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 Table of Contents  
ORIGINAL RESEARCH
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 36-39

Evaluation of a new ergonomic position for the operator/clinicians for the extraction of mandibular right posterior molar teeth


1 Department of Oral and Maxillofacial surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
3 Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Web Publication26-Feb-2018

Correspondence Address:
Dr. Komal Smriti
Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_259_17

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  Abstract 

Aims: This study aimed to assess and compare the feasibility of this new ergonomic position (2'o clock or left rear position) with conventional (12'o clock) position in the exodontia of the mandibular right posterior (MRP) teeth (second and third molars) among right-handed operators. Materials and Methods: An observational questionnaire study was conducted among dental students, faculty, postgraduates, and private practitioners. A self-administered questionnaire which evaluated eight domains, namely, posture of the operator, visibility of the teeth being extracted, fatigue to the operator, accessibility to the teeth being extracted, grasp of the molar teeth, delivery of force, retraction of cheeks, and difficulty in extraction were distributed to the operators. All the items in the questionnaire were based on visual analog scale. Results: A total of 63 operators have completed the study out of which 60.3% were females. The mean age of the participant was 25.63 ± 6.41 years. All the parameters have shown that the mean scores were significantly higher for 2'o clock than 12'o clock positions (P < 0.001), respectively. Conclusion: The new operator position (2'o clock) was more acceptable among the dentists for the extraction of MRP molar teeth.

Keywords: 12'o clock position, 2'o clock, ergonomics, extraction, teeth


How to cite this article:
Gadicherla S, Pentapati KC, Singh A, John ER, Smriti K. Evaluation of a new ergonomic position for the operator/clinicians for the extraction of mandibular right posterior molar teeth. J Int Oral Health 2018;10:36-9

How to cite this URL:
Gadicherla S, Pentapati KC, Singh A, John ER, Smriti K. Evaluation of a new ergonomic position for the operator/clinicians for the extraction of mandibular right posterior molar teeth. J Int Oral Health [serial online] 2018 [cited 2022 May 28];10:36-9. Available from: https://www.jioh.org/text.asp?2018/10/1/36/226184


  Introduction Top


Exodontia is the most common technique that all dentists are taught to perform in dental school and used by most general clinicians in their practice. The positions of the dental chair, patient, and operator are crucial for carrying out tooth extraction effectively.[1] The correct posture of the operator is essential not only to have good visibility and accessibility of the oral cavity but also to allow the operator to have the utmost control over the force being delivered to the patient's tooth through the forceps.[1] The appropriate working position would lead to an acceptable posture which in turn reduces fatigue, physical strain, and onset of musculoskeletal disorders for operators. Work-related musculoskeletal disorders in dental care providers are reported in the literature with symptoms affecting various regions of the body including neck, shoulders, upper extremities (elbows, hands, wrists, and fingers), and back.[2] Ergonomic studies had established that safety and management should begin on time before musculoskeletal injuries become persistent.[3]

Essentially, there are two schools of thoughts for performing the exodontia based on the operator stature, namely, operator either practicing exodontia in seated or orthostatic postures.[4] Dentists usually stand during exodontia, and the correct position allows them to provide stability and support and to keep the wrists and elbows straight enough to deliver the force with the arm and shoulder, and not with the fingers or hand.

Extraction in the lower arch requires the backrest of the dental chair and the patient positioned in a more upright position so that when the mouth is wide open, the mandible and occlusal plane are positioned in a parallel line with the floor.[5] A right-handed operator conventionally stand at the right rear position (11'o clock) or direct rear position (12'o clock)[6] for exodontia of the mandibular right posterior (MRP) teeth. It is fair to believe that these positions provide good visibility and maximal accessibility to the oral cavity for MRP molar teeth. However, many operators have reported reduced accessibility while extracting the MRP molar teeth with these positions. Hence, to overcome this problem of reduced accessibility, the operator tends to bend forward which results in unnecessary curvature of the spine or slumping of shoulders leading to physical strain during the procedure and also the operator tends to lean over the patient and put his/her face close to the patient's mouth. To overcome this problem faced due to awkward postures, a new ergonomic position was proposed which involves the operator to stand at 2'o clock position while performing extraction of teeth in MRP region.[7] Hence, we aimed to assess and compare the feasibility of this new ergonomic position (2'o clock or left rear position) with conventional (12'o clock) position in the exodontia of the MRP teeth (second and third molars) among right-handed operators.


