Comfort Zone: Headed in the right direction

March 1, 2001
Another group is what I call the "escape artist patients."

OK, so you probably think this month's article is going to discuss some type of long-term career or personal goal, don't you? Not this time. We're going to take a good look at where you and your patient are headed, ergonomically speaking.

There are almost as many ways for patients to position their heads during treatment as there are ways to fix your hair. How about patients who look like dogs sniffing the wind - staring straight up, with the tips of their noses pointing to the ceiling tiles directly above? Then there are the patients who drop their chins to their chests so that it takes a contortionist just to take a peek into their oral cavities. My favorite position is the patient who, in an effort to help us see, tilts his or her head so far back that we get a direct view of everything, including tonsils. Every little drop of water and every bit of prophy paste makes these patients sputter and gag. Ultrasonic scaling becomes sheer torture for all involved!

Another group is what I call the "escape-artist patients." They scoot their heads to the opposite side of the dental chair in the hope that we won't find what we're looking for - their mouths! How about the slouchers? They're the ones who slide farther and farther down in the chair in the hope that our arms will be too short to reach their pearly whites.

Now let's take a look at dental chair headrests. The term "headrest" implies that this item is a comfortable area to rest one's head. When was the last time you snuggled your head into a dental chair headrest? Generally speaking, we don't spend a lot of our time lounging in a dental chair, so why don't you just hop into the chair and feel what your patients are experiencing? Do you like "resting" your head on something shaped like an oval doughnut, a vinyl horseshoe, or a small loaf of bread? I don't. Some are rock-hard and others lack good neck support. Some headrests are shaped so that a patient cannot turn comfortably toward you. Some headrests scoot around like a Ouija board device, but the worst thing is that most models are "one size fits all!"

Are your patients all one size? Mine aren't. I have patients who are bent over with osteoporosis and have a big hump on their backs. Others are so stiff with cervical arthritis that they can hardly turn their necks at all. Some of my patients are big, barrel-chested men, and some are bosomy women who can't help but bury their chins in their chests! With the changing demographics and our ability to help people keep their teeth longer, we're going to see more older folks with bad necks coming to our practices. We also have lots of little kids with tiny necks, loads of slouching teenagers, and patients who are just plain scared. They're all going to keep coming to us for treatment, so now what?

A final straw in this backbreaking scenario is what we are doing to our own bodies. How often do you lean over a patient and place your head in an unsupported position, just to get a better view? Then you cock your head sideways and lean in closer and closer, just to see those tiny marks on the periodontal probe or get that last bit of deposit off! Remember that hunched-over, elderly, female patient or the guy with the really stiff neck?

You are headed in that direction if you continue to twist and turn your body to accommodate your patient.

Now I know we all are supposed to help our patients be as comfortable as possible, but think about it - most dental appointments last for about an hour. The patient leaves after that hour, but we're in the treatment room all day. You do the math. Accommodating our bodies to our patients' positions will come back to haunt us sooner or later. Many hygienists have already paid a high price in physical pain and fatigue.

There are ways to prevent headrest and neck-support problems. A low-tech solution for the patient needing neck support can be a roll of cloth towels or, in a pinch, a small roll of paper towels placed between the patient's neck and the back of the chair. Pillows that offer various types of support are widely available. There are foam models and inflatable versions, and ones shaped like dog bones, small logs, or horseshoes. Others are designed to conform to an individual patient's anatomy and can be filled with free-flowing polystyrene beads encased in stretchy nylon bags, special memory foam, buckwheat hulls, or an aromatherapy combination full of flax seeds and herbs. Some supports have elastic straps that allow you to secure the pillows or neck supports to the chair in the best location for each patient. Consider supports that are completely washable (or at least have washable covers). They get soiled even when you use headrest covers.

Now, where do you find devices like these? Start by asking your dental friends. You never know what nifty little device they have discovered that gets rid of a lot of pain and only costs a few dollars. Check the Internet or stores specializing in devices for people suffering from back and neck pain. Physicians, chiropractors, massage therapists, physical therapists, and sports-medicine specialists all may be able to recommend quality products. Start investigating, and you'll find there are many solutions.

Patient positioning is another factor in your comfort. Ask your patient to move closer to you if you are working in a 9 or 10 o'clock position (lefties will be at a 1 to 3 o'clock position). Encourage patients to position their heads closer to the top of the chair, especially if you are positioned directly behind them. Remember that we are the educators. Most patients are not aware of how fatiguing dental-hygiene practice is to our bodies. They are happy to accommodate our requests once they understand how important it is to maintain good posture. Another easy trick is to ask the patient to roll his or her head toward us, allowing more direct vision.

For the chin-to-the-chest patient, place your hand gently under the chin and raise it up an inch or so, explaining how this helps us see and work better. I find the arched-neck patient the most challenging! Somehow I am never able to convey the proper message to these patients, so I raise the back of the chair instead. This seems to improve my visibility and the patient's comfort, while minimizing the patient's sensation of gagging. Patients with stiff necks are the ones whom I will contort my body for, if needed. Thank goodness that they are the exception and not the rule!

The final piece to this puzzle is asking what you are doing for yourself as a clinician. Ergonomic issues receive more attention today, both in the workplace and in academic institutions. However, most of us practice the way we were taught in hygiene school, meaning - unless you are a very recent graduate - you probably are headed for some repetitive stress injuries.

Good posture is a fundamental key to preventing injuries and stress. Magnification and ergonomic operator seating are critical components in maintaining good posture. If you think loupes and a quality chair are not important, then you don't know what you are missing! If you think they are geeky or too expensive, please reconsider! No one can predict which hygienists or dentists will be victims of these career-threatening disorders, and no one can predict when the problems will start. Countless hygienists and dentists are suffering today. Failing to protect your body and your career can have devastating results. Is a pinched neck worth pinching pennies?

Are you and your patients headed in the right direction on the highway to the comfort zone? I certainly hope so!

Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics ( She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].