Ergonomics & Wellness in DentistryErgonomics & Wellness in Dentistry

Worldwide research shows an alarming incidence of musculoskeletal disorders (MSD) among dentists.

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Ergonomics & Wellness in Dentistry

by Dr Anikó Ball 

Feb 01, 2019

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Worldwide research shows an alarming incidence of musculoskeletal disorders (MSD) among dentists. Studies suggest up to 87% suffer chronic and 25% severe pain. Many dentists have become accustomed to pain and discomfort, believing it is the price paid for being in the profession. 


What we didn’t learn in dental school

As dental students, we were highly trained in diagnostic and clinical skills, but there was no training in how to organize our bodies to gain access to our patients’ mouths without compromising our musculoskeletal health. As a result, we bend and twist over patients in any which way, without paying attention to ourselves.


Biomechanical Design – what every dentist needs to know

Although there are fundamental biomechanical design principles governing movement and posture, we are not trained in how to co-operate with our design and we are not provided with a “User Guide” at birth. Anyone who drives a car knows what happens when you don't co-operate with its mechanical design. Speeding along a freeway in first gear or going up a steep incline in fourth gear results in engine damage and costly repairs. We receive training in how to co-operate with the car’s mechanical design when we have driving lessons, learning to drive in the correct gear. We don’t receive training in how to drive ourselves in the right gear.


Cumulative Trauma

When our posture and movement patterns are not co-operating with biomechanical design, cumulative trauma occurs. Soft tissue damage happens over time at a cellular level, when forward and downwardly directed, unilaterally collapsed dental work postures are held for prolonged periods, as we do in dentistry. Repetitive and prolonged twisting of the trunk results in spinal compression and inefficient use of muscles and joints.


This is the reason why there is such a high incidence of chronic pain in the dental profession. Pain and discomfort are late warning signs of cumulative trauma.


Dental Ergonomics

Ergonomic research and design have focused on dentists’ work environment - the Outer Ergonomics, overlooking the importance of their efficiency in posture and movement - the Inner Ergonomics.


HOW a dentist sits on a stool and bends over the dental chair is as important as the stool and chair design.


The WAY instruments are held is as important as the shape and the weight of the instrument.


Although ergonomically designed surgery layout, dental chair, stool, equipment and instruments are important, without knowledge of your Inner Ergonomics - understanding how your body is designed to work - you are literally driving yourself in the wrong gear in clinical practice, at a desk and in everyday activities.


Body Map Update 

Although anatomy is part of the curriculum at dental school, functional anatomy is not taught. Functional anatomy is essential for understanding in a practical way how the body works in posture and movement.


We move according to a mental picture of our body – the Body Map. Unfortunately, most of us have faulty body maps, as these were formed when we played with teddy bears and toy soldiers which have anatomically incorrect joints. Incorrect mapping of joints results in harmful posture and movement patterns. You need to know where your joints are and how they work, not just intellectually but as a practical blueprint for posture and movement. For example, if you map your hip joints incorrectly (the hip joints are situated lower and more medial than most people think) then you are bending forward over the patient at the lumbar spine, which is not designed for such a movement.


If you are looking at your mobile phone, with your neck bent at the level of the chin, which is where most people point to when asked where they think their head sits on top of the spine, you are asking the cervical spine to perform a task that is contrary to its biomechanical design. Such repetitive strain over time results in intervertebral disc damage and chronic back and neck pain.


Updating your body map with correct data on where the atlanto-occipital joint (a rod going through the ears marks the level at which the head nods) and the hip joints are, enables co-operation with biomechanical design. Flexing the head and trunk at the actual joints reduces the risk of chronic pain. Recruiting the appropriate joint for the task, for example bending the arm at the elbow (hinge joint) to bring a mobile device closer, instead of bending at the cervical spine (gliding joints), also reduces chronic pain.


The Inner Ergonomic Principles of the Alexander Technique 

Suffering chronic back and neck pain for over thirty years as a dentist, I tried all available medical and physical therapies. Unfortunately, all of them focused on treating my symptoms without dealing with the cause of the problem and resulted in short-term relief.


When I finally came across the Alexander Technique, a method for consciously altering habitual postural behaviour, I realized I was driving myself in the wrong gear. I was bending and twisting my spine, compressing intervertebral discs for prolonged periods and over-tensing muscles. The Alexander Technique is a cause oriented, evidence based kinaesthetic method for overcoming and preventing occupational chronic pain. Practically speaking it a User Guide for movement and posture in co-operation with biomechanical design. Using the Inner Ergonomic principles of the Alexander Technique, I learned to change harmful posture and movement habits in all activities, especially in clinical dentistry.


Out of a desire to contribute to the dental profession and save my colleagues from suffering occupational chronic pain, I undertook a 1600-hour part time training course at the Melbourne Alexander School and founded “Optimum Dental Posture”. I train dentists and their teams in Optimum Dental Posture Programs as well as in their own practices.


I am passionate about reducing the incidence of occupational musculoskeletal disorders in dentistry. My vison is to have ‘Ergonomics & Wellness in Dentistry’ training programs included in the undergraduate curriculum in all dental schools as an intervention to reduce the risk of occupational chronic pain, to ensure long and productive dental careers and to improve quality of life.


Tips for a long and comfortable dental career: 

  • Know the correct joints for bending so you can drive your body in the right gear
  • Maintain the length and width of your torso as you bend over patients 
  • Learn the Inner Ergonomic principles of the Alexander Technique and apply them in clinical practice and daily life 
  • Ensure your magnification loupes have sufficient angle of declination to enable you to look into patents’ mouths without bending your neck 
  • Don’t take short cuts with your body by twisting to pick up instruments/handpieces, reaching into draws or entering data on computer. Turn your whole body around rather than twisting your torso 
  • Use a finger rest for the hand holding the mouth mirror 
  • Use double sided mirrors  
  • Use indirect vision 
  • Cultivate paying attention to yourself as well as your patients 
  • Develop postural awareness by regularly taking short moments to check-in with yourself and ask: 


  • Am I bending at the correct joints?
  • Am I sitting evenly on my sit bones?
  • Are my feet on the ground?
  • Is my shoulder raised? Does it need to be?
  • Am I gripping instruments with too much tension? Can I use less force?
  • What can I change in this moment to take better care of myself?


Take care of yourself, you are your most precious instrument.


This article was originally published by Dr Anikó Ball and reproduced with permission.


The contents of this article and the opinions shared are that of the Author and not Nexlec.

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