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Ergonomic Applications to Ergonomic Applications to Dental PracticeDental Practice

Major Katharyn A. Grant, PhD, CPE, PE

Chief, Ergonomics Function

US Air Force IERA/RSHE

DSN 240-6116

David W. Hiipakka, MPH, CIH

Industrial Hygiene Department

U.S. Naval Hospital Rota Spain

DSN 727-2783

OverviewOverview

What is Ergonomics? What are the Consequences of Poor

Ergonomics? What Policies/Standards Address

Ergonomics? How can Ergonomic Principles Be

Applied to Dental Practice?

JobCharacteristics

HumanCapabilities

What is Ergonomics?What is Ergonomics?

ERGONOMICS is a way to work smarter--not harder by designing tools, equipment, work stations and tasks to fit the job to the worker--NOT the worker to the job

Ergonomics is Not NewErgonomics is Not New

Early emphasis: Improving pilot performance via optimal layout / type of controls & displays

Recent interest: Improving comfort, health & productivity via workstation design

--Lighting & Temperature--Tools--Process (Heights, reaches, weights)

Application of Ergonomics in Application of Ergonomics in DesignDesign

Tools

Workstations

Work methods

Environments

Ergonomic Design GoalsErgonomic Design Goals Improve job process by eliminating unnecessary

tasks, steps & effort Reduce potential for overexertion injury Minimize mental / physical fatigue potential Leverage workers’ skills / knowledge of their

jobs to re-design work to increase their satisfaction, comfort, morale and fulfillment

Consequences of Poor DesignConsequences of Poor Design Discomfort Chronic Pain Accidents Injuries

Fatigue Increased Errors Work-Related Musculoskeletal

Disorders (WMSDs) Low back pain Tendonitis Epicondylitis Bursitis Carpal tunnel syndrome

U.S. Navy Ergo-Injuries

Source: OSHSYS RAW DATA FY 89 to FY 97

Non Ergonomic Related Cases Declined

Compensation Cases FY89 - FY97

-

4,000

8,000

12,000

16,000

20,000

24,000

FY89 FY90 FY91 FY92 FY93 FY94 FY95 FY96 FY97

Num

ber

of C

ases

Ergonomic Related Cases Non Ergonomic Related Cases

Ergonomic - Carpal Tunnel Syndrome, Chrondromalacia, Back Strain, Multiple Strain

WMSDs in DentistryWMSDs in Dentistry

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WMSDs in DentistryWMSDs in DentistryReasons for Early Retirement Among DentistsReasons for Early Retirement Among Dentists

Musculoskeletal Disorders (29.5%) Cardiovascular Disease (21.2%) Neurotic Symptoms (16.5%) Tumors (7.6%) Diseases of the Nervous System (6.1%)

Source: Burke et al., 1997

WMSD Symptoms Among WMSD Symptoms Among DentistsDentists

0%10%20%30%40%50%60%70%80%

Body Part

% R

ep

ort

ing

Males

Females

Source: Finsen et al., 1998

WMSD Symptoms Among WMSD Symptoms Among Dental HygienistsDental Hygienists

01020304050607080

*DiagnosedCTS

*Hand-wristpain

*Shoulderpain

*Neck pain Low Backpain

% R

epor

ting

Dental Hygienists Dental Assistants

Source: Liss et al., 1995* indicates difference is significant

What Factors Contribute to WMSDs?What Factors Contribute to WMSDs?

Repetitive motions (e.g., scaling, polishing)


Static neck, back, and shoulder postures


Grasping small instruments for prolonged periods


Prolonged use of vibrating hand tools

Ergonomics Standard Setting Ergonomics Standard Setting ActivitiesActivities

OSHAOSHA ANSIANSI DoDDoD

OSHA Ergonomics StandardOSHA Ergonomics Standard HistoryHistory

Draft ergonomics standard released in Feb 99

Final Rule issued in late 2000

Repealed by Congress & The President in 2001

Renewed efforts underway to “re-invent” a version more palatable to new administration & industry

OSHA Ergonomics StandardOSHA Ergonomics Standard Program-oriented approach

Based on six elements: Management leadership Employee participation Hazard identification Job hazard analysis and control Training Medical management Program evaluation

Applicable to manufacturing and manual handling operations; workplaces where WMSDs are reported

ANSI Z-365ANSI Z-365Control of Cumulative Trauma DisordersControl of Cumulative Trauma Disorders

Voluntary standard to address work-related musculoskeletal disorders

Developed by committee of government, labor, business, industry and science representatives (including ADA)

Draft approved by the Accredited Standards Committee in May 98

Public comments under review

Navy/DoD Ergonomics PolicyNavy/DoD Ergonomics Policy DOD Ergonomics policy

memo of 4 Feb 1997 OPNAVINST 5100.23E

Ergonomics Program Chapter

Ergonomics program elements integrated into DODI 6055.1, “DoD Occupational Safety and Health Program”

DOD Ergonomics Program DOD Ergonomics Program

ElementsElementsWorkplace AnalysisWorkplace Analysis Hazard Prevention and ControlHazard Prevention and Control

Education and TrainingEducation and Training

Program Evaluation and ReviewProgram Evaluation and Review

Health Care ManagementHealth Care Management

Level I Level I ErgonomicsErgonomics

MethodologyMethodologyGuidesGuides

Computer Based Computer Based ErgonomicsErgonomics

TrainingTraining

DOD Ergonomics Working DOD Ergonomics Working Group Tool BoxGroup Tool Box

Job Requirements/Job Requirements/Physical DemandsPhysical Demands

SurveySurvey

ErgonomicsErgonomicsProgramProgram

ManagementManagementGuidelinesGuidelines

Web Site Web Site http://chppm-www.apgea.army.mil/ergowg/index.htm

Applying Ergonomics Principles Applying Ergonomics Principles to Dental Workto Dental Work

