Proper Patient Positioning- The Key to Prevention of MSD’s

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Musculoskeletal Disorder’s (MSD’s)  are progressive and degenerative conditions that affect two out of three dental professionals. Close to one-third of dentists are forced to retire early due to this disorder. The causes of MSD’s in dentistry are diverse, and symptoms include recurrent pain, inflammation/swelling, stiff joints, and dull aches in the neck, back, shoulders, wrists, hips, legs, knees, and feet.

Proper patient positioning techniques can prevent MSD’s and other types of chronic conditions in the dental field. Adopting this system is beneficial when taken into account that the operator is using other favorable equipment such as professionally fitted loupes and lighting, and ergonomic operator seating, such as a saddle stool.

Patient Positioning:

  • Position the patient supine for treatment of the maxilla and semi-supine for treatment of the mandible.
  • Instruct the patient to move to the end of the headrest after reclining
  • Frequent movement of the clinician will mandate the patient rotate their head and move their chin to maintain a line of sight that is perpendicular to the surface of the tooth.
  • An ergonomic dental headrest cushion that is held in place by a strap can be used to help with patient comfort and maintain proper orientation of the occlusal plane while being reclined during treatment. Choose a supplemental cushion that is designed for dental chairs.
  • When treating the maxilla, the headrest should be adjusted so that the occlusal plane of the maxilla is 15 to 20 degrees backward in relation to the vertical plane. Use a contoured pillow made for dental chairs with the larger end of the pillow under the patient’s neck which positions the head back and chin higher.
  • When focusing on the mandible, the headrest should be adjusted so that the occlusal plane of the mandible is around 30 degrees elevated from the occlusal plane. If using a contoured pillow, reverse the position used in the maxillary position with the large end being behind the patient’s head.
  • Mandibular Arch 8-9 o’clock positioning is best for treating anterior surfaces of the non-dominant hand, posterior right buccal, & left lingual. The patient’s chin should be down and their head slightly away from the operator.
  • Maxillary Arch 8-9 o’clock positioning is best for treating anterior surfaces of the non-dominant hand, posterior right buccal, & left lingual. The patient’s chin should be up and head slightly away from the operator.
  • Mandibular Arch 10-12 o’clock positioning is best for treating the anterior surfaces away from the non-dominant hand, posterior right lingual, & left buccal. The patient’s head should be slightly toward the operator and chin should be down.
  • Maxillary 10-12 o’clock positioning is best for treating the anterior surfaces away from the non-dominant hand, posterior right lingual, & left buccal. The patient’s chin should be up and their head toward the clinician.
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