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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Dental Lab Products. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
Not being mindful of ergonomics can lead to an unwanted, early retirement.
Chronic pain is a pervasive problem for dental practitioners. Chiropractor Timothy Caruso estimates that as many as 60 percent of dentists report back pain, while 85 percent report neck pain. As many at 69 percent of hygienists report hand and wrist pain. As such, it is especially important to be mindful of ergonomics, because if not observed, it can lead to an unwanted, early retirement.
Good ergonomics can help stave off those pains, but require good planning and good site and operatory design.
The design and layout of your operatories is an important consideration, starting with how you come into the room. It seems like an insignificant detail, but it matters.
“If you’re going in a room and have to circulate around the chair and take extra steps and it’s cumbersome and difficult to get you and the patient in and out, that impacts your ability to succeed or produce,” Dr. Jeffrey Carter, DDS, says.
Dr. Carter is co-owner of the Practice Design Group, based in Austin, Texas. PDG specializes in providing architectural, interior design and equipment, and technology integration services to dentists nationwide. PDG also works with Midmark Dental on its ImpactDesign educational courses and hands-on consulting opportunities.
The most efficient design, Dr. Carter notes, is the dual-head entry design. In this layout, at the head of the treatment room (near the head of the patient chair) are two openings-the doctor enters on one side, the assistant on the other.
“It’s most efficient if each person entering the room has their own opening,” Dr. Carter says. “Behind the head of the patient you would have the 12 o’clock cabinet abutted up against the wall in that scenario, because you’re creating the shortest travel patterns for the doctor and assistant. To enter the room and get to their stools is, at most, three or four feet.”
By comparison, an operatory with a single door adds extra travel for the doctor and assistant. They might have to walk 8 or 9 extra feet-or even more if they have to walk around the patient chair. Nine feet may not sound like a lot, but that extra distance adds up.
“If you add that distance up over the course of a year, the more inefficient ways to get into the operatories adds miles to your ability to get in and out of the operatory,” Dr. Carter says. “So you’re wasting time walking in a circuitous pathway with a poorly conceived access opening to an operatory.”
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Room to work
Another design option is to make the overall operatory bigger and a little more private.
“People in the last decade or so have kind of moved away from that to favor openness and easy access in and out,” Stephane Leduc, product marketing manager for treatment centers, cabinetry and instruments at Dentsply Sirona, says. “But I think a more private operatory is something that a lot of doctors are actually going back to, to remove a lot of the distractions.”
“Bigger is better these days,” Dr. David Rice, DDS, a general dentist in Amherst, New York, and founder of IgniteDDS.com, observes. “There are so many technologies that are mobile, and getting them in and out of a treatment room so you don’t have to buy multiple pieces of that technology is helpful.”
Further, he notes that having extra room is necessary for patient access.
“The population of the people that we are treating is aging,” Dr. Rice says. “For the next 10 to 15 years in dentistry, we are going to have a population of patients that are older. People are living longer, and having that extra space to get wheelchairs or walkers in it out is going to be very helpful.”
Allocating where space is used is an important consideration when designing a practice.
“This is where [dentists] make all their money,” Leduc says. “Sometimes I think they overlook that fact. They may try and save space, and they cut a few square feet in the operatory to put a little bit more in the waiting room, but they don’t make any money when the patient is waiting. Realize what is going to be the patient’s experience and what is going to be your experience.”
How the room, equipment and supplies are laid out matter, as well. Placing equipment in easy-to-reach locations will reduce wear and tear on the practitioner’s body.
“My preference is for a thing called ‘split delivery’,” Dr. Carter says. “The doctor’s module is attached to the base of the chair and it’s a left-right unit, but it swivels around the chair for whoever needs it. It holds your handpieces, air, water. You can reach forward, and you deliver it to the patient’s oral cavity.”
Another version of that placement is on the 12 o’clock cabinet and it is called “dual function rear delivery.”
“Some people like that because the patient can’t see it,” Dr. Carter says. “It’s off the chair, it unclutters the chair and it looks more inviting. Almost all pediatric dentists don’t want a chair mount delivery system because the kids will be grabbing stuff and wondering what it does.”
Righties and lefties
Another consideration is whether the room can be configured to accommodate right-handed practitioners as well as left-handed ones.
“Rear delivery systems, from an ergonomic standpoint, are nice because, whether you’re right-handed or left-handed, everything is easy,” Dr. Rice observes. “The patient chair is simply the patient chair, everything else functions behind them, so rear delivery makes everything work better.”
“We like to make the rooms mirror image, ambidextrous,” Dr. Carter says. “Because 20 percent of the population is left-handed, we don’t want to eliminate one-fifth of the people who may work in the office. The tough one is when a doctor is left-handed and everybody else is right-handed. It just puts more emphasis on that. It’s next to impossible for a left-handed person to work ergonomically in what’s really a right-handed only operatory.”
When selecting equipment, Dr. Carter recommends looking for designs that can adjust to both.
“For instance, Midmark has a left-right option on every major piece of dental equipment that goes in a treatment room,” Dr. Carter says.
Being able to tweak a room is not only necessary to accommodate righties or lefties. Everyone is different, so rooms should be easily adjustable, too.
“A little bit of flexibility is always good, because no two people are always the same,” Leduc says. “We’re not the same height, we don’t have the same leg lengths or torsos, so everything is going to be different. You can have two people that are the exact same height, but have different arm lengths or leg lengths, and the way they work will differ. The same thing can be said for patients. While they can be similar, the practitioner will always have to adapt to all the positions that change between each situation.”
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When the doctor or assistant gets in position and is ready to work is the next consideration. The patient and the necessary tools and equipment must be within reach and located on the same plane.
The average location of a patient’s oral cavity is 32 inches from the floor, when they’re fully reclined, Dr. Carter notes.
“We want to make ergonomic planes where everything is more efficient,” Dr. Carter says.
As such, tools and side cabinets should be located at about the same height as the patient’s oral cavity.
“It should be in-sync and in-plane with the patient’s oral cavity,” Dr. Carter says. “So it doesn’t make sense to have supporting services that are at 24 inches and then having to reach down or at 48 inches and have to reach up higher and then come back down to the oral cavity.”
The world of ergonomics is broken down into five different movement classes:
Keeping everything on the same plane reduces move extreme, damaging movements.
“We’re minimizing unhealthy ergonomic movements, like Class IV movements, where we have to reach for things,” Dr. Carter says. “And when we’re working on the same plane, we can limit ourselves to Class I, II and III-the Class IVs and Vs should be avoided as much as possible.”
There’s nothing wrong with asking for help. Consulting with an ergonomist, a practice designer or even an equipment supplier can prove beneficial.
“The best thing to do is to get with one of the big dental distributors,” Dr. Rice says. “Get with somebody that does office design for living. They’ve done this time and time and time again, and having the right support system on your site will save you tons of money and hassle down the line.”
“The dealer reps are all trained to help coach doctors and then you’re going make a well-designed operatory,” Dr. Carter adds. “It’s not intuitively obvious how some of that works. Some people will sit in improper, poor positions and try to make the operatory work, not understanding the design intent.”
Whether remodeling your office or just making some small changes to the uncomfortable ways you may be working can make your day less painful and can lead to a longer, happier career.