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Tailoring appointments: Treating patients who need special accommodations

May 1, 2019
We frequently have patients with special positioning needs due to injuries, arthritis, and the like. But that can lead to bad ergonomics for us. Kate Melko, MSDH, RDH, shares tips for helping these patients without injuring ourselves in the process.

By Katie Melko, MSDH, RDH

As clinicians, we have all experienced those patients who say, “I can’t lean back all the way,” “I need a pillow for my neck,” or “May I have a pillow for under my knees or for my lower back?”

These appointments are very strenuous for clinicians because we often end up overadapting to reach certain areas in the mouth. Some of the patients who have these requests have had neck or back surgery, have been in a car accident, have bad arthritis, are elderly, or tell us they become too dizzy when they lie back that low. Here I’ll share some of my experiences with these types of patients and how I did my best to provide for them without injuring my neck and back.

My top five must-haves for these appointments are:

  1. Neck pillows
  2. Rolled-up disposable lab coats
  3. Standing during appointments
  4. Neck rest that adjusts
  5. Good clinician positioning

Patients who can’t recline

I have a 34-year-old female patient who won’t sit in the dental chair and must sit in a regular chair for her hygiene appointment. She also can’t put her head back and she has severe dental anxiety. When I treated her, my body was really hurting. There was no good way for me to position myself with my patient sitting up and unable to move her head or neck to help me.

After her appointment I started researching ergonomics for these types of situations. I also found myself encountering similar situations at the community health center where I also worked. Some of the patients I see there are elderly or have special needs and cannot get out of their wheelchairs, and their chairs won’t recline.

We’re all familiar with patients who become dizzy and will not recline more than a few inches. I find that standing during these appointments and raising the height of the chair make the appointments more manageable for both me and the patients. Remember to keep your back as straight as possible and ask your patients to move their neck and head to a position that works well for you.

The kicker here is when the doctor comes in for the patient checkup, and the patient goes all the way back in the chair! I’ve had patients tell me, “Well, the dentist is only looking in my mouth for a few minutes and I can tolerate that. But I can’t tolerate leaning back for a whole cleaning.” It’s important to respect our patients and adjust in these situations.

I’ve now learned that I have to keep a wide stance, keep my back as straight as possible, and bend my knees to avoid the back pain from bending over with my feet close together and not using my core to assist me. Strengthening the core and back is very important for hygienists when it comes to situations like this. There are many exercises that we can do at home or in the operatory to help strengthen these muscles. I’ve seen a huge difference by incorporating these exercises into my routine for just 10 minutes a day.

Wearing my loupes is also a great help because then I don’t need to bend over as much. I always position a wheelchair so I can work at any angle, and this helps me reach more difficult areas. Also, instead of being trapped by the 9 and 6 position, going to 12 and 3 definitely gave me more range of motion and access to difficult areas. I know these aren’t ideal, but when working in public health, hygienists just have to go with what works.

Patients with neck and back issues

I also have patients with neck and back issues who need more support in order to lie in a position that is best for me to work. For these patients, I offer a rolled-up disposable lab coat, a blanket in a plastic chair cover, or a neck pillow covered with a bib. These usually suffice, but sometimes patients bring their own items to make themselves comfortable for the appointment. Sometimes adjusting the headrest works for a patient, but not often. It takes some trial and error to see what works. Otherwise, they keep lifting their head or moving constantly because they’re uncomfortable.

Some patients need support under their knees to alleviate pressure on their backs. I use the same items I listed above to place under their knees. Patients always tell me when something needs to be fixed or changed. They don’t want to feel any more uncomfortable than they already are because they’re at the dentist’s office.

Be prepared

I always place pop-up notes in their charts so I can plan for their appointments and prepare before they come in. This way I’m not running around trying to get what I need while they’re in my operatory, losing valuable appointment time. If your office has a morning huddle, let your team know you need special accommodation for a patient you’re seeing that day. That way the team will know you’ll be using those items or might need another operatory for a wheelchair patient. All of these things will help the appointment move along smoothly and reduce your stress.

Remember to keep your ergonomics at the forefront during difficult appointments to avoid pulling a muscle, aggravating your back or neck, and to help you stay efficient and effective. Our patients’ comfort is important, but so is ours. If you hurt yourself by constantly twisting and bending, you’ll have your own physical problems, which can decrease how long you’ll be able to remain in your career.

Now go out there and tailor your appointments, and let me know if this has helped make a difference in your day!

Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She has practiced dental hygiene since 2009.