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Ergonomic Applications to Dental 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. Overview. What is Ergonomics?

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Ergonomic Applications to Dental Practice

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    1. Ergonomic Applications to Dental 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

    2. Overview • What is Ergonomics? • What are the Consequences of Poor Ergonomics? • What Policies/Standards Address Ergonomics? • How can Ergonomic Principles Be Applied to Dental Practice?

    3. What is Ergonomics? Job Characteristics Human Capabilities • ERGONOMICSis 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

    4. Ergonomics is Not New • Recent interest: Improving comfort, health & productivity via workstation design • --Lighting & Temperature • --Tools • --Process (Heights, reaches, weights) Early emphasis: Improving pilot performance via optimal layout / type of controls & displays

    5. Application of Ergonomics in Design Tools Work methods Environments Workstations

    6. Ergonomic 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

    7. Consequences 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

    8. U.S. Navy Ergo-Injuries Non Ergonomic Related Cases Declined Ergonomic - Carpal Tunnel Syndrome, Chrondromalacia, Back Strain, Multiple Strain Source: OSHSYS RAW DATA FY 89 to FY 97

    9. WMSDs in Dentistry ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

    10. WMSDs in DentistryReasons 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

    11. WMSD Symptoms Among Dentists Source: Finsen et al., 1998

    12. WMSD Symptoms Among Dental Hygienists * indicates difference is significant Source: Liss et al., 1995

    13. What Factors Contribute to WMSDs? • Repetitive motions (e.g., scaling, polishing)

    14. What Factors Contribute to WMSDs? • Static neck, back, and shoulder postures

    15. What Factors Contribute to WMSDs? • Grasping small instruments for prolonged periods

    16. What Factors Contribute to WMSDs? • Prolonged use of vibrating hand tools

    17. Ergonomics Standard Setting Activities • OSHA • ANSI • DoD

    18. OSHA Ergonomics StandardHistory • 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

    19. OSHA 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

    20. ANSI Z-365Control 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

    21. Navy/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”

    22. DOD Ergonomics Program Elements Workplace Analysis Hazard Prevention and Control Health Care Management Education and Training Program Evaluation and Review

    23. DOD Ergonomics Working Group Tool Box Ergonomics Program Management Guidelines Level I Ergonomics Methodology Guides Computer Based Ergonomics Training Job Requirements/ Physical Demands Survey Web Site

    24. Applying Ergonomics Principles to Dental Work • Tools/Instruments • Workstations • Work Practices

    25. Ergonomics in DentistryTool/Instrument Design Goals: Reduce force exertion; Maintain hand/wrist in neutral posture • Considerations: • Overall shape/size • Handle shape/size • Weight • Balance • Maneuverability • Ease of operation • Ease of maintenance

    26. Ergonomics in DentistryHand Instruments Look for: • Hollow or resin handles • Round, knurled or compressible handles • Carbon steel construction (for instruments with sharp edges)

    27. Ergonomics in DentistryAutomatic 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

    28. Ergonomics in DentistrySyringes and Dispensers Look for: • Adequate lumen size • Ease in cleaning • Knurled handles (no finger cut-outs) • Easy activation and placement

    29. Ergonomics in DentistryMagnification Systems Goal: Improve neck posture; Provide clearer vision Consider: • Working distance • Depth of field • Declination angle • Convergence angle • Magnification factor • Lighting needs

    30. Ergonomics in DentistryWorkstation 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

    31. Ergonomics in Dentistry Operator Chair Goal: Promote mobility and patient access; accommodate different body sizes • 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

    32. Ergonomics in Dentistry Patient Chair Goal: Promote patient comfort; maximize patient access • 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

    33. Ergonomics in Dentistry Posture/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

    34. Ergonomics in Dentistry Work 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

    35. Ergonomics in Dentistry Scheduling Goal: Provide sufficient recovery time for staff to avoid chronic muscular fatigue 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

    36. Ergonomics in Dentistry Prosthetics 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

    37. Ergonomics in Dentistry Prosthetics Labs 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 directlybelow technician which optimizes spinal / neck / head vertical alignment

    38. Ergonomics in Dentistry Prosthetics Labs 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

    39. 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

    40. 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: • Dave Hiipakka, NAVHOSP Rota Spain: • Visit USAF Dental Investigative Services website