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The reality of rear delivery

Sept. 1, 2005
Let’s face it, dental manufacturers design equipment for the people who purchase it.

Let’s face it, dental manufacturers design equipment for the people who purchase it. For many years, patient chairs, operator stools, handpieces, hand instruments, and a myriad of other items were developed to please the people who wrote the checks.

Companies want to make sales, so the first priority is to make the purchaser happy. This can be done through price, quality, durability, comfort, or ease of use. Recently, there has been a rush in the marketplace to produce products labeled as ergonomic.

What are ergonomic products? Ergonomic equipment is designed to fit the user so that the user does not have to accommodate his/her body to the equipment or task. The term ergonomic is a hollow promise if the equipment or room design strains the clinician and his/her musculoskeletal system.

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Companies used to focus most of their attention on the purchaser and only a bit on the actual user. Most dental equipment is still designed to accommodate an average to tall male. The majority of dentists used to be males of European descent, so the design made sense from a business standpoint.

Some subtle shifts are occurring in the marketplace. Companies recognize that many of today’s dental professionals are women or people with smaller physical statures than the professionals of 40 years ago. Some equipment is now being designed for more petite clinicians.

In addition, dental hygiene is an emerging market. A growing number of dental hygienists now purchase their own equipment, such as operator chairs, hand instruments, ultrasonic scalers, magnification loupes, and auxiliary lighting systems. This trend has come about through hygienists’ interest in preventing cumulative trauma disorders. Many hope to ensure the course of their careers by acquiring the exact equipment they want to use in their hygiene practice.

Many distributors advise doctors on treatment room design. Again, the big buzzword is ergonomics. While this approach may seem fine on the surface, many offices are being told that all treatment rooms should have identical layouts, regardless of whether they’re used for dental hygiene services or operative procedures.

The new trend is to design all treatment rooms with a rear delivery system. This configuration places all instruments, air/water syringes, and handpieces behind the patient’s head. The idea is that it looks pretty and patients don’t have to see all of the equipment.

Rear delivery isn’t a problem if a full-time chairside assistant is available to pass instruments and assist with suction, isolation, and light curing. But most dental hygienists don’t practice with a full-time assistant. Rear delivery is a nightmare for solo clinicians. The system forces anyone working solo to constantly twist and turn to reach the tools.

These seemingly innocent micro assaults to the musculoskeletal system add up. Countless hygienists live with wrist, arm, shoulder, neck and back pain due to poor treatment room design.

Fortunately, more dental hygienists overall are aware of the tremendous potential for developing a career-ending injury every time they pick up an instrument.

A number of years ago I worked in an office for one day. The instrument tray sat on a counter directly behind the clinician. After only eight hours, my right shoulder ached from constantly reaching for my instruments. The three hygienists who worked in this practice all suffered from chronic shoulder pain, which was a direct result of the room configuration.

The rooms were later retrofitted with over-the-patient bracket tables. The ergonomic problem was solved, but it was too late for the three hygienists. Years of microtraumas had resulted in irreversible shoulder pain for them. They had become three more dental hygiene bodies for the repetitive stress injury scrap heap!

Repetitive motion leads to injury through repeated microtraumas.These subtle injuries are often ignored and brushed off as simply part ofdental hygiene. When big injuries do manifest themselves, cliniciansoften believe the problem happened over night, which is rarely the case. Not all cumulative trauma disorders are reparable. Many become chronic and result in permanent disabilities that haunt victims long after the clock strikes five or they leave the practice of dentistry.

The trend for uniform rooms does not make sense. How many dentist operatories really need an ultrasonic scaler? Unless a doctor enjoys doing dental hygiene procedures, a power scaler would be an expensive piece of equipment taking up precious counter space. By the same token, there are numerous devices that would never be used by dental hygienists.

A number of savvy hygienists are alarmed at the trend toward uniform treatment rooms. They are calling for new treatment rooms that facilitate the practice of dental hygiene in a safe environment. These hygienists are gathering information about ergonomics before challenging the status quo. Instead of whining or remaining silent, they are showing employers how rear delivery can create a dangerous situation

Most employers will listen if they are told that these designs can be hazardous to the health of their staff. Most doctors go to great lengths to avoid workplace realted injuries or worker"s compensations claims.

It is devastating emotionally and financially for a practice to lose a valuable employee for a short time or permanently. The dental marketplace is more competitive than ever, and today"s dentists are wiser business owners than many of their counterparts were decades ago.

I recommend that offices do their homework about treatment room layouts. Role play with colleagues and figure out what movements create stress on the body. Take pictures of each other to analyze positioning. Movements should not be strained. Reaches should be short and comfortable

Take the time to educate staff about the alternatives that could make the treatment room an ergonomic dream instead of a painful nightmare. Remember, it is up to each office to create their comfort zone.

Anne Nugent Guignon, RDH, MPH, is an international speaker, 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, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540 and her Web site is