The Right Fit: Delivery Systems and Ergonomics in Dentistry

But if you allow them to do more of the passing of the instruments, the reaching for the burrs and things like that, they're less apt to be in your headspace and you're less apt to have your arm reaching towards something that you need. Like let them do what they were trained to do. And then you can work cohesively in a way that is much more efficient. And then you can kind of stay where you need to be. I'm not saying statically. We want to have micro shifting. We want to have movements from clock position and whatnot. Definitely allow those assistants to take the burden of reaching away from you. Welcome to the Phil Klein Dental Podcast. In a field where precision and stamina are paramount, which is the field we work in as dentists and dental hygienists and assistants, poor ergonomics can lead to chronic pain, fatigue, and long-term health issues. But it doesn't have to be this way. By understanding and implementing ergonomic practices and choosing the right kind of operatory delivery systems and equipment, we can transform our work environment into a space that supports our bodies as much as our skills. To tell us more about it is our guest, Katrina Klein. Katrina is a registered dental hygienist for 16 years, national speaker, author, competitive bodybuilder, and certified personal trainer. She's the founder of ErgoFit Life, where ergonomics and fitness are a lifestyle to prevent, reduce, or eliminate pain. We'll be getting to Katrina in a second, but first, thanks to GC America, we're now able to incorporate all the advantages of glass ionomer into a beautifully aesthetic, strong, long-lasting restoration. That's a great reason to try GC Fuji Automix LC. You'll love the convenient automix delivery system and ergonomic dispenser. which allows precise placement into the preparation. And GC Fuji Automix LC is bioactive, allowing for a high rechargeable fluoride release, which is ideal for high caries risk patients. And because it forms a chemical bond to tooth structure, even in the presence of saliva, there's no need for etchant and adhesive bonding. This saves steps and is ideal for challenging patients where access and isolation are difficult. And the small filler particles in the material allow for superb polishability and excellent aesthetics. So when you're thinking glass ionomer for your clinical cases, think GC America, a world leader in dental materials. To learn more, visit gc.dental. Katrina, it's a pleasure to have you on our show. Thank you for having me again. I'm looking forward to it. Yeah, so when it comes to buying operatory chairs and equipment, the dentist has a lot to choose from. And moreover, we need to consider the different delivery options, and there's so many of them. The operatory equipment can be mounted on the side of the patient, behind the patient, over the patient. There's systems where they're mounted in the cabinetry, the wall, and even in mobile carts, which I actually had some mobile carts in my endo office back in the day. So with all these options, How does the dentist decide what's best for the practice? And I assume considerations include cost as well as the pros and cons for the patient, clinician, and overall workflow. At the end of the day, if we can advocate for our patients better, perform more quality care, and feel good and rested at the end of the day, any equipment that we get that lends to that is going to be part of... what should be considered our ROI. So getting a chair that allows you to do those things is gonna be monumental. It's not just whether or not there's a heating massaging element in there. Patient comfort is important. So when we ask our patients, are you comfortable? What we might wanna try saying is, are you comfortable enough for me to treat you safely? Because ultimately this is a healthcare facility. And so we need a chair that allows us to do our job safely. so that we're not hurting ourselves and we're not putting extra trauma on them, making them uncomfortable for the sake of a massager in their chair back. So the things we want to consider are, do we have the ability to get in close to the midline? to get to 12 o'clock you know when we're setting up our operatories is there a cabinet behind us where we can't get in there does the patient chair move does the patient chair go high enough so i can stand does the chair swivel is it a thick back chair or is it a very wide lazy boy shoulder width you know six foot span wide shoulder There's a lot of different factors that go into it. And ultimately, the goal is so that we can get our job done without having to lean, having to hunch over, create our next one way, and be able to get from one clock position to the next easily. With these different options, and again, of course, cost is a factor because not every delivery system is the same price because some are more expensive to install and so forth. So does the dentist... go to a showroom and sit in these things and say, I really like this better? I guess they talk to their colleagues or do they reach out to an expert like you who knows so much about ergonomics and all the things that you know about regarding making sure that the clinician is positioned properly so they extend their career? What's the best way to pull the trigger and say, okay, this is what I want? Because if you just listen to the salesman, they're going to tell you what they want you to buy. So, yeah. So there's a lot of factors, including the space in the operatory, how the cabinets are mounted, the lighting, where the windows are. But overall, what would you suggest a dentist that could choose anything? How would they make that best decision? So I would definitely reach out to an ergonomics person. If you're focused on making your job easier, less painful, I would talk to an ergonomics specialist like myself. um before you make the purchase after you've done so it's already difficult and done um that way you can ask those questions hey my operatory is this big what do you think about rear delivery which by the way is a big no-no we'll talk about that later i'm sure um you know we want to make sure that we're not having to trunk twist in order to reach the instruments and that we have