module 1—ergonomics and periodontal instrumentation (2)

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

Copyright © 2017 Wolters Kluwer • All Rights Reserved

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 (2)

Education