Principles of Positioning 1

JUNE 2014

Module 1 Principles of Positioning

UNIVERSITAS JENDERAL SOEDIRMAN

PURWOKERTO

Overview

This module introduces the principles of positioning for periodontal

instrumentation and treatment. Correct positioning techniques help to

(1) prevent clinician discomfort and injury,

(2) permit a clear view of the tooth being worked on,

(3) allow easy access to the teeth during instrumentation, and

(4) facilitate efficient treatment of the patient.

Goals

n Develop an appreciation of evidence-based knowledge of positioning in the

dental environment.

n Understand the relationship between neutral position and the prevention of

musculoskeletal problems.

n Demonstrate operation of the clinician chair and the patient chair.

n Demonstrate correct patient position relative to the clinician.

n Position equipment so that it enhances neutral positioning.

n Demonstrate correct clinician and patient position in each of the mandibular

and maxillary treatment areas while maintaining neutral positioning.

n Recognize incorrect position and describe how to correct the problem.

KEY TERMS

Work-related musculoskeletal disorder Repetitive task Ergonomics Supine position Neutral position Nondominant hand Dominant hand Anterior surfaces toward my

nondominant hand Anterior surfaces away from my

nondominant hand Posterior aspects facing toward me Posterior aspects facing away from me

Contents

Introduction to Work-related Muscular Disorders

Brief introduction of some muscular disorders which is seen in the dental workers

Neutral Position for the Clinician

For right-handed clinician. Help to understand an ideal and ergonomics position.

Patient Position

Details on patient clinician position.

amiliarevisiMungkin lebih oke lagi kalo ada video yang bisa menunjukkan posisi operator dan pasien yang tepat supaya lebih mudah dibayangkan

Principles of Positioning 2

INTRODUCTION TO WORK-RELATED MUSCULOSKELETAL DISORDERS (WMD)

In simple terms, a work-related musculoskeletal disorder (WMD) is an

injuryaffecting the musculoskeletal, peripheral nervous, and neurovascular

systemsthat is caused or aggravated by prolonged repetitive forceful or

awkward movements, poor posture, ill-fitting chairs and equipment, or a fast-

paced workload. According to the U.S. Bureau of Labor Statistics,

musculoskeletal disorders result in more than 60 percent of all newly reported

occupational injuries. The result is injury to the muscles, nerves, and tendon

sheaths of the back, shoulders, neck, arms, elbows, wrists, and hands that can

cause loss of strength, impairment of motor control, tingling, numbness, or pain.

Work-related musculoskeletal disorders are a common complaint of practicing

dentists and dental hygienists.

The human body was not designed to maintain the same body position or

engage in fine hand movements hour after hour, day after day. B.A. Silverstein, in

an article in the British Journal of Industrial Medicine, defined a repetitive task as

a task that involves the same fundamental movement for more than 50 percent of

the work cycle. Periodontal instrumentation would certainly be categorized as a

repetitive task under this definition. More than 50 percent of the time is spent

performing very controlled, fast motions. Periodontal instrumentation requires

excessive upper body immobility while the tendons and muscles of the forearms,

hands, and fingers over work. The dental healthcare professional has a high risk of

musculoskeletal injury when repetitive motions are combined with forceful

movements, awkward postures, and insufficient recovery time. Fortunately, injury

to the muscles, tendons, and nerves can be prevented in most cases. This module

presents strategies for the prevention of musculoskeletal injuries.

Main Causes of WMD

Principles of Positioning 3

MUSCULOSKELETAL DISORDERS USUALLY SEEN IN

DENTAL HEALTHCARE PROVIDERS

n Carpal Tunnel Syndrome (CTS) A painful disorder of the wrist and hand caused by compression of the median nerve within the carpal tunnel of the wrist

n Ulnar Nerve Entrapment A painful disorder of the lower arm and wrist caused by compression of the ulnar nerve of the arm as it passes through the wrist

n Pronator Syndrome A painful disorder of the wrist and hand caused by compression of the median nerve between the two heads of the pronator teres muscle

n Tendinitis A painful inflammation of the tendons of the wrist resulting from strain

n Tenosynovitis A painful inflammation of the tendons on the side of the wrist and at the base of the thumb

n Extensor Wad Strain A painful disorder of the fingers as a result of injury of the extensor muscles of the thumb and fingers

n Thoracic Outlet Syndrome A painful disorder of the fingers, hand, and/or wrist as a result of the compression of the brachial nerve plexus and vessels between the neck and shoulder

n Rotator Cuff Tendinitis A painful inflammation of the muscle tendons in the shoulder region

