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Dental Tribune Middle East & Africa Edition | 3/2018 mCME 11 ◊Page 10 vature. The pelvis rotates downward and forward, enabling the knees to stay below hip level. This creates less stress and strain on the back, neck and shoulder muscles. A slight in- cline of the seat (5-15 percent) is ideal. If you adjust more than 20 percent out of a neutral position for an ex- tended period of time, muscle imbal- ances are created, which means the muscles are adaptively shortening on one side and elongating on the other. This results in misalignment of the spine and joints, and in this case, the hip joint. When a person sits properly on a saddle seat, the pelvis is properly positioned and stabilized, so the body naturally and automati- cally assumes the least-stressful po- sition. Static vs. dynamic seating For sitting positions, there are two more checklist considerations. In tra- ditional chairs, the practitioner sits in a static position that does not pro- vide much movement or stimula- tion of the muscles. A new term has been given to some of the advanced- design chairs: dynamic seating. The dynamic chair offers the option of movement, allowing the muscles to both contract and relax while one remains seated. Prolonged mus- cle contraction results in increased pressure of the blood vessels in the muscle, creating a decreased blood flow through the muscle. Blood flow assists in the repair and health of the muscles by delivering oxygen to the muscle and removing waste prod- ucts in the muscle that might oth- erwise cause localized, intense pain (ischemia). A dynamic chair allows a period of rest and rebuilding for the muscles needed for healthy seating. In some dynamic stools the seat pan moves; with others it’s the seatback that moves forward and backward as you move; and, with some, all parts of the chair move. In any case, these chairs help strengthen the body’s core. Seating materials A chair can be made of rubber, plastic, leather, mesh or other man- made materials that may or may not breathe. These materials can make a difference in comfort depending on where you live. In the South, or if there is high humidly in the of- fice, a practitioner might complain about the material of the seat. If there is sweating while sitting, the seat may not allow the legs and back to breathe. This can be uncomfort- able and/or embarrassing. Asking the manufacturer about options for breathability is the best choice. There are new fabrics that control odor and stain-causing bacteria. With or without arms Many practitioners wonder if they should or shouldn’t have arms on their chairs. The answer depends on how that individual works. If the per- son’s arms are always flapping in the breeze because the patient isn’t seat- ed back properly, then arms on the chair will not help. It is imperative for the patient to either lay back in the appropriate position, or the prac- titioner must stand. One suggestion is instead of saying “Ok, let’s put the chair back and get started,” the prac- titioner says, “Let’s put the chair back and get both of us comfortable.” They are very similar phrases with very different meaning. Patients are not the only ones who need to be comfortable; the best work can hap- pen when everyone is comfortable. How many times during the day do practitioners stop to get com- fortable? Usually none. Health care providers often worry more about patient comfort and end up compro- mising themselves all day long, lead- ing to pain and injury. alternative Goldilocks theory of seating Chairs are often inherited from someone else when first employed in a different practice. Steve Knight’s Goldilocks™ theory is like the old story, sometimes it’s too tall or too short and no matter how much it is adjusted, it is still not just right. Not getting that just-right position will lead to pain and other issues. Many companies can exchange the cylin- der in a stool, for different heights to make it just right. Checking with the supplier or the manufacturer of the stool is the best way to find out if the cylinder can be changed to create a better fit. The important lesson is: Don’t just try to live with it; it hurts the practitioner, the patients, and eventually, the practice’s bottom line. Considering seating may be the best choice. Creating a checklist for buying a new chair (Ta- ble 2) can help you find the best one for your needs. A new chair may be needed because some chairs can’t be jerry-rigged enough to fit. Other issues also play a part. Some patient chairs are extremely wide, or our patients can be very broad. This can make it impossible to work close enough when seated in a traditional stool. The saddle stool allows much closer access to the patient, so tasks can be accomplished with less stress. The professional should not have to reach more than 15 inches. The light, instruments on the bracket tray, the handpieces, the computer or anything needed for patient care should be within arms-reach. Strain- ing for items stresses the muscles in the neck and shoulder. The biggest culprit is the overhead light. A head- light attached to loupes is no longer a choice; it is a necessary part of a healthy ergonomic armentarium. Checklists and the culture of teamwork Hospital checklists are saving lives and money. Pilots use several dif- ferent checklists for every flight to prevent pilot error and crashes. Winning race car teams and race car drivers use checklists for every race. Dentistry can use checklists to great benefit as well. We’ve come a long way, yet dentistry still has a way to go. It won’t happen without a change of culture. First, the problem must be recognized, hopefully before there is Fig. 4. Traditional upright seating: Notice how this causes a stretching in the thigh muscles. (Drawings/Provided by Crown