an ease of proximity so we really shouldn't have our delivery system more than 12 to 16 inches away depending on your reach as a five foot one clinician with a short arm I can't have it be 16 inches away. It's got to be right in. So when I teach my lecture on ergonomics to dental professionals, I say, bring it in. It doesn't matter if it's, you know, your hand pieces, your hand instruments, your carts of things, your lasers, whatever it is, make it accessible so that you don't have to lean your body and reach out with your arm and all of these things make it accessible. And delivery. systems are one of those things it's always up for debate the the rear delivery factor is the least expensive way to go and i hate to say to compare it to a manual toothbrush but like you get what you pay for it's least expensive because it's the most harmful for your body why is that why is the rear delivery system the most harmful so it's because if the patient is in front of you you have to trunk twist repeatedly. And so what we do the easiest is what we're going to do the most frequent and moving and twisting your body in order to get to something real quick is what we're going to do the easiest until it becomes painful. And then we're going to start actually, you know, rotating our chair. and and going that route and then sometimes you've got all the tubes on the floor and you can't move the chair because you know you're gonna roll over your handpiece cord and and things like that so having the ability to put your delivery system next to you to the side of the patient where you can easily grab it is so fundamentally important that you know the only thing that should be behind you really are things that the assistant is going to get to that you don't need access to. I'm a really, really big fan of the mounted monitor keyboard systems that are swivelable. I don't even think that's a real word. You know, you can move it to the right, to the left. You can move it out towards you. You can push it back up against the wall when the patient's not there. Having a screen or a monitor in front of you, not just to show pretty videos to the patient, but also so that you can see that x-ray right in front of you with a glance up from the oral cavity, huge. Just a little game saver so that you don't have to twist your body. back and look at that monitor behind you to see, oh, the assistant just messaged me. The hygienist needs a check. What tooth am I working on? Are they allergic to septo? All the things that we go back and we relook at the chart for are suddenly eliminated. They're right in front of you. So we've talked about the 12 o'clock position. How important is the 12 o'clock position for the operator in relation to the patient laying in the chair? It's important because if you can get to 12 o'clock, that's the place where you are either forced to use indirect vision on a maxillary tooth for example you can't do it any other way unless you're completely going upside down and you know what you're doing or you can use direct vision you're not going to lean to one side or the other because you're already there so that's your most ergonomically neutral place to be And when that patient is in supine, you need 24 inches of space between the patient head and whatever cabinet or wall or whatever it is behind you in order to move easily in that 12 o'clock space. You got to go over to 11 o'clock or one o'clock. You can do that without having to worry and hesitate. Am I going to run over something? Is there a cabinet next to me? You know, I can't tell you how many times I've seen a dentist at more of like a 10 o'clock position with their chair completely wedged up against the cabinet. Because I can't get in. How important is it for the assistant to be positioned properly in relation to the operator, which we'll call the dentist? Let's say the dentist is 12 o'clock. It's got to be very important for the assistant to be positioned properly as well. So how does that relationship work? And what do you say to those dentists that are reaching for things even though they have an assistant and they're not really delegating properly to having that assistant do more handing off to the dentist? That is a comfortability thing, you know, when a dentist doesn't have an assistant that they're completely comfortable with yet to know what they need without verbalizing it. My encouragement is always, dentists, you do really, really cool things. We love it. We want to see what you're doing. As an assistant, they want to know what you're doing. They want to have their head all in your space so they can observe it. But if you allow them to do more of the passing of the instruments, the reaching for the burrs and things like that, they're less apt to be in your headspace and you're less apt to have your arm reaching towards something that you need. Like let them do what they were trained to do. And then you can work cohesively in a way that is much more efficient. And then you can kind of stay where you need to be. I'm not saying statically. We want to have micro shifting. We want to have movements from clock position and whatnot. Definitely allow those assistants to take the burden of reaching away from you. So let's pivot a moment, Katrina, to handpieces. The workhorse tool of every dental practice is the dental handpiece. And for generations, the air-driven handpiece has been the leader in this, the most popular choice, in large part due to the fact that air-driven has been around a lot longer than electric handpieces. And for me personally, I preferred an air-driven throughout my career as an endodontist. There are a myriad of reasons why dentists continue to stick with their air-driven handpiece. Some of these may be misconceptions or myths, but nonetheless, it's always a challenge for dental companies and people like you to get dentists to change their behavior. But considering how electric handpieces have advanced over the past few years, do you think a dentist should consider transitioning to electric handpieces over air-driven or just use a hybrid method where they're using some air-driven and some electric? And why do you feel that way? So I hear you and I hear this every time I do an assessment with someone who is holding on