  Materials and Methods Top


This observational questionnaire study was conducted among dental students, faculty, postgraduates, and private practitioners in the field practice area of Manipal College of Dental Sciences, Manipal from January to April 2017. A self-administered questionnaire which evaluated eight domains, namely, posture of the operator, visibility of the teeth being extracted, fatigue to the operator, accessibility to the teeth being extracted, grasp of the molar teeth, delivery of force, retraction of cheeks, and difficulty in extraction were distributed to the operators. All the items in the questionnaire were based on visual analog scale (VAS) which ranged from “not acceptable” (0) to “highly acceptable” (10). The questionnaire was pilot tested to evaluate the feasibility. Each operator was asked to evaluate both the proposed 2'o clock and conventional 12'o clock positions in the exodontia of MRP teeth of the single patient [Figure 1] and [Figure 2]. Before performing the exodontia with new proposed position, a brief interactive personalized session was conducted by the principal investigator to familiarize the operator positions and contents of the questionnaire. Any clarifications and queries were clarified before conducting the study.
Figure 1: Operator position for conventional exodontia of mandibular right posterior molar teeth

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Figure 2: New proposed position for exodontia of mandibular right posterior molar teeth

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The inclusion criteria were operators who practiced right-handed dentistry for exodontia of MRP teeth, especially molars in standing position. The exclusion criteria were operators with a history of myalgia, osteoarthritis, operated wrist of the right hand with guarded prognosis, and operators preferring to do the exodontias in sitting posture. Permission to conduct the study was obtained from the Institutional Ethics Committee of Kasturba Hospital, Manipal (IEC 488/2016). Prior informed consent was sought from patients and the operators. All the analyses were done using SPSS version 18 (SPSS Inc, Ill, Chicago, USA). P < 0.05 was considered statistically significant. Data were evaluated for normality using Shapiro–Wilk test. Comparison of mean VAS scores was done using Wilcoxon signed-rank test between both the operator positions.


  Results Top


A total of 63 operators have completed the study out of which 60.3% were females. The mean age of the participant was 25.63 ± 6.41 years. A total of eight parameters were evaluated on VAS scores for both the operator positions (12'o clock and 2'o clock). All the parameters have shown that the mean scores were significantly higher for 2'o clock than 12'o clock positions (P< 0.001, respectively). This implied that the 2'o clock operator position was more acceptable for the eight domains that were evaluated for exodontia of MRP molar teeth [Table 1].
Table 1: Comparison of mean scores for the 12'o clock and 2'o clock positions

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  Discussion Top


Working posture of the dentist is the most debated subject when principles of ergonomics were applied to the field of dentistry. The specific consideration is justified by the widely documented and recognized fact that posture is the key to prevent the musculoskeletal disorders. The dentist's posture evolved from the orthostatic posture to a seated posture, especially on the account of adopting the concept of four hand dentistry.[8] Orthostatic posture is often adopted despite its many disadvantages, especially while performing the exodontia.[9]

The essence of ergonomics has often been overlooked while performing minor oral surgical procedures which progressively lead to various musculoskeletal disorders as well as compromises on the quality of work being delivered. Work-related musculoskeletal disorders are considered as one of the major health hazards for the dentists[10],[11] and have been attributed as the leading cause for early retirement of the dentists.[12]

It is observed that when performing minor oral surgical procedures such as tooth extraction, dental graduates especially in their early career; when they start, dental clinics usually stand and perform exodontia. However, inexperienced operators may require more duration to complete the procedure, which involves unfavorable standing posture particularly for exodontia of MRP teeth with conventional 12'o clock position. A recent study had reported a high prevalence of knee disorders in students performing alveolar surgeries in an unfavorable standing posture.[13]

Exodontia of MRP teeth requires a controlled force. The operator tends to stoop or bend their shoulders when standing at the conventional position for gaining visibility and accessibility for exodontia of MRP teeth which might lead to neck pain or back pain and compromises on the ability to deliver the controlled force. To an extent by the posture in the conventional position might lead to breakage of root apices, increased appointment time, elevated unwanted stresses on the mandible or even can affect the operator due to the awkward posture.

A previous report proposed the use of 2'o clock position for exodontia of MRP molar teeth in orthostatic and seated positions. However, in our study, we evaluated this new operator position only in orthostatic position as it was widely followed in our institution. To date, there were no studies which compared the conventional 12'o clock position with the 2'o clock position.[3] Hence, a comparison of the results with previous studies was not possible.

