 35–40 cm.[8] The following modifications can help achieve ergonomic principles:

  • Posture: poor postural alignment puts pressure on nerves and blood vessels, causing excessive strain on muscles and causes wear and tear of joint muscles.[9] Attempts should always be made to maintain an erect posture. An adjustable chair with lumbar, thoracic, and arm support and adjustable footrest should be used. The height of the chair should be adjusted to a comfortable level. Excessive wrist movements should be avoided. The dental chair should be raised so that the operator's thighs can freely turn beneath it. A balanced posture features can be summarized as:

    • Straight back and respect for body symmetry
    • Avoid forward inclination of the body
    • Arms placed along the body
    • Feet symmetrically positioned below the operator's hands.

  • Selection of instruments: The instrument performs the majority of the work when the working edges are sharp thus reducing the excessive force application. An additional force is required while using instruments with dull or blunt edges. Furthermore, the use of lightweight and durable automatic handpieces should be encouraged instead of manual hand instruments
  • Lighting and magnification: Parallel positioning of the light beam in the observational direction provides shadow-free lighting thus improving the work quality.[10] The use of dental loupes and microscope having multiple levels of magnification facilitates a more upright posture and diminishes back and neck pain
  • Dentist microbreaks: Frequent breaks should be taken to relax the body parts. Work positions should be constantly changed for moving the muscle workload from one area to another. A dentist can take a break to perform stretches' by the chairside
  • Scheduling: The appointment schedules should be planned to provide sufficient recovery time and to avoid muscle fatigue. Alternate easy and difficult cases should be undertaken with buffer periods
  • Training of dental personnel: Training is essential for any health-care setup. It ensures that the employees are well versed about the occupational hazards, and they can self-volunteer in identifying and controlling the possible risks.

  Four-Handed Dentistry Top

Four-handed dentistry has been described as a practice in which the dentist and assistant work as a team to perform some operations planned with an intention to benefit the patient.[11] It involves the use of a trained chair side assistant to work constantly with the dentist in performing the technical procedure during the course of any dental procedure in the dental setup.[12] Proper utilization of an extra pair of hands of the dental auxiliary in a four-handed dentistry setup is generally regarded as an ideal method of delivering dental services. To practice true four-handed dentistry, the following criteria must be met:[13]

  • All equipment must be ergonomically designed
  • The operating team and patient must be seated comfortably in ergonomically designed equipment
  • Preset trays should be utilized
  • The dentist should assign all legally delegable duties to qualified auxiliaries based on the state's guidelines
  • The patient's treatment plan should be planned in advance in a logical sequence.

Zones of activity

The work area around the patient is basically divided into four zones called “zones of activity.”[11] Zones of activity are identified using the patient's face as the face of a clock. The four zones of activity are as follows:

  • Operator's zone
  • Assistant's zone
  • Transfer zone
  • Static zone.

Different activity zones for the right operator are shown in [Figure 1].
Figure 1: Zones of activity for right-handed operator[11]

Click here to view

  Future Directions Top

The subject of ergonomics lays down the foundation of dental training. Proper ergonomics should be inculcated in every aspect of dental practice, including instrument designing, planning of workstations, and should be implemented while performing clinical work. The application of ergonomic principles that identify, point out, and modify postural inadequacies is necessary. The teaching of this discipline is inevitable as budding dentists' in today's world are becoming more prone to develop occupational diseases. Audiovisual resources should be incorporated in dental institutions so that the students as well as practitioners can tempt to identify the mistakes and come up with solutions. Dentists' knowledge and attitudes toward ergonomics should constantly updated by conducting the educational programs to increase awareness, reduce the incidence of occupational pathologies leading to early retirement among dentists, and improve the quality of the dental health-care services rendered to the patient.

  Conclusion Top

Successful application of ergonomics in the dental operatory assures high productivity, avoidance of injuries, and increased satisfaction among patients. Adapting some basic principles and maintaining a balanced posture can prevent the occurrence of MSDs. Awareness among dental practitioners through continuing dental education programs and lectures should be encouraged on a regular basis. Four-handed dentistry should be routinely incorporated into the practice to enhance the efficiency and ease of work.

Hence, aspire to inspire before your expire!

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Conflicts of interest

There are no conflicts of interest.

  References Top

Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in dentistry. Int J Clin Pediatr Dent 2014;7:30-4.  Back to cited text no. 1
Buckle PW, Devereux JJ. The nature of work-related neck and upper limb musculoskeletal disorders. Appl Ergon 2002;33:207-17.  Back to cited text no. 2
Hill KB, Burke FJ, Brown J, Macdonald EB, Morris AJ, White DA, et al. Dental practioners and ill health retirement: A qualitative investigation into the causes and effects. Br Dent J 2010;209:E8.  Back to cited text no. 3
Gupta S. Ergonomic applications to dental practice. Indian J Dent Res 2011;22:816-22.  Back to cited text no. 4
  [Full text]  
Gupta K. Ergonomics and dentistry. Int J Med Health Res 2017;3:67-8.  Back to cited text no. 5
Batham C, Yasobant S. A risk assessment study on work-related musculoskeletal disorders among dentists in Bhopal, India. Indian J Dent Res 2016;27:236-41.  Back to cited text no. 6
[PUBMED]  [Full text]  
Borhan Haghighi A, Khosropanah H, Vahidnia F, Esmailzadeh S, Emami Z. Association of dental practice as a risk factor in the development of carpal tunnel syndrome. J Dent (Shiraz) 2013;14:37-40.  Back to cited text no. 7
Deolia S, Dubey S, Chandak A, Patni T, Padmawar N, Sen S. Application of ergonomic postures during routine dental procedures in a private dental institute. Dent Med Res 2018;6:41-5.  Back to cited text no. 8
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Thakral R, Shukla P, Kapoor S, Jaiswal RK, Bhagchandani J, Warsi F. Ergonomics for healthy orthodontic practice. Int J Oral Health Med Res 2016;2:110-4.  Back to cited text no. 9
Diniz DG, Diniz JP. Current considerations in dental ergonomics: Standards and guidelines, teaching and prevention. J Ergonomics 2017;7:1-3.  Back to cited text no. 10
Singh N, Jain A, Sinha N, Chauhan A, Rehman R. Application of four-handed dentistry in clinical practice: A review. Int J Dent Med Res 2014;1:8-13.  Back to cited text no. 11
Dalai DR, Bhaskar DJ, Agali CR, Gupta V, Singh N, Bumb SS. Four handed dentistry: An indispensable part for efficient clinical practice. Int J Adv Health Sci 2014;1:16-20.  Back to cited text no. 12
Kilpatrick HC. Functional Dental Assisting. Philadelphia: W. B. Saunders Co.; 1977.  Back to cited text no. 13


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