Tools/InstrumentsTools/Instruments

WorkstationsWorkstations

Work PracticesWork Practices

Ergonomics in DentistryErgonomics in DentistryTool/Instrument DesignTool/Instrument Design

Considerations: Overall shape/size Handle shape/size Weight Balance Maneuverability Ease of operation Ease of maintenance

Goals: Reduce force exertion;Maintain hand/wrist in neutral posture

Ergonomics in DentistryErgonomics in DentistryHand InstrumentsHand Instruments

Look for: Hollow or resin

handles Round, knurled or

compressible handles Carbon steel

construction (for instruments with sharp edges)

Ergonomics in DentistryErgonomics in DentistryAutomatic HandpiecesAutomatic Handpieces

Look for: Lightweight, balanced models (cordless preferred) Sufficient power Built-in light sources Angled vs. straight-shank Pliable, lightweight hoses Swivel mechanisms Easy activation Easy maintenance

Ergonomics in DentistryErgonomics in DentistrySyringes and DispensersSyringes and Dispensers

Look for: Adequate lumen

size Ease in cleaning Knurled handles

(no finger cut-outs) Easy activation and

placement

Ergonomics in DentistryErgonomics in DentistryMagnification SystemsMagnification Systems

Consider: Working distance Depth of field Declination angle Convergence angle Magnification factor Lighting needs

Goal: Improve neck posture; Provide clearer vision

Ergonomics in DentistryErgonomics in DentistryWorkstation LayoutWorkstation Layout

Ensure: Instruments, materials, medications, etc. are accessible while seated Hoses are positioned away from the body Set-up can be adapted for different operators

Ergonomics in Dentistry Ergonomics in Dentistry Operator ChairOperator Chair

Look for: Stability (5 legged base w/casters) Lumbar support Hands-free seat height adjustment Adjustable foot rests Adjustable, wrap-around body support Seamless upholstery

Goal: Promote mobility and patient access;accommodate different body sizes

Ergonomics in Dentistry Ergonomics in Dentistry Patient ChairPatient Chair

Look for: Stability Pivoting or drop-down arm rests (for patient ingress/egress) Supplemental wrist/forearm support (for operator) Articulating head rests Hands-free operation

Goal: Promote patient comfort; maximize patient access

Ergonomics in Dentistry Ergonomics in Dentistry Posture/PositioningPosture/Positioning

Goal: Avoid static and/or awkward postures

Potential Strategies: Position patient so that operator’s elbows are

elevated no more than 30 degrees.

Adjust patient chair when accessing different quadrants

Alternate between standing and sitting

Ergonomics in Dentistry Ergonomics in Dentistry Work PracticesWork Practices

Goal: Maintain neutral posture, reduce force requirements

Potential Strategies: Ensure tools are sharpened, well-maintained Use automatic handpieces instead of manual

instruments where possible Use full-arm strokes rather than wrist strokes

Ergonomics in Dentistry Ergonomics in Dentistry SchedulingScheduling

Potential Strategies: Increase treatment time for more difficult

patients Alternate heavy and light calculus patients

within a flexible scheduling system Vary procedures within the same appointment Shorten patient’s recall interval

Goal: Provide sufficient recovery time for staff to avoid chronic muscular fatigue

Ergonomics in Dentistry Ergonomics in Dentistry Prosthetics LabsProsthetics Labs

Naval Station Rota Spain Clinic Case Study: Lab techs mentioned chronic back, shoulder & neck discomfort / pain during periodic Industrial Hygiene survey from working at non-adjustable bench in obviously stressful static postures -- with no forearm support nor bench edge padding


Naval Station Rota Spain Clinic Case Study -- Post intervention improvements offered by Kavo ergonomic lab benches : Lab techs affirm GREATLY increased comfort / decrease in back, shoulder & neck discomfort / pain.

KAVO dental prosthesis lab benches offer ample forearm supports and workpiece support centering prosthesis directly below technician which optimizes spinal / neck / head vertical alignment


Naval Station Rota Spain Clinic Case Study: Lab technicians now work in optimized ergonomic posture. In addition to forearm supports and central workpiece support (locally-ventilated for air contaminant removal !) , the table also has much improved overhead lighting, a magnifying lens and a drill speed control operated by the tech’s right knee

ERGONOMICS SUMMARY

• Good ergonomic design of tools, processes and furniture DOES improve personnel comfort, health, morale, productivity and readiness.

• Individual effort as part of a workshop team is the greatest means of identifying / improving workplace ergonomic issues.

• It’s critical to seek prompt medical aid for symptoms of ergonomic stress / CTDs

Need More Information?Need More Information? Call Us !!

Air Force IERA/RSHE (DSN 240-6116 or 6118) providing expert technical support for ergonomic issues across the AF

Dave Hiipakka, Naval Hospital Rota IH Dept DSN 727-2783

Electronic Mail Major Kathy Grant, USAF: [email protected]

Dave Hiipakka, NAVHOSP Rota Spain: [email protected]

Visit USAF Dental Investigative Services websitehttp://www.brooks.af.mil/AL/AO/AOC/AOCD/dis-home.htm

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