module 1- ergonomics and periodontal instrumentation

Copyright © 2017 Wolters Kluwer • All Rights ReservedCopyright © 2014 Wolters Kluwer • All Rights Reserved

Module 1—Ergonomics and Periodontal

Instrumentation

Section 1Ergonomic Risk Factors Associated with

Periodontal Instrumentation

Copyright © 2017 Wolters Kluwer • All Rights Reserved

What is Ergonomics?

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Ergonomics

-Ergonomics is an applied science concerned with the “fit” between people and technological tools and environment-Focuses on making tasks comfortable and efficient for user-Equipment should fit the user instead of forcing user to fit equipment-Efficiency makes tasks easier to do

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Poor Ergonomic Working Conditions

-Worker comfort, productivity, and workplace safety can suffer-For the dental hygienist the work environment includes the dental office layout, dental equipment, and instruments-Dentists and dental hygienists are exposed to ergonomic risk factors that can lead to discomfort, pain, and possible disability

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Musculoskeletal Disorders

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Common Musculoskeletal Disorders

in Dental Healthcare Providers

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Musculoskeletal Disorder (MSD)

-MSD is a condition where parts of the musculoskeletal system (muscles, tendons, nerves) are injured over time

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Causes of Musculoskeletal Injuries

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Forceful or Awkward Movements

Periodontal instrumentation involves forceful movements combined with awkward postures.Injuries occur with overuse of small muscles and tight grips.Injury to the musculoskeletal system can cause loss of strength, impairment of motor control, tingling, numbness, or pain.

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Poor Posture

A twisted torso or uneven shoulders for an extended period of time can increase the risk of musculoskeletal injury.

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Repetitive Movements

The human body was not designed to make the same movements hour after hour, day after day.Dental work requires repeated use of arms and hands in a fixed work position.

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Ergonomic Hazards for Dental Hygienists

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Ergonomic Hazards

-Awkward postures-Ideal is neutral posture, that means the

joint is being used near the middle of the full range of motion

-Further from neutral posture puts more strain on the joint (e.g., outstretched arms for a long time)

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Poor Positioning of Wrist

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Ergonomic Hazards (cont.)

-Static postures-Maintaining the body in one fixed position for

an extended period of time-Human body is not designed for static

positions-Static gripping of instrument handles is

common during periodontal instrumentation

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-Force-Refers to the amount of effort created by the muscles, and the amount of pressure placed

on body part-“Pinch gripping” is undesirable while holding

an instrument

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-Repetitive movements-A task that involves the same fundamental

movement for more than 50% of the work cycle-Periodontal instrumentation would be

categorized as a repetitive task-Consider the frequency, the duration, and the recovery time during work tasks

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Thoracic Outlet Syndrome

A painful disorder of the fingers, hand,

and/or wrist caused by compression of the

brachial nerve plexus and vessels

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Causes of Thoracic Outlet Syndrome

-Tilting the head forward-Hunching the shoulders forward-Continuously reaching overhead

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Rotator Cuff Tendinitis

A painful inflammation of the muscle tendons in the shoulder region

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Causes of Rotator Cuff Tendinitis

-Holding the elbow above waist level-Holding the upper arm away from the body

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Pronator Syndrome

A painful disorder of the wrist and hand caused by compression of the median nerve by the pronator

muscle

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Causes of Pronator Syndrome

-Holding the lower arm away from the torso of the body

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Extensor Wad Strain

A painful disorder of the fingers as a result of injury to the extensor muscles

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Causes of Extensor Wad Strain

-Extending the fingers independently of each other

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Carpal Tunnel Syndrome

A painful disorder of the wrist and hand

caused by compression of the median nerve in

the wrist

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Causes of Carpal Tunnel Syndrome

-Repeatedly bending the hand up, down, or from side to side at the wrist-Pinch-gripping an instrument without resting the muscles

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Ulnar Nerve Entrapment

A painful disorder of the lower arm and

wrist caused by compression of the

ulnar nerve at the wrist

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Causes of Ulnar Nerve Entrapment

-Repeatedly bending the hand up, down, or from side to side at the wrist-Holding the little finger a full span away from the hand

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Tenosynovitis

A painful inflammation of the tendons on the side of the wrist and base of the thumb

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Causes of Tenosynovitis

-Hand twisting-Forceful gripping-Bending the hand back or to the side

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Tendinitis

A painful inflammation of the tendons of the wrist

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Causes of Tendinitis

-Repeatedly extending the hand up or down at the wrist

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Musculoskeletal Injuries

A high risk for musculoskeletal injury occurs when repetitive motions are combined with forceful movements, awkward postures, and insufficient recovery time.

