Get Your Face out of There…Stand up and Work Smarter!
Posted: May 31, 2020
Stand-up dentistry in the COVID-19 era and beyond will:
- Make dental personnel safer
- Increase your social distance working length by 20-30% compared to sit-down dentistry and get you closer to practicing aerosol free dentistry
- Decrease your disease transmission risk exposure to contaminated aerosol
- Decrease your pain, discomfort, fatigue and risk exposure to repetitive stress injuries
Practicing dentistry smarter is key to your good health. And stand-up dentistry is smart. Now’s the time to stand up and take charge of your health. Stand up and get your face out of there!
This blog post shares some key tips from the workshop Functional Movement & Body Alignment Workshop for Dental Professionals that I lead for periodontal residents at UCSF each year.
The Sit-Down Dentistry Backstory
Professional disability, pain, discomfort and fatigue all went up when dentistry sat down.
Sit-down dentistry came along in the 1960s with the reclining dental chair. It brought the operator’s face 20-30% closer to the patient’s face, right into the aerosol field. Nobody was thinking about disease transmission risks and social distancing back then.
Sit-down dentistry also resulted in neck, shoulder and wrist injuries and pain. We became healthcare contortionists. Dental workers were far ahead of the curve. Decades before the world knew about the internet, personal computers and mobile devices contributing to physical pain and injury, dental treatment delivery systems were doing the same to our profession.
Sit-down dentistry disengaged us from integrated full body functional movement and good body mechanics. It put our lower bodies out of commission. We lost the functional range of motion provided by a moving pelvis and we said goodbye to the dynamic movement afforded by dozens of moving joints from the sacrum and hips through the ankle joints and down to the first metatarsal joints in our toes.
To compensate for abandoning the use of our lower bodies, we raised and hunched our shoulders, winged out our elbows, cocked our wrists and tipped our 12-pound heads off its spinal axis, teetering on just a few little vertebrae, C-3 through T-1.
Results? Sit-down dentistry keeps medicine busy. We frequent orthopedic surgeons, neurologists, psychologists, occupational therapists and physical therapists. We are big pharma consumers and we take special nutrients like Vitamin I (ibuprofen and its cousins).
Let’s get off our buckets and stand up to this self-inflicted bad habit!
Key Tips for Better Stand Up Dentistry This blog is not a substitute for Functional Movement and Body Alignment for Dental Professionals workshop, but you can get started here.
Shoes matter: Dansko clogs with heel cup https://www.dansko.com/mens-shoes-clogs are a staple of nurses and surgeons who are often on their feet all day long. I find that they make standing easier because the foot bed inclination angle helps prevent “knee lock” which strains the knee joints and limits mobility in the dozens of moving joints in the kinetic chain below.
- Tip: Often with new clog users, standing and shifting sideways can initially feel a little “tippy”. Practice these movements wearing clogs before wearing the shoes at work and this will resolve.
- Tip: For upper shoe clog construction material, select the easy-to- disinfect shiny leather. Disinfectant wipes work quite nicely. And remember–-leave the clogs in the office. Don’t run to the coffee shop or go home in them.
Socks make the difference: Over-the-calf compression hose (10-40mm Hg pressure range) dramatically decrease leg fatigue and improve circulation. They come in wool, wool blends, cotton and synthetics. Explore the many options including:
Treat your feet with improved mobility and flexibility: Check out a great alternative for a personal foot masseuse and physical therapist here https://www.yamunausa.com/collections/frontpage/products/foot-fitness-kit
Balance and flexibility improvement: it’s great for everybody. Go online and find simple things to do on your own. If you like group classes consider Yoga, Pilates and other movement-oriented approaches.
Functional alignment mechanics: This is the core of it–literally. For my personal stand-up mechanics and for what is taught in my workshops, I incorporate common features drawn from various physical movement disciplines including dance, Kung-fu and Tai-chi martial arts, the Alexander Technique, Feldenkrais Method, Yoga and Pilates.
If you have experience in movement disciplines, rethink what you practice in the studio. The key is to actually apply it all day long, especially while you are treating patients. Yes…Kung-fu dentistry! If you have not explored functional alignment mechanics, treat yourself to a healthier body and explore quality online resources and/or take classes. An especially helpful resource that assisted me in functional alignment and movement is https://www.chirunning.com/chiwalking/
A word about your loupes when doing stand-up dentistry: Stand-up dentistry increases your working length which is a good thing in the COVID-19 Era and beyond. You may find that your loupe declination angle and focal length need to have a minor adjustment for your new found social distancing.
Patient chair positions for Stand-Up Dentistry–some suggestions to help you get started:
- Raise the chair base, lower the back portion and use the head rest articulation.
- The patient’s mouth should be at the horizontal level where you do not need to raise, tense or contract your shoulders and neck. As a general guide, start with patient mouth placement just a bit below your elbow level. This also helps decrease wrist bending.
- For work on mandible try to make the mandibular occlusal plane approach parallel to floor. Be sure to use the articulating headrest. Also, a small memory foam neck pillow placed under the plastic chair protection bag substantially helps boost articulation and make it more comfortable for patients. Example: https://www.pattersondental.com/Supplies/ProductItemFamily/657431/Dental-Chair-Delivery-System-Accessories?ss=657435
- For work on maxilla try to make the maxillary occlusal plane approach perpendicular to floor.
- Work with elbows close to your body, not “winged out” and not rigidly held next to your torso.
- Explore working from the 4 o’clock to 8 o’clock chair positions.
- Explore wide, medium and narrow stances.
- Keep knees slightly bent, lengthen spine, relax neck & shoulders.
- Breathe! Do it from the belly…deep full inhales through the nose, exhale through the mouth like you are blowing out a candle – empty your lungs. So relaxing and tension relieving!
Disclosure: The links to websites contained in this blog are for information purposes only. Dr. Merijohn has no conflicts of interest with any of the companies or products referenced.
George K. Merijohn, DDS
San Francisco periodontist George K. Merijohn practiced 28 years and is associate professor in postdoctoral periodontics at UC San Francisco and U Washington. He is appointed special expert to the California Dental Board; serves as a consultant to dental schools, clinicians, and the legal profession; and is on the editorial board of the Journal of Evidence-Based Dental Practice. Dr. Merijohn leads seminars and workshops at major dental conferences and is published in peer-reviewed journals with articles on mucogingival clinical decision-making, risk assessment, and the evidence-based approach. More about George >