We have compared the results of the 12'o clock position with 2'o clock position on various parameters pertaining to the operator's ergonomics as well as the difficulty in extraction in carrying out exodontia of MRP molar teeth in standing posture. In ergonomics, both the parameters, i.e., posture and fatigue, had a P < 0.001 which signified that the operators were more comfortable in performing the exodontia of MRP molar teeth with a 2'o clock position rather than the conventional 12'o clock position. The operators reported muscle fatigue of much lesser degree while working at 2'o clock position. Our results indicated that 2'o clock position was easier, acceptable, and ergonomic for the operator for the exodontia of MRP molar teeth.

Improving the ergonomics for the delivery of dental services while accounting for working conditions in dental offices enhances the well-being and safety of patients, staff, and practitioners. It might be difficult for the well-established clinician/operators to adopt to this new working position. We propose that this 2'o clock position can be incorporated into the curriculum so that the dental trainees can be trained to this ergonomic and acceptable posture, without compromising on the quality of work. The ideal posture of an operator should give effective working conditions (access and visibility) as well as the corporeal and psychosomatic well-being during the execution of the clinical procedure. A suitable posture is not a comfort, and it does not need major expenses but reorganizing the way of working. The strength of this study was that the same operators have evaluated both the positions in the same individuals for the extraction of teeth. Further studies have to be done to evaluate the long-term effect of this new position which can also be assessed in seated position.


  Conclusion Top


Our results indicated that new ergonomic position (2'o clock position) was easier, acceptable, and ergonomic for the operator for the exodontia of MRP molar teeth in comparison to the conventional position.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hupp JR. Principles of routine exodontia. In: Hupp JR, Ellis E, Tucker MR, editors. Contemporary Oral and Maxillofacial Surgery. 6th ed. St. Louis, Missouri: Mosby Elsevier; 2014. p. 88-118.  Back to cited text no. 1
    
2.
Finsen L, Christensen H, Bakke M. Musculoskeletal disorders among dentists and variation in dental work. Appl Ergon 1998;29:119-25.  Back to cited text no. 2
[PUBMED]    
3.
Ranney D. Work-related chronic injuries of the forearm and hand: Their specific diagnosis and management. Ergonomics 1993;36:871-80.  Back to cited text no. 3
    
4.
Pîrvu C, Pătraşcu I, Pîrvu D, Ionescu C. The dentist's operating posture – Ergonomic aspects. J Med Life 2014;7:177-82.  Back to cited text no. 4
    
5.
Saker M, Ogle OE, Dym H. Complex exodontia and surgical management of impacted teeth. In: Fonseca R, editors. Oral and Maxillofacial Surgery. 2nd ed., Vol. 1. Philadelphia: Elsevier; 2009. p. 185-211.  Back to cited text no. 5
    
6.
Robinson PD. Tooth Extraction: A Practical Guide. 1st ed. Oxford: Wright; 2000. p. 34-5.  Back to cited text no. 6
    
7.
Kumaresan R, Pendyala S, Dhanavel J. The most compatible position of the operator for mandibular right posterior teeth extraction. Plast Aesthet Res 2016;3:257-8.  Back to cited text no. 7
    
8.
An Introduction to Ergonomics: risk Factors, MSDs, Approaches, and Interventions – A Report of the Ergonomics and Disability Support Advisory Committee (EDSAC) to Council on Dental Practice (CDP). Available from: https://www.cdn.shopify.com/s/files/1/1171/2566/files/topics_ergonomics_paper_2.pdf. [Last accessed on 2017 May 14].  Back to cited text no. 8
    
9.
Anghel M, Argesanu V, Talpos-Niculescu C, Lungeanu D. Musculoskeletal disorders (MSDs) consequence of prolonged static posture. J Exp Med Surg Res 2007;4:167-72.  Back to cited text no. 9
    
10.
Brown J, Burke FJ, Macdonald EB, Gilmour H, Hill KB, Morris AJ, et al. Dental practitioners and ill health retirement: Causes, outcomes and re-employment. Br Dent J 2010;209:E7.  Back to cited text no. 10
    
11.
Hill KB, Burke FJ, Brown J, Macdonald EB, Morris AJ, White DA, et al. Dental practitioners and ill health retirement: A qualitative investigation into the causes and effects. Br Dent J 2010;209:E8.  Back to cited text no. 11
    
12.
Burke FJ, Main JR, Freeman R. The practice of dentistry: An assessment of reasons for premature retirement. Br Dent J 1997;182:250-4.  Back to cited text no. 12
    
13.
Yi J, Hu X, Yan B, Zheng W, Li Y, Zhao Z, et al. High and specialty-related musculoskeletal disorders afflict dental professionals even since early training years. J Appl Oral Sci 2013;21:376-82.  Back to cited text no. 13
    


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