Copyright © 2017 Wolters Kluwer • All Rights Reserved Copyright © 2014 Wolters Kluwer • All Rights Reserved Module 1—Ergonomics and Periodontal Instrumentation Section 2 Foundational Skills for Periodontal Instrumentation
Copyright © 2017 Wolters Kluwer • All Rights ReservedCopyright © 2014 Wolters Kluwer • All Rights Reserved
Module 1—Ergonomics and Periodontal
Instrumentation
Section 2Foundational Skills for Periodontal
Instrumentation
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Foundational Skills for Periodontal Instrumentation
-Periodontal instrumentation is a complex psychomotor skill -Requires the proper position, instrument grasp, mirror use, finger rests, and stroke production-For successful instrumentation, must have mastery of individual skill components…these skills are mastered one-by-one
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Building Blocks for Periodontal Instrumentation
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Ergonomic Do’s and Don’ts
-Don’t alter posture positions just to get the job done-Do assume a neutral, balanced body position-Do make adjustments to patient’s chair and dental equipment to complete periodontal instrumentation
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Neutral Positioning
-Refers to ideal positioning of the body in a balanced position-Results in a decreased risk of musculoskeletal injury
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Neutral Position for the Clinician
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Neutral Neck Position
Goal: Head tilt of 0 to 15 degrees
AVOID:– Head tipped too far
forward– Head tilted to one side
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Neutral Back Position
Goal: Leaning forward slightly
from the waist or hips
AVOID: Curved back
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Neutral Torso Position
Goal: Torso in line with long axisAVOID: Leaning or twisting torso
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Neutral Shoulder Position
Goal: Shoulders even
AVOID: Shoulders hunched up toward
ears
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Neutral Upper Arm Position
Goal: Elbows at waist level held
slightly away from the body
AVOID: Elbows held above waist level
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Neutral Forearm Position
Goal: Forearm parallel to the floor
AVOID: Angle between forearm and upper arm of
less than 60 degrees
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Neutral Hand Position
Goal: Little finger-side of palm slightly
lower than the thumb-side of palmAVOID: Palm parallel
to floor
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The spine has three healthy curves:
1. Cervical (inward curve)2. Lumbar (inward curve)3. Thoracic (slight outward curve)
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Neutral Clinician Posture – Step 1
-Position buttocks all the way back in the chair
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Neutral Clinician Posture – Step 2
Adjust seat height so feet are flat on the floor
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Neutral Clinician Posture – Step 3
-Weight evenly distributed-Seat back about 1 in higher than front of seat-Hips slightly higher than knees
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Selecting Clinician Stool
-Each clinician should adjust stool height and seat back to his or her own body proportions and height-Adjust seat tilt and lumbar height of backrest-All three normal back curves should be present while sitting
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Neutral Position for the Patient
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Supine Patient PositionMaxillary Treatment Areas
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Characteristics of Neutral Patient Position
Patient’s feet even with, or slightly higher than the tip of nose
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Characteristics of Neutral Patient Position (cont.)
Chair back nearly parallel to the floor for maxillary treatment areas
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Characteristics of Neutral Patient Position (cont.)
Top of patient’s head even with the upper edge of the headrest
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Characteristics of Neutral Patient Position (cont.)
Chair back raised slightly for mandibular treatment areas
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Patient Head Adjustment
-Once chair is in position, ask patient to adjust head for optimum visibility of treatment area
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Patient Head Tilt for Maxillary Arch(Chin-up position)
-Angle the headrest up into the back of patient’s head so nose and chin are level
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Patient Head Tilt for Mandibular Arch(Chin-down position)
-Angle the headrest forward and down so that the chin is lower than the nose level
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Neutral Positioning of Equipment
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Light Position for Mandibular Arch
-position light directly over the oral cavity-position at arm’s length
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Light Position for Maxillary Arch
-position will vary from being over the oral cavity to being positioned over the neck-position at arm’s length
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Clinician Position Relative to the Patient
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-upper arms parallel to torso-arms are not raised-shoulders relaxed
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-elbows are raised up in a stressful position-patient chair is too high
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-patient positioned too high for clinician-clinician’s chair is raised so she can reach the mouth-her feet are not flat on the floor
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Easy Neutral Position
1. Sit alongside the patient.2. Position your arm against your side. 3. Position your arm crossed at your waist.
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Easy Neutral Position (cont.)
4. Lower the patient’s chair until the patient’s open mouth is below the point of your elbow.
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Easy Neutral Position (cont.)
5. Make sure that your shoulders are not
raised up toward your ears!
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Patient Head Position
-Ask patient to adjust his or her head to have access to treatment area-Maxillary arch: patient in chin-up position-Mandibular arch: patient in chin-down position
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Ancillary Equipment
Ancillary equipment helpful during periodontal instrumentation: -Coaxial illumination -Magnification loupes
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Coaxial Illumination
-Spectacle-mounted or headband-mounted lights (dental headlights)-Light beam parallel to clinician’s line of vision
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Magnification Loupes
-Magnifies treatment area-Improves visual sharpness-Reduces strain to clinician’s back and shoulders-Decreases eyestrain
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Field of Vision Without Loupes
-When learning the skills of positioning, mirror use, and finger rests, the clinician needs a normal field of vision-Permits self-evaluation of skills
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Neutral Positioning
-The ideal positioning of the body-Results in a decreased risk of musculoskeletal injury
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Summary: Neutral Position
Comprised of:-Neutral, balanced clinician position-Neutral patient position-Neutral clinician position in relation to the patient and to dental equipment
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