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Copyright © 2017 Wolters Kluwer • All Rights ReservedCopyright © 2014 Wolters Kluwer • All Rights Reserved

Module 1—Ergonomics and Periodontal

Instrumentation

Section 2Foundational Skills for Periodontal

Instrumentation


Foundational Skills for Periodontal Instrumentation

-Periodontal instrumentation is a complex psychomotor skill -Requires the proper position, instrument grasp, mirror use, finger rests, and stroke production-For successful instrumentation, must have mastery of individual skill components…these skills are mastered one-by-one

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Building Blocks for Periodontal Instrumentation

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Ergonomic Do’s and Don’ts

-Don’t alter posture positions just to get the job done-Do assume a neutral, balanced body position-Do make adjustments to patient’s chair and dental equipment to complete periodontal instrumentation

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Neutral Positioning

-Refers to ideal positioning of the body in a balanced position-Results in a decreased risk of musculoskeletal injury

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Neutral Position for the Clinician

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Neutral Neck Position

Goal: Head tilt of 0 to 15 degrees

AVOID:– Head tipped too far

forward– Head tilted to one side

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Neutral Back Position

Goal: Leaning forward slightly

from the waist or hips

AVOID: Curved back

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Neutral Torso Position

Goal: Torso in line with long axisAVOID: Leaning or twisting torso

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Neutral Shoulder Position

Goal: Shoulders even

AVOID: Shoulders hunched up toward

ears

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Neutral Upper Arm Position

Goal: Elbows at waist level held

slightly away from the body

AVOID: Elbows held above waist level

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Neutral Forearm Position

Goal: Forearm parallel to the floor

AVOID: Angle between forearm and upper arm of

less than 60 degrees

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Neutral Hand Position

Goal: Little finger-side of palm slightly

lower than the thumb-side of palmAVOID: Palm parallel

to floor

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The spine has three healthy curves:

1. Cervical (inward curve)2. Lumbar (inward curve)3. Thoracic (slight outward curve)

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Neutral Clinician Posture – Step 1

-Position buttocks all the way back in the chair

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Adjust seat height so feet are flat on the floor

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-Weight evenly distributed-Seat back about 1 in higher than front of seat-Hips slightly higher than knees

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Selecting Clinician Stool

-Each clinician should adjust stool height and seat back to his or her own body proportions and height-Adjust seat tilt and lumbar height of backrest-All three normal back curves should be present while sitting

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Neutral Position for the Patient

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Supine Patient PositionMaxillary Treatment Areas

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Characteristics of Neutral Patient Position

Patient’s feet even with, or slightly higher than the tip of nose

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Characteristics of Neutral Patient Position (cont.)

Chair back nearly parallel to the floor for maxillary treatment areas

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Top of patient’s head even with the upper edge of the headrest

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Chair back raised slightly for mandibular treatment areas

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Patient Head Adjustment

-Once chair is in position, ask patient to adjust head for optimum visibility of treatment area

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Patient Head Tilt for Maxillary Arch(Chin-up position)

-Angle the headrest up into the back of patient’s head so nose and chin are level

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Patient Head Tilt for Mandibular Arch(Chin-down position)

-Angle the headrest forward and down so that the chin is lower than the nose level

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Neutral Positioning of Equipment

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Light Position for Mandibular Arch

-position light directly over the oral cavity-position at arm’s length

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Light Position for Maxillary Arch

-position will vary from being over the oral cavity to being positioned over the neck-position at arm’s length

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Clinician Position Relative to the Patient

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-upper arms parallel to torso-arms are not raised-shoulders relaxed

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-elbows are raised up in a stressful position-patient chair is too high

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-patient positioned too high for clinician-clinician’s chair is raised so she can reach the mouth-her feet are not flat on the floor

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Easy Neutral Position

1. Sit alongside the patient.2. Position your arm against your side. 3. Position your arm crossed at your waist.

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Easy Neutral Position (cont.)

4. Lower the patient’s chair until the patient’s open mouth is below the point of your elbow.

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Easy Neutral Position (cont.)

5. Make sure that your shoulders are not

raised up toward your ears!

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Patient Head Position

-Ask patient to adjust his or her head to have access to treatment area-Maxillary arch: patient in chin-up position-Mandibular arch: patient in chin-down position

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Ancillary Equipment

Ancillary equipment helpful during periodontal instrumentation: -Coaxial illumination -Magnification loupes

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Coaxial Illumination

-Spectacle-mounted or headband-mounted lights (dental headlights)-Light beam parallel to clinician’s line of vision

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Magnification Loupes

-Magnifies treatment area-Improves visual sharpness-Reduces strain to clinician’s back and shoulders-Decreases eyestrain

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Field of Vision Without Loupes

-When learning the skills of positioning, mirror use, and finger rests, the clinician needs a normal field of vision-Permits self-evaluation of skills

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Neutral Positioning

-The ideal positioning of the body-Results in a decreased risk of musculoskeletal injury

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Summary: Neutral Position

Comprised of:-Neutral, balanced clinician position-Neutral patient position-Neutral clinician position in relation to the patient and to dental equipment

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module 1- ergonomics and periodontal instrumentation

Education