5. chair positions class.ppt

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Transcript of 5. chair positions class.ppt

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    CHAIR POSITIONS- HANDEDDENTISTRY

    INSTRUMENT GRASPS

    ANDFINGER RESTS

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    The concept of four-handed dentistrydescribed by Dr. G.E.Robinson

    Research shows that production can beincreased by 100% and simultaneouslystress and fatigue will be reduced by 50%

    -70%.

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    The Benefits Include:

    Increased efficiency

    Decrease in the muscularstresses involved with thepractice of dentistry throughconservation of muscularactivity, adherence to theprinciples of balanced posture.

    The dentist is able toconcentrate their skill and

    judgment on the tasks directlyassociated with patient care.

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    Goals of work simplification Decrease the number of instruments to be used for a

    procedure.

    Sequence the instruments on a tray by their use.

    Minimize the stress and fatigue by using correctpositioning of the patient, dentist and assistant.

    Use of appropriate moisture control techniques.

    Transfer of instruments and dental materials as necessary.

    Use the least amount of motion during the transfer ofinstruments and materials.

    Allow the assistant to perform expanded functions.

    Team Dentistry

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    POSITIONING THE PATIENT ANDTHE OPERATIVE TEAM

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    Objectives of a Favorable

    Seated Position Access to the operative field

    Good visibility

    Comfort for the operative team- reducedstress and increased efficiency

    Relative comfort and safety for the patient

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    Position should permit

    direct or indirect vision

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    ZONES OF ACTIVITYPatient in a supine positionUsing center of patients face as a clock

    Zones designated as time

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    The dentist will normally work within a range from

    the 12 oclock to the 7 oclock position relative to the

    patients head.However, most operative procedures are completed

    from, at, or near, the 12 oclock position.

    The dental nurse will normally remain in a fixed

    position at 4 oclock .

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    Maxillary incisor labial

    surface 7 o clock

    Maxillary incisors lingual

    surface 12 o clock

    Maxillary posteriors 12

    o clock

    Mandibular incisorslabial surface- 7 o clock

    Mandibular posteriors

    9 o clock and 7 o clock

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    Characteristics of Balance

    Posture for Operator Operators thighs parallelto floor

    Entire surface of seatused to support weight

    Backrest supports backwithout interference

    Forearms parallel to floorwhen hands are in

    operative position Elbows close to the body

    Back and neck reasonablyupright with top of

    shoulders parallel to floor

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    Distance ofapproximately 14 18 inches betweenthe operators noseand the patients oralcavity maintained

    Operative field isoperators midline

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    Positioning the Patient in

    the Working Position Oral Cavity at height of operators elbow

    Head placed at upper end of chair and slightly

    to operators side of chair All patients are seated from the head down

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    Tilt seat portion back so foot rest is raisedapproximately 6 to 8 inches

    Lower back of the chair until patient is about

    way toward a horizontal position Pause to allow patient to adjust

    Continue lower chair back until following

    relationships exist Imaginary line from patients chin to the top of

    ankles is parallel with floor

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    Once seated Observe

    Patient Lying flat with little bending at waist

    Similar to sleep position

    Legs slightly lower than head if highermight cause pt. Anxiety/circulationproblems.

    Patient in supine position

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    Lower chair to operators lap

    Approximately 1 inch above knees of operator

    Plane of the patients forehead is also parallel withthe floor

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    Patient Dismissal

    Patient dismissal should be accomplished byreversing the steps of seating the patient

    Remember to pause for the patient on theway up as well

    Most important patient dismissal precaution

    Encourage the patient to remain seated to

    reestablish their equilibrium

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    Position of Assistant 3 4 oclock position for all

    quadrants Right handed operator

    9 oclock position for all quadrants

    Left handed operator

    Stool positioned so edge toward

    the top of patients head is in line

    with the patients oral cavity

    Stool as close to chair as possible Stool elevated to top of assistants

    head is 4 6 inches higher than the

    dentist

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    Standardization of Work Procedures

    and use of transfer zone

    Contributes to effective teamwork by being able toanticipate the dentists needs & increasingefficiency/production

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    Benefits Standardized operating sequence.

    Reduces the amount of time in the dental chair forthe patient.

    Increased productivity.

    Less fatigue and stress.

    I nstrument Transfer and Exchange

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    Principles of instrument transfer

    The assistant must understand the sequence of thetreatment procedure and anticipate when an instrumenttransfer will be required.

    The transfer of instruments should be accomplished with a

    minimum of motion involving only the fingers, wrist, andelbow.

    Instruments are transferred in the position of use.

    An instrument is transferred so the dentist can grasptheinstrument for its appropriate use.

    The instrument being transferred must be positioned in thedentist's hand firmly.

    The assistant will transfer dental instruments and dentalmaterials with his or her left hand.

    I nstrument Transfer and Exchange contd

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    Variations in instrument transfer

    Mirror and explorer

    Cotton pliers

    Handpiece

    Instruments with hinges

    I nstrument Transfer and Exchange contd

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    Sit Down Dentistry

    Body mechanics/task performance studies

    Seated worker uses 27% less energy

    Seated worker has 17% greater life expectancy

    Production increases from 33 78%

    Seated in a balance posture concept

    the efficiency of a D.A. Is the result ofworking with a well-organized dentist whopractices 4-handed dentistry

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    Instrument

    Grasps

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    Pen Grasp

    With the pen grasp

    hold the instrument the way

    you would hold a pen whenwriting. Grasp the handlewith your thumb and first whileyour middle finger supports theinstrument from beneath.

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    Inverted Pen Grasp

    Inverted Pen Grasp. Thefinger positions of theinverted pen grasp are thesame as for the modified

    pen grasp.However, the hand is rotatedso that the palm facesmore toward the operator(Fig).

    This grasp is used mostly fortooth preparations utilizingthe lingual approach onanterior teeth.

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    Palm and thumb

    grasp

    PALM GRASPWhen using the palm grasp, the index, middle, ring, andlittle finger hold theinstrument so that it rests in

    the palm of your hand. Yourthumb remains free tostabilize your hand in thepatient's mouth, or it may beused to support an instrument when sharpening (fig).

    This grasp is rarely used in themouth and only whenexceptional force is needed.

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    Modified Palm-and-Thumb Grasp

    The modified palm-and-thumbgrasp may be used when it isfeasible to rest the thumb on thetooth being prepared or theadjacent tooth (Fig.).

    The handle of the instrument isheld by all four fingers whosepads press the handle againstthe distal area of the palm, aswell as the pad and first joint ofthe thumb.

    Grasping the handle under thefirst joint of the ring and littlefingers