The Ergonomics of Hygiene Operatory Design

This operatory isn’t fit for hygiene! 

How many of you have uttered these words? I know I have numerous times. For the past few years I have been working full-time as a dental hygiene sub/temp after enjoying two long-term positions with doctors who listened to my input when remodeling and designing new office space. 

I was lucky – and admittedly maybe a little pushy – when asking for certain accommodations where the design of my primary workspace was concerned. BUT, if you don’t ask for it, you’ll never get it! Now, working as a hygiene temp, I’ve seen so many operatories that are the epitome of poor design.

And I’ve also seen the direct cause of many of us sustaining injuries and disabilities.

The Good, The Bad and The Truly Awful

Raise your hand if you have any of the following in the op you primarily work from:

• Counter directly behind the head of the patient chair
• Rear delivery of water, vacuum and handpiece
• Coiled cords on handpiece lines
• A stool that is not fit to your body
• Vacuum line arms that do not extend or do not extend far enough to be within reach
• Patient chairs that are wider than the patient
• Poor overhead lighting
• Walls, cabinets or partitions surrounding the 9 o’clock to 1 o’clock positions

These will all cause pain, fatigue and injury if we allow ourselves to continue accepting this as the norm. Why are operatories not designed for the delivery of hygiene procedures? Typically, dentists do not understand the ergonomics of how hygienists work.

They’re working with an assistant, and with four-handed dentistry done properly, will never have to do more than extend their hands to be within reach of what they need. They also only work on one tooth at a time. As hygienists, we are accessing everything ourselves while also working on an entire dentition within one appointment.

While a counter directly behind the patient chair is optimal for dental procedures, it is the absolute worst for hygiene procedures when we need to access the 11, 12 and 1 o’clock positions.

What Can We Do?
In an ideal world, we would ask for our ops to be redesigned to accommodate our work patterns. I realize this is done at some expense, and many of our employers are not willing to spend money for our comfort (although it’s always free to ask!).

So what can we do???

Chairs
Most patient chairs have a built-in swivel on the base. Use it! Even if you have to let the patient sit in the chair first, then swivel the chair on the base so you have access to the 12 o’clock position, try it! If you suffer from a rear delivery system, it will now be in the 2 o’clock position (still not ideal, but better) and easier to access without twisting your torso to reach it.  

Coiled Cords
Coiled cords can be replaced with straight cords for much less expense than purchasing a new unit. Ask for it! Or better yet, get a cordless handpiece and enjoy not being tethered by any cord at all! Movable carts or trays can be utilized to provide front delivery of your instruments and ultrasonic unit, and can be pushed out of the way at the end of the appointment.

Stools
Operator stools can be tricky. We are not all built the same, and therefore one size does not fit all. When you are in the market for a stool, make sure you demo multiple options before purchasing one. If you are the one sitting on it every day, this decision needs to be yours, not your employer’s.

Lighting
Weak overhead lights cause us to lean forward to gain better vision while we work. This can often be remedied by a new lightbulb or investing in a LED headlamp for your loupes. Can the cabinetry behind you be moved? If so, measure the ideal space you need to fit behind the head of the patient chair while sitting at the 12 o’clock position. This distance will vary because we are all built differently.

Why This Matters
If we as hygienists do not educate our employers and advocate for proper operatory design, we will suffer – quite literally.

Twisting, leaning, bending and stretching to reach are all postures that will shorten your career and threaten your health. Good equipment, self-care habits and proper operatory design are the three key factors to a healthy, and hopefully long career.