Principles of Positioning 4

NEUTRAL POSITION FOR THE CLINICIAN

Research indicates that over 80 percent of dental hygienists

complain of pain in the upper body and back. This musculoskeletal

pain often is the direct result of body positioning and movements

made by dental hygienists in their daily work. Neutral position is the

ideal positioning of the body while performing work activities and is

associated with decreased risk of musculoskeletal injury. It is

generally believed that the more a joint deviates from the neutral

position, the greater the risk of injury.

Neutral Seated Position

1. Forearms parallel to the floor

2. Weight evenly balanced

3. Thighs parallel to the floor

4. Hip angle of 90

5. Seat height positioned low enough so that

you are able to rest the heels of your feet

on the floor Head and body position

Shoulders and arms position

Principles of Positioning 5

PATIENT POSITION

Supine positionthe position of the patient during dental treatment, with the patient lying on his or her back in a horizontal position and the chair back nearly parallel to the floor. Recommended Position in Supine Position

Body The patients heels should be slightly higher than the tip of the nose. This position maintains good blood flow to the head. An apprehensive patient is more likely to faint if positioned with the head higher than the heels. The chair back should be nearly parallel to the floor for maxillary treatment areas. The chair back may be raised slightly for mandibular treatment areas.

Head The top of the patients head should be even with the upper edge of the headrest. If necessary, ask the patient to slide up in the chair to assume this position.

Headrest If the headrest is adjustable, raise or lower it so that the patients neck and head are aligned with the torso.

Establishing Neutral Position in Relation to the Patient

1. First, adjust the height of the clinician chair to establish a hip angle of 90.

2. Next, lower the patient chair until the tip of the patients nose is below the clinicians waist level. Your elbow angle should be at 90 when your fingers are touching the teeth in the treatment area.

3. AVOID placing your legs under the back of the patient chairin this position the patient will be too high and you will need to raise your arms to reach the patients mouth. It is acceptable to place your legs under the headrest of the chair.

Position for mandibular teeth Position for maxillary teeth

Principles of Positioning 6

POSITION OF TREATMENT AREAS OF THE MOUTH (Right-handed clinician only)

Instrumentation of the various treatment areas may be accomplished

from one of four basic clinician positions. The four basic clinician positions are usually identified in relation to a 12-hour clock face: 1. 8 oclock positionto the front of the patients head 2. 9 oclock positionto the side of the patients head 3. 10 to 11 oclock positionnear the corner of the patient headrest 4. 12 oclock positionbehind the patients head

Positioning for the anterior sextants 8 to 9 oclock (8:00 option shown); Anterior Surfaces TOWARD My Non-dominant Hand

Positioning for the anterior sextants 12 o`clock; Anterior Surfaces AWAY from My Non-dominant Hand

Positioning for the posterior sextants 10-11 o`clock; Posterior Aspects Facing AWAY From Me

Positioning for the posterior sextants 9 o`clock; Posterior Aspects Facing TOWARD Me

Principles of Positioning 7

SUMMARY OF POSITION RELATED TO PATIENT HEAD

(for right-handed clinician only)

Treatment Area Clock Position

Patient Head Position

Mandibular ArchAnterior surfaces toward my nondominant hand

89:00 Slightly toward, Chin DOWN

Maxillary ArchAnterior surfaces toward my nondominant hand

89:00 Slightly toward, Chin UP

Mandibular ArchAnterior surfaces away from my nondominant hand

12:00 Slightly toward, Chin DOWN

Maxillary ArchAnterior surfaces away from my nondominant hand

12:00 Slightly toward, Chin UP

Mandibular ArchPosterior aspects facing toward me (right facial and left lingual)

9:00 Slightly away, Chin DOWN

Maxillary ArchPosterior aspects facing toward me (right facial and left lingual)

9:00 Slightly away, Chin UP

Mandibular ArchPosterior aspects facing away from me (right lingual and left facial)

1011:00 Toward, Chin DOWN

Maxillary ArchPosterior aspects facing away from me (right lingual and left facial)

1011:00 Toward, Chin UP