by Anne Nugent Guignon, RDH, MPH
Patient positioning should be based on keeping things simple and safe for the clinician. Yes, patients should be kept as comfortable as possible. Patients, however, are in the chair for a relatively short period of time, particularly when compared to the thousands of hours clinicians spend providing valuable treatment, year after year.
Patients come in all sizes and shapes. Some general guidelines, though, will help create as safe an environment as possible.
Once reclined, position the patient so that his or her head is at the top of the chair. Adjust the chair height so that the patient’s mouth is at the same level as your waist, keeping your arms parallel to the floor. Small patients should sit as close as possible to you, preventing unnecessary reaching. Depending where you are working, ask the patient to reposition their head or mandible, facilitating access to every part of the mouth.
Problems can arise when patients are physically challenged, have limited movements because of arthritis, are in a wheelchair, suffer from body tremors, have neck issues from osteoporosis, or are very small or obese. A combination of solutions are available for these unique situations.
A growing number of health-care providers are injured every year while transferring wheelchair bound or obese patients. While a single person transfer is possible, it must be done correctly. Ask the patient’s caregiver to perform the task. Offer assistance, but don’t attempt to make the transfer alone without proper training. It’s not a matter of being nice or accommodating. It’s a matter of avoiding an injury to either you or the patient if you don’t know the correct procedure.
Special neck pillows are available for those who have neck issues or a forward bent head as a result of osteoporosis. A roll of towels will work in a pinch, but this option is much less comfortable than a specially designed neck pillow. Patients appreciate these pillows as well, especially during longer appointments.
It is frustrating to treat patients with head tremors. We worry about poking them accidentally, and they are embarrassed about not being able to sit still. Recently, I was challenged with this situation. I solved the problem by using a large, u-shaped neck pillow filled with polystyrene beads that conformed to and supported her neck. Her head didn’t twitch at all during the one-hour appointment — a miracle that kept us both more relaxed, especially while taking the radiographs.
Additional amenities that can ensure optimal patient comfort and relaxation include pillows or supports that fit the lumbar region or slip under the patient’s knees, reducing back strain. Massage pads that vibrate in a variety of patterns and intensities provide a welcome distraction from the actual nuances of a dental appointment. Some even have built-in heaters. A small beanbag chair, perched in a patient chair, provides a safe, relaxing haven for children and can bring their bodies into an ideal working height.
Two-thirds of all Americans are now classified as overweight or obese, creating an ergonomic challenge. A small pillow placed just below the neck between the shoulder blades repositions the head, similar to the CPR head-tilt, chin-lift. At times obese or arthritic patients can’t or won’t recline. Standing up is often the only answer, and the varied posture can be a welcome change for a brief period of time. Standing restores the natural spinal curve in the lower back, which is flattened out when clinicians sit with thighs parallel to the floor.
Often, our clinical space is no larger than a small closet, brimming with paraphernalia critical to delivering quality care. We usually do not have the luxury of moving to another room, so it’s important to make the best use of space. Shelves, mobile carts, and bracket tables can be the perfect answer for keeping everything in order and within an easy reach. Cart casters should roll smoothly, and shelves or bracket tables need to accommodate the weight and size of equipment or supplies.
Sometimes the patient chair can be either moved or repositioned to provide a more efficient workflow, or create additional room to scoot around from a 10 o’clock to 2 o’clock position. Working comfortably with any patient includes sitting in a relaxed posture with the hips higher than the knees, using properly fitted magnification loupes, adequate illumination, and a comfortable, supportive clinician chair. If space is tight, saddle chairs or stools with a beveled, sculpted front edge allow clinicians to move in closer, avoiding dangerous reaches.
When was the last time that you sat in your patient chair or any dental chair for that matter? Take a few minutes tomorrow to experience the world from that point of view. You will come away with an entirely new perspective of whether your patient chair is a place of torment, or an oasis of relaxation. Most likely you’ll see new ways to improve the comfort zone in your treatment room.
Working in sitting/standing positions. Canadian Centre for Occupational Health and Safety. http://www.ccohs.ca/oshanswers/ergonomics/standing/sit_stand.html. Accessed March 10, 2010.
Lord M, Small JM, et al. Lumbar Lordosis: Effects of Sitting and Standing. Spine:1 November 1997. 22;21.
Pheasant S, Haslegrave CM. Bodyspace: anthropometry, ergonomics, and the design of work. Boca Raton: Taylor and Francis. 2006.
Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston since 1971.