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Do you see how I see?

May 1, 2010
When you were younger did you tend to bring items close to your eyes to see fine details? Think of a time when you needed to thread a needle or find a part for your model airplane.

Don’t let vision compromise your posture

by Juli Kagan, RDH, MEd, and Lynn Pencek, RDH, MS

When you were younger did you tend to bring items close to your eyes to see fine details? Think of a time when you needed to thread a needle or find a part for your model airplane. One reason you strained is that in youth your vision was better in close range than long range. It’s true; you can read a millimeter probe just fine from 18 inches, but it’s easier to read at 10 or 12 inches.

Then at midlife, most adults experience loss of visual acuity when viewing close objects. This is a normal change of the eye lens due to aging. Reading glasses can correct this. It’s not uncommon for an eye doctor to prescribe reading glasses to provide mild magnification for dental practitioners; unfortunately, if the reading prescription is over corrected, the working distance is further shortened. This is not a wise choice for a dental practitioner. This method of linear magnification encourages the practitioner to lean closer, which further compromises posture and balance.

In practice, most hygienists will lean to get their eyes closer to the patient to see more clearly. When we lean closer to the patient we often bend our backs in an unhealthy posture.

Loupes provide angular magnification. Stated another way — true image enlargement is created with a dedicated working distance. Loupes can be customized to best suit an individual’s preferences. Loupes with depth are forgiving, and not all loupes have significant depth. When choosing a pair, make sure they have depth to accommodate patients who do not fully recline, or the lack of depth will dictate your posture.

One smart way to determine your working distance is to ignore what your visual preference dictates in body posture. To figure this out, try sitting with a patient and close your eyes, take a deep breath, relax, and see where your body is most comfortable when working. Then open your eyes and work from this frame of reference. It’s important that you do not force yourself to work within confines that are not inherently comfortable for your body and eyesight.

Most hygienists have a natural desire to provide the best care possible, yet we tend to compromise ourselves to treat our patients.

Sometimes going back to basics is best. While you are seated, make sure:

  • You are sitting all the way in your chair — do not have one buttock hanging off the side!
  • Keep your feet flat and supported by the floor underneath them. Do not cross your legs! As a test you should be able to comfortably place two fingers under your thighs.
  • Check the length of your seat pan. It should be about two to three inches between the back of your leg and the edge of the seat.
  • Be sure your lumbar spine is supported — preferably in both an active and passive position. Be sure your lumbar spine is supported — preferably in both an active as well as a passive position. Several companies make chairs with this design feature.
  • Check to be sure your neck is an extension of your spine and that it aligns with your hips. Don’t crane your neck, and please stop warping your spine to see!
  • Keep your elbows at your sides. Imagine you are ready to shake someone’s hand. That’s the height at which your arms should be working.
  • Avoid twisting at all costs. Keep those moves for a dance floor where you can do it any way you please.
  • Use props when necessary: lumbar supports, wedges that allow the hips to be higher than the knees, and even footrests are handy and very valuable if you will be in a position for an extended period of time.
  • New information: Sit slightly “pitched forward” from the hips. Clinical dentistry is an athletic event — be ready by propping or pitching yourself forward a little while actively working.
  • Keep moving! As muscles tire, slouching or slumping becomes likely. Change your posture frequently. Take a break from your chair as often as possible. Stand for the mandible and sit for the maxilla.

Exercise regularly to prevent injury and promote healthy posture. Walk, bike, swim, and get your heart pumping at least four times a week. Strengthen the muscles that support your back. (Go to and visit the video library for “Best Back Exercises” for three great strengthening moves.)

Finally, motion is lotion. Seeing easily is essential to working most comfortably and effectively.

Mind your eyes and seating positions. But mostly, keep moving!

Lynn Pencek, RDH, MS, is a senior regional manager for Orascoptic. Since 1993 she has published and presented on the topics of ergonomics, posture, vision, and use of loupes. Lynn has presented at RDH Under one Roof and serves on the corporate advisory board for Dimensions in Dental Hygiene as an expert in magnification, coaxial illumination, and ergonomics. Before her career with Orascoptic, Lynn served as the past president of the Philadelphia Dental Hygiene Association and is a former delegate for the Pennsylvania Dental Hygiene Association. She has worked clinically as a dental hygienist for 12 years and served as part-time clinical faculty at Thomas Jefferson University.

Juli Kagan, RDH, MEd, is responsible for the ergonomics lectures and clinical instruction in the perio department at Nova Southeastern University, Ft. Lauderdale, FL. In addition to her clinic responsibilities, Juli is a 600-hour certified Pilates instructor. Passionate about physical and mental fitness and proper posture, Juli wrote “Mind Your Body: Pilates for the Seated Professional.” Visit her Web site at for speaking engagements for your local society or state association.

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