Back to basics

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FIG. 1D: Pelvis is rolled forward when too much seat tilt is used or from congenital abnormality causing excessive lordosis, or swayback posture. (©2008 Posturedontics, LLC/Images)

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FIG 2: A saddle stool places the pelvis in a near-neutral position, which balances the spinal curves and minimises muscle strain. (©2008 Posturedontics, LLC/Images)

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FIG. 3: Non-tilting seat pans may also be retro-fitted with an ergonomic seat cushion. (©2008 Posturedontics, LLC/Images)

A lumbar support is a key ergonomic feature that has been shown to significantly reduce low back pain by facilitating a lumbar lordosis and reducing muscle activity when used continuously.^11,15

However a lumbar support is difficult to utilise effectively in dentistry; maintaining constant contact with a backrest is nearly impossible due to the inevitable need to intermittently lean forward to view the oral cavity.

Although dental operators cannot generally maintain constant contact with these supports throughout procedures, they are helpful to periodically allow relaxation of the lumbar musculature during naturally occurring pauses in procedures. These must be the proper size, shape and position to be effective.

In dentistry, an easier method to maintain your neutral pelvic position which facilitates your natural low back curve involves the use of a seat pan tilted inclined 5-10 degrees forward¹⁶ (Fig. 1C) and adjusting the stool height so your hips are positioned higher than your knees.^11-17

This rotates your pelvis forward, to a more neutral position, as in standing, brings more balance to the curves of your spine, and facilitates more dynamic body movement. Maintaining this curve reduces disc pressure, helps reduce low back pain¹⁸ and the downward slope of the thighs usually enables closer positioning to the patient.

Sitting with the seat pan tilted forward 5-10 degrees opens the hip angle to about 110 degrees, while a saddle-style stool increases the angle to about 125 degrees. Using a saddle stool (Fig. 2) moves your pelvis toward its most neutral seated position, (very close to a standing posture) which requires the least muscular effort to maintain the spinal curves.

This is one reason the saddle stool does not usually require a backrest. Since these stools place compression on the peritoneal structures, comfort will vary between the different operators.

Tilting the seat pan too far forward (beyond 15 degrees) may cause the operator to slide forward on the seat pan, losing contact with the lumbar support, and may also cause an excessive curve of the low back (Fig 1D).

Individuals with a severe lumbar lordosis (extreme curvature of the low back) or spondylolisthesis may benefit less from a tilting seat pan, as it will further promote this curvature and may cause discomfort. Individuals with these postural dysfunctions should consult with an ergonomic specialist or healthcare professional to determine what seating is best for them.

Non-tilting operator stools may be retrofitted with a wedge-shaped ergonomic cushion to economically gain the benefits of a tilting seat pan (Fig. 3)

Available research and the author's clinical consultation outcomes support the idea that low back pain problems in dentistry can be effectively prevented or managed.

Dental professionals should implement a multifaceted approach that includes not only proper seating, but also strengthening exercise, correct body mechanics, operator positioning, patient proximity, rheostat position, weight management, trigger point management, chair height, chairside stretching and other variables.

This represents a paradigm shift for daily dental practice. Incorporating ergonomic prevention strategies into your practice to facilitate balanced musculoskeletal health may enable increased productivity, a safer workplace and a longer, healthier career.

1-18 References supplied.

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