Ergonomic Applications to Dental Practice


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  • 3 3 3 Ergonomics comes from the combination of two Latin words, “ergos,” meaning work, and “nomos” meaning natural laws or systems. Hence, in its broadest sense, ergonomics is the science of work. Practically applied, ergonomics seeks to optimize the functioning of systems by ensuring that they are compatible with human capabilities and needs. When applied to job design, ergonomics seeks to - improve productivity - reduce the number of problem tasks that make it difficult to staff them - increase the number of jobs within the capabilities of women and older workers
  • 4 4 4 Ergonomics is not really new - it only seems that way with the new emphasis from the news media and regulators. The term was actually first cointed in 1850 by a Polish scientist. Interest in ergonomics was heightened during WWII, as increasingly complicated technologies were introduced into aircraft. These items were placed into the aircraft with little thought as to how the pilot or maintenance personnel would react to new systems. Unfortunately, the initial result was a rash of accidents with subsequent loss of life. Maintenance issues also became more complex, and aircraft turnaround became longer. As a result, human interaction with aircraft and other military systems became a key issue then and remains an important issue now. Interest in occupational ergonomics increased in the late 1970s with the beginning of the information age. As computers became more commonplace in the workplace, the percentage of hand intensive tasks increased as jobs requiring gross whole body activity were automated. Work pace increased along with productivity demands from management. At the same time, equal employment laws and occupational health and safety standards were enacted. As a result the workforce today is much more diverse than at any other period of our history; yet the tools and tasks performed by workers in many inudstries have not changed much since WWII.
  • Same data in previous ‘How did we get here side” in table instead of graph representation Source: John Bodi OSHSYS Data reduction using the Raw data FY 89 to June 98. Underestimates 98 costs and cases Chondromalacia Definition: A softening or wearing away and cracking of the cartilage under the kneecap, resulting in pain and inflammation. The cartilage becomes like sandpaper because the kneecap is not riding smoothly over the knee.
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  • 17 17 16 Given the spiraling numbers and costs of these disorders, you might be wondering how the AF Medical Service has responded. On March 6, 1998, an interim ergonomics policy was signed into effect by Gen Mabry, requiring implementation of integrated risk-based ergonomics programs “to specifically and prudently address WMSDs”. These programs must contain the elements shown in the slide. The program elements are typical of all effective occupational safety and health programs.
  • 18 18 17 9 Key Point: The AF has tools/resources to address WMDs now. - The AF PREMIER (PReventing Musculoskeletal Illnesses through ERgonomics) Program provides: -- a template for developing an installation level ergonomics regulation (Management Guidelines), -- tools for workplace analysis and hazard prevention and control (Job Requirements/Physical Demand Survey, Level I Guides), -- guidelines for health care management and material acquisition, -- quality performance indicators (QPIs) for program evaluation and review. - Introductory and advanced ergonomics training is available through USAFSAM and USACHPPM. -- 500+ Bioenvironmental Engineers (BEEs) and Public Health Officers (PHOs) trained in use of AF PREMIER Program tools. -- Computer based training in office ergonomics (Ergoeaser) available on CD ROM. - Resources are readily accessible by AF personnel. -- PREMIER program available through DTIC (AL/OE-TR-1996-0158) -- Ergonomics/PREMIER program information available on Internet ( -- PREMIER Program on CD ROM under development.
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  • 23 23 22 HCP is responsible for ensuring that work-related illnesses are appropriately recorderd and referred to PH for investigation. Should also be involved in efforts to monitor trends for WMSDs across base by participating in reviews of sign-in logs, OSHA 200 forms and individual employee medical records. To facilitate early evaluation of WMSDs all employees must be educated on the causes and symptoms of WMSDs and encouraged to report symptoms to superviosors with subsequent referral to medical. Important to avoid potential disincentives to employee reporting. Written health care management protocols should be established. One example is the Clinical Practice Guidelines developed for Acute Lob Back Problems by the USPHS, Agency for Health Care Policy and Research (attached to Gen Mabry’s policy letter). HCPs should also perform evaluations of employees with known ergonomic hazards. These should include medical/occupational history and a brief non-invasive physical exam. Not currently incorporated into AF Physical Exam protocols. Conservative treatment deserves adequate trial before surgery is contemplated (at least 6 months).
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  • Ergonomic Applications to Dental Practice

    1. 1. Ergonomic Applications to Dental Practice dr shabeel pn
    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
    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> </li></ul>