to their air driven handpiece. And I'm going to say I think a hybrid is great. I think it's whatever you are comfortable with. But I do believe that opening up your mind to something that has better torque that can cut through, you know, a. a very heavy duty material like draconia or metal and things like that with much more ease is worth your time and effort. Maybe being selective about the things that you use your electric or your air driven on. And I think the more open minded you are to learning to use that tool for what it's best at is going to be good for you. I understand there's a control issue is like most people that use air driven or excuse me, hand pieces will say, I feel like I have more control. And that's because you haven't gotten comfortable with the electric yet. So just like anything else, you know, hygienists way back when weren't comfortable with their mechanized scalars either, so they needed to get comfortable with it. And now everybody uses them like it's a normal staple. So being open-minded to something that is going to perhaps make some procedures less fatiguing for you is good. And then keep your air-driven handpiece for things that... you can do real quick and you like to have that finesse. You like to have that control, you know, your composites and things like that. So the additional torque, that certainly is a huge advantage, right? Because especially like you mentioned, zirconia is something you hope you don't have to go through too often, but the more zirconia that's being used, the more we're going to have to drill it out and manipulate it. So electric's great for that. But in the past and not too long ago, these electric hand pieces were big and heavy and much more. more unwieldy than an air-driven handpiece. So there's an ergonomic deficiency there from the standpoint of weight and size, and also access to small areas in the back of the mouth, because if it's bigger and the head is bigger, it's harder to get to the distal of number 15. Now that's improved dramatically, right? I mean, so tell us about what advancements have recently been made in the area of electric handpieces and why we're now getting to the point where we should seriously look at this as an option. for dentists to use as a handpiece on a regular basis ergonomically. Katrina will be right back with us to answer that question. But first, are you looking for an air-driven handpiece that rivals the power and torque of electric? Well, I have good news. It's finally here. It's called the TMacZ, and it's from NSK, a company we all know and trust as a world leader in dental handpieces. In addition to being lightweight and ergonomic, this revolutionary air-driven handpiece delivers unprecedented 44 watts of power, allowing it to cut through tough zirconia smoothly and quickly. In fact, the TMac-Z reduces overall cutting time by 30%. That means less chair time, reducing the burden on you and your patient. Take a test drive of the TMac-Z air-driven handpiece from NSK. For a free 10-day trial, go to nskdental.com and find your local rep to inquire. Experience the power and excitement of the TMAX Z series. Yeah, they're definitely much lighter and smaller now. I know in my practice, we have both of them. And I only know that it's an electric handpiece because of the design on the side of it. of the handpiece itself um i can feel the weight a little bit differently and you know so i can tell when i when i'm paying attention to it um that there is some weight and that weight does make a difference you know if we're talking about old school electric polishers versus now it's night and day it really is there's there's such a a close um match as far as you know weight and size you really can't tell a lot with it. I mean, there is a difference, but it's not so vast anymore. And if you slow down that speed on it, you can do more things with the electric. Now, if you have small hands, a lot of our female dentists, you have smaller hands, that may be more difficult to manage. So again, it's all personalized. This is why. I have to go out and actually work in offices because what works for one body is not going to work for another body. I'm much more likely to recommend an air-driven polisher for a tiny-handed dentist. It's just simply easier to manipulate. What about integrating the electric unit into the delivery system, that conversion process? Is that a big deal and very costly? You know, I see most often that people don't do that conversion. They wait until they do a build out and they buy it all at once. And that just is part of their budget in their build out. I rarely see anybody transitioning without that. They're redoing their operatory. And that's where they get the electric ham piece to be incorporated into the delivery unit. That's interesting. Yeah. Okay. So let's talk about the ergonomic assessment. We all know that bad ergonomic habits take a severe toll on the clinician, resulting in all kinds of pain and discomfort while working. So part of your job, as you described to me, is to assess a practice and come up with recommendations. And that's what you were referring to as an ergonomic assessment. Tell us how the ergonomic assessment works and the role of training in resolving these issues. So the way that an ergonomic assessment works is I go out and initially I'm just shadowing. I'll shadow each. clinician. I'm taking photos of their posture, of their positioning without working with patients. And then I start coaching and it's put your arm this way, put your back that way, you know, move your head this way, move the patient head this way. And, and things like that, raise them, lower them, put the headrest, let's put the headrest like this. Let's try that. See how that feels. Does that feel good? If that feels good, we know we did something right. And so we keep manipulating and keep working and keep coaching. And I do that with every every person in the office and and then do the lunchtime lecture so they can kind of get that message reinforced and then in the afternoon i go back and um you know kind of check on everybody oh wait let's put that patient this way you know let's we got to practice it like you said it's it's training and there is something different about having somebody