This pandemic has certainly given us time to reflect. I find myself looking back on my 45 years in sales, marketing, and the manufacturing of dental equipment.
I’ve been fascinated over these years observing how dental equipment manufacturers approach the needs of the dentist, especially as they attempt to make the product safer to use, ergonomically speaking. My focus has primarily been on the stool, patient chair and delivery system.
I recently read a paper that said 67% of dentists and 80% of dental hygienists suffer from work-related musculoskeletal pain. The Bureau of Labor Statistics points out that dentists and hygienists rank highest above all occupations in cases of carpal tunnel syndrome and work-related disabilities in general.
As a result, millions of dollars of professional income are lost due to time off from chronic pain in the neck, shoulders, back, arms and wrists. It my belief that this pain and resulting downtime are not necessary. But several things must happen, and I suggest that this unprecedented coronavirus timeout can be just the moment you need to start in motion what you need to do to avoid these losses.
A perfect place to begin is a look back at the reasons behind the success of a product that many consider had more influence than any other on how you work safely around the mouth. Let’s look at the DENTALEZ® J-Chair®.
In the 60s DENTALEZ was selling an exciting new approach of sit-down dentistry, but what they were really selling was the concept of how the product helped the dentist stay healthy, because it was an ergonomically better way. It was a huge step forward in that it eliminated a host of musculoskeletal and circulatory problems which had been related to standing in a variety of contorted postures.
How they presented the J-Chair goes a long way to explaining needs that makers were trying to satisfy, back then, that still exist today. It’s also interesting to see how some of the J’s features and benefits were used and how the same, yet more evolved, versions are largely ignored today.
The DENTALEZ sales rep began with instruction on how to set up and use the doctor’s stool. That meant positioning the back support to meet the lower back, adjusting the stool height so that your thighs were almost parallel to the floor, maybe with the thighs sloped down a couple degrees toward the knees. The chair back was low, often between the knees, if not resting on top of them, with the thighs parallel or sloped down a couple degrees.
Today, btw, the more ergonomically safe thinking has the stool raised such that your hip bones are higher than your knees, with the seat and thighs sloping down about 15 degrees. This takes pressure off your lumbar disks.
Then the presentation moved to the patient chair. They spent a lot of time on the revolutionary headrest cushion, called the “horseshoe”. They explained that if the focus was on the upper arch, the chair back was supine, the occlusal plane was moved back a few degrees from vertical by positioning the thick part of the horseshoe under the occipital bone, right above the neck. The lower arch required the chair back to be raised up ~15 degrees (there were no presets, so the button had to be held down) and the cushion rotated so the thick part was above the occipital, helping to move the chin down. Dentists understood this and could easily understand the benefit. The concept of controlling the angle of the occlusal plane with the placement of the horseshoe went a long way towards helping the dentist work from a more balanced posture.
So today with the stool set to a higher position, sloping down (Forest’s Comfort stool has a mesh seat so you won’t slip off), the patient chair is raised so that the clinician’s forearms are up at ~45 degrees relative to the floor, stabilized at the hands to remove shoulder and forearm stresses. The resulting operational point gives access to the patient’s mouth at about the clinician’s heart height, which is exactly the position chosen for fine work by humans in free-space studies. (Think of threading a needle.) The patient’s mouth is now much closer, so surgical loupes must be adjusted to match. No more drastic out-of-balance leaning forward. Your entire body, especially your spine, will love you.
Change is tough. If you try these things, now, before you go back to work, say with your spouse, or roommate, it will feel awkward. If I look at a video of my golf swing, I see that it’s definitely a long way from where it should be. When an instructor asks me to change, to swing correctly, it feels awkward. The tendency is to go back to the old way. But with persistence, “awkward” becomes a new habit --- the new you --- and you lower your handicap. Well, these clinical performance changes are way more important than lowering your handicap!