Dr. Huda Yasir

INTRODUCTION DENTAL CHAIR AND PATIENT POSTIONS OPERATOR POSITIONS OPERATING STOOLS GENERAL CONSIDERATIONS HISTORY

1790 was a big year for dentistry, as this was also the year the first specialized dental chair was invented. It was made from a wooden chair with a headrest attached.

 Until a few decades ago, most dental procedures were performed with patient seated upright and dentist standing next to patient,this prolonged period caused musculoskeletal disorders for dentists.

 Modern dental chairs are designed to provide total body support in any chair position.  The patient head is supported by a head rest cushion which elevates the chin and thus reducing strain on neck A patient who is in a comfortable position is more relaxed, has less muscular tension and is more capable of cooperating with the dentist.

The choice of patient position varies with the operator, the type of procedure, and the area of the mouth involved in the operation. For operative dental procedures, the patient may be seated in one of the following positions: 1. Upright position 2. Almost supine 3. Reclined 45 degrees

This is the initial position of chair from which further adjustments are made

 In this position the chair is tilted so that the patient is almost in a lying down posture  The patient’s head,knees and feet are approximately at the same level  Patient’s head should not be lower than feet except in case of syncopal attack

 In this position the chair is reclined at 45 degrees so that when the patient is seated, the mandibular occlusal surfaces are almost at 45 degrees to the floor  Once the treatment is over the chair is brought back to upright position so that the patient can leave the chair easily

Once the patient has been comfortably positioned, the dentist and the assistant should sit themselves in the proper positions for treatment. Correct positioning of the operator is very important to have good visibility and accessibility to oral cavity.

Operator position: Usually sitting position is preferred in modern dentistry to relieve stress on operator's leg and support the operator's back. 11

The level of teeth being treated should be placed at same level as the level of operator's elbow. Forearm parallel to the floor Thighs parallel to the floor Hip angle of 90 degrees Seat height positioned low enough so that the heels of your feet touch the floor

 When working from clock positions 9-12:00, feet spread apart so that your legs and the chair base form a tripod which creates a stable position  Back of the operator should be always straight  Head erect and should not be bent of drooping

1. Right front or 7’o clock position 2. Right or 9’o clock position 3. Right rear or 11’o clock position 4. Direct rear or 12’oclock position LEFT HANDED OPERATOR'S POSITIONS, 5 o'clock, 3 o'clock and 1 o'clock. OPERATING POSITIONS

RIGHT HANDED OPERATOR— 3 PREFERRED POSITIONS LEFT HANDED OPERATOR— 3 PREFERRED POSITIONS 7 O’CLOCK5 O’CLOCK 9 O’CLOCK3 O’CLOCK 11 O’CLOCK1 O’CLOCK 15

RIGHT FRONT OR 7 ’O CLOCK POSITION  This is convenient for examination and working on the 1. Mandibular anterior teeth 2. Mandibular right posterior teeth 3. Maxillary anterior teeth

RIGHT OR 9 ’O CLOCK POSITION  The operator is directly to the right of the patients.  The position is convenient for operating on the 1.Facial surface of the maxillary & mandibular right posterior teeth 2. Occlusal surface on mandibular right posterior teeth.

RIGHT REAR OR 11 ’O CLOCK POSITION  Position of choice for most operations.  Most areas of mouth are accessible and can be viewed directly or indirectly using a mouth mirror.  The dentist sits to the right and slightly behind the patient and the left arm is positioned around the patient’s head  WORKING AREAS INCLUDE: a) Palatal and incisal surfaces of maxillary teeth (indirect vision) b) Mandibular teeth, particularly on the left side (direct vision).

DIRECT REAR OR 12 ’OCLOCK POSITION  Here the dentist sits directly behind the patient and looks down over the patient’s head  This position is mainly used only for working on lingual surfaces of mandibular and maxillary anterior teeth.

 The design of the stool is important.  It should be sturdy and well balanced to prevent tipping/gliding away from dental chair  It should be well padded with cushion edges and should be adjusted up and down  A well designed stool increases operator comfort and reduces fatigue

 The operator should be well illuminated either by natural or artificial light.  If the light is kept too close, it impairs the physical movement of operator & also increases patient discomfort due to heat production.  If the light is kept far away, it reduces the illumination.  As a rule for mandibular arch the light is kept in a higher position & for maxillary arch it is kept in a lower position.

 The patient’s head should be rotated according to need of operator without hesitation  During working maxillary occlusal surfaces should be perpendicular to the floor and for mandibular occlusal surface should be 45 degrees  The operator should maintain space between the patient as while reading a book

 There should be reduced contact with patient a) The operator should never rest his hand on patient’s face b) The chest of patient should never be used as trays to keep instruments

Magnification achieved with either surgical loupes or dental microscopes enlarges the operating site. Both allow the clinician to visualize features not otherwise perceptible to the naked eye.

The Benefits Of Magnification Magnified Image Brilliant Illumination Better Posture and Improved Comfort Increasing Accuracy Improved Dental Care Additional Treatment Options The Benefits Of Magnification Magnified Image Brilliant Illumination Better Posture and Improved Comfort Increasing Accuracy Improved Dental Care Additional Treatment Options