Patient Seating is Just As Important As Operator Seating In A Dental Chair
A polish scholar, Wojciech Jastrzebowski, first conceived the word ergonomics. Ergonomic research, however, wasn't even a thing before Japanese Physician Gito Teruoka founded the Kurashiki Institute of Science and Labour in 1921. That same year, Kan-ichi Tanaka, published the book, “Research of Efficiency: Ergonomics”. He stressed the importance of methods to use human power more economically. In the 1950’s, US scientists began writing textbooks around ergonomics. The first edition of the masterpiece, “Fitting the Task to the Man” by Professor E. Granjean was published in 1963. This textbook is now in its 5th edition and available on Amazon. It’s fitting to note that while scientists were writing textbooks on ergonomics, dentists were pioneering their own path to practicing it.
Dental chairs have come a long way. The first dental chair was designed by an American Dentist, Dr. Josiah Flagg in 1790. It was a padded old wooden writing chair with a tray for equipment on the side. Next came the reclining chair invented in 1832 by London dentist James Snell. In 1877, Basil Manly Wilkerson designed the first hydraulic type dental chair to make it easier to position the patient and improve the way he worked. Soon manufacturers started producing cosmetic variations of dental chairs. It wasn’t until 1958 before Dr. John Naughton invented the most significant improvement to the dental chair; inspired by John Anderson’s design of the pilot seat in an aircraft, Dr. Naughton’s “recliner” style dental chair is still the basic standard for dental chairs today. These guys were not inventors, strictly speaking. They were dentists, desperate to improve the way they worked - improving ergonomics.
You’ve got to think of ergonomics as ‘an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely’, Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in Dentistry. Int J Clin Pediatr Dent 2014;7(1):30-34. It doesn’t just apply to practitioner seating though. Ergonomics applies to patient seating as well. Today, most dental equipment manufacturers focus efforts on patient comfort as a benefit feature to a patient chair. While those things are important, you (doctor/hygienist/assistant), are going to spend more time hovering over your patient during your career than any single patient is sitting in a dental chair.
I am a clinical trainer with Reboot Practice Productivity Training. My job is to offer efficiency (ergonomic) solutions to the way you practice - including the way you sit and positioning in the operatory. There are challenges. Oftentimes, the patient chair restricts proper ergonomics. Some wide back style chairs keep you from reaching a close proximity to your patient - especially the oral cavity. A right handed practitioner must be able to work comfortably, sitting or standing, from 7 o’clock to 1 o’clock.
I bet you’ve never thought about the headrest. The headrest should be fully articulating; meaning, it should easily adjust to any angle and extend higher for taller patients and lower (even onto the top of the chair) for children. The headrest is critical and should be adjusted based on the dentistry at hand. I hate those knob style adjusting headrests: 1. They are too difficult to access. Twisting that knob while a long haired patient is sitting in the chair is an accident waiting to happen. (So much for patient comfort!) 2. They can be too difficult to turn. 3. There are too many motions - you’ve got to twist loose, adjust, twist tight. Just sayin’.
Have you ever found yourself stuck between the top of the headrest and your 12 o’clock wall? Don’t worry, you’re not alone. I love some of these pop-up consultant groups who “give you the best for less”. They are making up their own definition of ergonomics. You cannot offer short operatories without compromising ergonomics when there are no Ergonomic Products in the room. There are more dentists who have some type of cabinetry behind them in the operatory. Grab a measuring tape and do this for me? Position the chair as if you are ready to start treatment - in a supine position. Now measure the distance between the headwall (12 o’clock wall) and the top of the headrest. What is the distance? It should be between 42”and 44”. How far off are we?
What about patient comfort? When was the last time you sat in a patient chair? Is it comfortable? Where are your hands? What were dental equipment manufacturers thinking when they designed a chair without armrests? Have they ever worked chairside? Where is a patient supposed to put their hands? During a procedure, the patient’s arms should not be playing flippity-flop on and off the chair - or worse, your lap. Ask me how I know! These are basic patient comfort features. Removing intimidating factors of dentistry from right in their face to out of the patient’s direct line of sight is another - but this topic deserves its own blog! Added features to a patient chair like heat and massage offer next level comfort - distractions more or less. But don’t let the word “distraction” fool you… a patient that is happily distracted by their comfy heated chair, and relaxing massage is MUCH easier to treat than the apprehensive one tensing up at every sound or motion.
Remember, I write this blog to make dentistry easier. If you can see, you can provide care. The next time you’re prepping tooth #15 for a crown try not to stand on your head. Open the airway with a headrest. The right patient chair should work with you, not against you. I only trust the Ergonomic Products 3-Series ™ Patient Chairs because, like the early pioneers of dental chairs, they are designed by a dentist for dentists.
