Best Dental Ergonomic Assessments & Practices

Dedication to great ergonomics may be the most important effort one can make in the dental office (yes, even more than winning the thermostat battle). Ergonomics is the study of one’s efficiency in their working environment, which can be poor in dental professions. An ergonomic quality analysis produces guidelines for improving mechanics by assessing subjective and measuring objective data.

Connect with Caitlin Parsons, RDH, CEAS, C-IAYT, on Instagram

An ergonomic analysis of the dental office can identify risks for musculoskeletal injury and allow for building a list of ideal modifications. To perform an ergonomic analysis, follow the steps below. 

Gather Subjective Data

This data is based on a person’s report of what they experience or feel. Any staff member can be appointed to the task of gathering data, but ideally it will be a non-clinical staff member so that all clinical staff can be interviewed and observed. Employee feedback is critical in this aspect. To collect this, try the following;

•    Do a walk-through during the work day and observe patient operations.
•    Record notes of observed posture, hazard areas and faulty equipment.
•    Capture pictures or videos for further review to better allow the generation of solutions.
•    Interview all employees, and find out what strains may be occurring on their bodies and what ideas they have to improve ergonomics.
•    Ask if they experience fatigue or discomfort performing their duties.
•    Find out what would make them more comfortable in their workspace.
•    Isolate any incidence of repetitive reports of occupational strain or injury.

Gather Objective Data Using Ergonomic Assessment Tools

Assessment tools are used to measure objective data. Specific tools that may be helpful in the dental setting to establish a standard ergonomic assessment method include:

Rapid Upper Limb Assessment (RULA)

The RULA tool evaluates the upper limbs (shoulder, elbow, wrist) but also the neck and trunk. It's a rapid tool in worksheet format that is simply scored according to one's ability to perform movements. It applies to tasks in which a person uses mostly their upper limbs, with little or no movement. This tool is helpful in determining beneficial changes in instrument selection for dentists and hygienists.

Rapid Entire Body Assessment (REBA)

With this tool, the body is divided into different segments within two groups. The first group includes the neck, torso and legs, while the second group is composed of the arm, forearm and wrist – without distinction from the right or the left one. REBA is helpful in assessing the workspace setup of a dental operatory in regards to layout. Poor layout can inhibit the use of ideal operator positioning. The inability to access equipment with ease can contribute to fatigue and even injury. 

Additional assessment tools may suit your needs and can be downloaded and printed, or may have a convenient app format. These include:

•    WISHA Caution Zone Checklist 
•    WISHA Hazard Zone Checklist
•    The NIOSH Lifting Equation
•    Liberty Mutual Manual Material Handling Tables 
•    Hand-Arm Vibration Calculator (HAV)

Essentially, these tools will produce observable data that can be combined with and compared to subjective data. The product of assessing this information leads to developing a plan.

Design a Plan to Implement Modifications 

As a team, including the clinical staff, evaluate the data and formed outcomes to create an actionable list of ergonomic risk factors, and present these modifications to management. The list may be categorized by department and tasks prioritized by the potential for injury. Organize your list by defining a clear time frame of what modifications should be implemented by when, and decipher what resources and training will be needed to complete each task. 

Goals for short-term and long-term changes will be identified through this process. These goals should be presented to management in a staff meeting and further discussed as an office.  

Short-term Goals (Educational Resources) 

Some risk factors may have the potential for quick mitigation. Ergonomic education is a learning moment the entire office can take advantage of. Better chairs, like saddle seats, may be researched. Reviewing photograph documentation of poor posture can promote mindfulness. 

Hygienists particularly struggle with poor posture. They work with the full dentition, as opposed to one section of the mouth, and often lack four-handed assistance compared to dentists. 

Train to acquire a mindset that the comfort and positioning of the operator is very important – even more important than accommodating requests of the patient for seating. In fact, when a hygienist cannot properly see their working field, technical adaptations are lost, and there's an increased incidence of pain and injury to the patient. 

Try the mantra, the better I can see, the more comfortable we’ll be. Don't be afraid to ask a patient to move properly into position in the chair or by instructing head tilting and turning movements. Even for a patient with limited mobility, small changes in their position can make big improvements to a hygienist's ergonomics. 

Short-term Goals (Product Replacement)

Reducing pain that may have been assessed with the RULA method can be achieved with proper ergonomic equipment. Efficient scalers, such as American Eagle XP® Sharpen-Free Instruments, are a desirable option among hygienists because they maintain their sharp edge throughout their useable lifespan. Cordless handpieces, which are lightweight and reduce repetitive hyper-extension practices, reduce strain and injury. Proper overhead lighting or usage of lighted loupes should be observed during this assessment, as the field of visibility directly impacts the act of neck craning or hunching over.

Mid-long-term Goals

Ultimately, orientating an office space and equipment in each operatory to be ergonomically ideal is a great end game in this assessment. Outcomes from the REBA method can better help you determine a well-designed layout. Methodical replacement of all tools and equipment for ergonomically mindful ones will help the office maintain its modifications. 

Stay Committed

As a part of the clinical staff, you should develop intentions to complete the produced list of goals with office management and review newly learned habits with the team frequently. Hygienists can plan to initiate the cycle to measure and re-evaluate ergonomics in the office quarterly. Findings can be discussed in a staff meeting annually. By making ergonomics a staple in your career, your body, your mind and your patients will thank you.