Seating) Fig. 5. Reclined seating Fig. 6. Inclined seating serious damage. Dental professionals know that be- fore there is a cavity, before there is periodontitis, before there is oral cancer; there is a risk for a cavity, periodontal disease and oral cancer. Preventive care and early detection is the purpose of routine hygiene care. Half or more of those reading this article already have MSDs; the other half are probably accumulat- ing damage but haven’t reached crit- ical mass to experience symptoms. Dental professionals are caring indi- viduals who don’t have to hurt them- selves to help others. Ultimately not sitting comfortably hurts the practi- tioners, the patients and the practice bottom line. With simple ergonomic seating checklists professionals can be more successful at practicing in a pain-free environment. References 1. The 1964 Report on Smoking and Health. National Library of Medicine. 1964. Available at: www.profiles. nlm.nih.gov/ps/retrieve/Narrative/ NN/p-nid/60. 2. Nixon signs legislation banning cigarette ads on TV and radio. Time Magazine. April 1 1970. Available at: www.history.com/this-day-in-histo- ry/nixon-signs-legislation-banning- cigarette-ads-on-tv-and-radio. 3. Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2010. U.S. Department of Labor, Bureau of Labor Statistics. Available at: www.bls.gov/news.re- lease/osh2.nr0.htm. 4. Survey of Dental Hygienists in the United States Executive Summary. American Dental Hygienists Associa- tion. 2007. Available at: www.adha. org/downloads/DH_pratitioner_ Survey_Exec_Summary.pdf. 5. Weerdmeester, B. Ergonomics for Beginners: A quick reference guide. 2008. CRC Taylor & Francis. 6. Hazard Recognition, Control and Prevention. Occupational Safety & Health Administration. Available at: www.osha.gov/SLTC/dentistry/rec- ognition.html. 7. An Introduction to Ergonomics: Risk Factors, MSDs, Approaches and Interventions. A Report of the Er- gonomics and Disability Support Advisory Committee to Council on Dental Practice American Dental Association. 2004. www.rgpdental. com/pdfs/topics_ergonomics_pa- per(2).pdf. 8. Ergonomics for Dental Students. American Dental Association. 2011. Available at: www.ada.org/sections/ educationAndCareers/pdfs/ergo- nomics.pdf. 9. Ergonomics. American Dental As- sociation Alliance. Available at: www. ada.org/4500.aspx. 10. Schamel, J. How the Pilot’s Check- list Came About. January 1, 2011. Flight Field Service History. Avail- able at: www.atchistory.org/History/ checklst.htm. 11. Gawande, A. The Checklist Mani- festo: How to Get Things Right. New York: Metropolitan Books, 2010. 12. Pronovost, P., Vohr, E. Safe Pa- tients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out. Penguin Group, 2011. 13. Checklist for Ergonomic Risk Fac- tors. PMA.org. Available at: www.pma.org/osha/docs/wsc- checklist.pdf. 14. Scott II, R. The Direct Medical Costs of Healthcare-Associated In- fections in U.S. Hospitals and the Benefits of Prevention. March 2009. Centers for Disease Control and Pre- vention. Available at: www.cdc.gov/ HAI/pdfs/hai/Scott_CostPaper.pdf. 15. Pronovost P, Needham D, Ber- enholtz S, Sinopoli D, Chu H, Cos- grove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goe- schel C. An intervention to decrease catheter-related bloodstream infec- tions in the ICU. N Engl J Med. 2007 Jun 21;356(25):2660. Available at: www.nejm.org/doi/full/10.1056/ nejmoa061115#t=articleTop. 16. Purdy, Cindy. “Ergonomics” e- mail. E-mail to AmyRDH group. Au- gust 14, 2012. 17. Gilkey, D. Occupational Ergonom- ics Certificate. 2012. Available at: www.ramct.colostate.edu/webct. Judy Bendit, RDH, BS, Patti DiGangi, RDH, BS. They are national speakers who created and present Creating a Flight Plan Be- yond the Routine. The one-of-a-kind program includes topics such as elec- tronic health records, risk assessment, in- strumentation and ergonomics to name a few. They are presenting “Flight Plan: Checklists” in its new format during the Yankee Dental Congress, www.yankee- dental.com, in January. Contact DiGangi at pdigangi@comcast.net or Bendit at JZBeducate@aol.com. mCME SELF INSTRUCTION PROGRAM CAPPmea together with Dental Tribune provides the opportunity with its mCME - Self Instruction Program a quick and simple way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership Yearly membership subscription for mCME: 1,100 AED One Time article newspaper subscription: 250 AED per issue. After the payment, you will receive your membership number and allowing you to start the program. Completion of mCME • • • • • • • • mCME participants are required to read the continuing medical education (CME) articles published in each issue. Each article offers 2 CME Credit and are followed by a quiz Questionnaire online, which is available on www.cappmea.com/ mCME/questionnaires.html. Each quiz has to be returned to events@cappmea.com or faxed to: +97143686883 in three months from the publication date. A minimum passing score of 80% must be achieved in order to claim credit. No more than two answered questions can be submitted at the same time Validity of the article – 3 months Validity of the subscription – 1 year Collection of Credit hours: You will receive the summary report with Certificate, maximum one month after the expiry date of your membership. For single subscription certificates and summary reports will be sent one month after the publication of the article. Table 1. Seating Risk Assessment Checklist (Table adapted from the Occupational Safety and Health Administration’s ‘Checklist for Ergo- nomic Risk Factors’) Table 2. Checklist for buying a new chair The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available on www.cappmea.com after the publication. For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE AUTHORS FIND THE CONTACT DETAILS AT THE END OF EACH ARTICLE.