work with you in your room with your chair and your patients, customizing your programmable settings on your patient chair, for example, getting you seated correctly in your stool that is monumentally bigger and better than reading from a textbook or watching a video that you then try to replicate on your own. Because just like when you go to the gym, If you don't have someone cuing you in a movement, you're just hoping that you're doing it correctly. And we all know if we've ever been on social media, how many times you can see people doing things not the right way and they have no idea. So it's truly the benefit of having a trained eye walk you through that process, be there for you on that journey, giving you ways to make corrections and then staying with you for a while to help you practice it. Because in dental school, you're learning a craft. You don't have time to focus on your ergonomics. It's sit up straight and get it done. Yeah. And what you're saying makes so much sense. And it seems to me that if I was a practice owner, whether I own one practice or 10 offices, however big my business is, I think it would be a huge plus for team morale, for employee retention, to have someone like you. And I'm not plugging you personally. I certainly hope people use you. having a consultant that has your expertise come in and personalize good ergonomic behavior based on each individual employee. Because I think that employee would be like, wow, I really think this organization is really cool. I mean, this is a great place to work. Of course, it's in the interest of the practice owner to make sure their employees are healthy so they can produce. But at the same time, Just look at what could happen if you don't do anything like that. And these individuals start to develop discomfort and pain and they're miserable. You know, you work under a miserable environment, which could all be prevented, but it does have to be prevented in more of a personalized manner. And I was going to hit on that, but you described that very well. Well, and you think about it too. Thank you. You know, we have to talk about the business of dentistry and how this all is part of that because, you know. Dentistry is a business and we need to make a profit and in order to keep our practices going. And if you think about it, the cost of a disability claim for a staff member is approximately their annual salary to have them out, to rehire for them, to retrain this person, the drain on the team, the whole thing. It's very expensive to have somebody go out. But you think about all of the time that clinician was not advocating for their patient because they were in pain. If you've got this nagging pain sitting in the back of your neck or your shoulder or whatever, and you see a spot and you're thinking, oh, that means I'm going to have to take a PA and I'm exhausted. What are you going to do? You're just going to hope that the dentist recognizes it and he doesn't ask you to take a PA. And that's the lack of patient advocacy that you cannot have if you want to be delivering the care that these patients deserve. And truly, we deserve to be that kind of clinician. We deserve to be the person that says, oh, my gosh, I'm going to really listen to you, patient. And I'm going to give you the training that I know how to give because I care about this profession and I care about you. And I'm investing my time, energy and effort into you because that way you know that you're going to come back to me. And by the way, I'm going to teach you the stretch that I learned in my ergo lecture at lunchtime because it's going to make you feel good too. And that you, those relationships, you know, dentistry is a, is a people business. It's a relationship business. And if we ignore that, we're in trouble. Yeah, no, it's all good points. And I think we all agree that there's a physical burden on the operator when you're doing dentistry day in and day out. And there's no question it's a physically demanding. business, right? Now, if you look at sports and you're a bodybuilder, so you're very familiar with the gym and you're familiar with sports, I'm sure you see baseball players in the gym. I'm sure you see high school football players in the gym, maybe off season where they're not working out with their team. They're doing it at the gold gym or wherever you work out because training is so integral now in all sports. And when I went to high school, I played in the tennis team. I played in the tennis team in college. We did some training. We both basically ran laps around the track. That was our training was more cardio. We didn't really have a lot of gym training, weight training. But dentistry, as I mentioned, is very physically demanding. It's not a sport, but at the same time, it requires us to prepare our musculoskeletal system for the demands of dentistry. And that's what people like you do. And I think that's not only not taught in dental school, it's probably not even thought about by many dentists. until later in their career as they age. But in your opinion, isn't it valuable to start this process like right out of the gate when you're a young, enthusiastic dentist before these things start to develop into problems? Absolutely. Muscle is now being considered the longevity organ of the body. We know that people who have more muscle, they battle cancer better, they live longer. They have more quality of life longer. They have less health. I mean, we could go on and on and talk about the benefits of muscle mass. As far as the ergonomics of dentistry is concerned, muscle is like compound interest. And if you start younger and you develop those muscle fibers younger and earlier in your career, those are the things that are going to hold you up into neutral posture. for longer. That's what's going to be the determining factor as you go into the later years of your career, whether you get to retire from disability, which by the way, 25% of dentists retire from disability. 25% if we strength trained and it doesn't have to be in a gym. You can do it at home. You can do it with your shampoo bottle for a little bit of resistance training if you want. Whatever it is, you can do calisthenics, getting some sort of physical exercise in there so you can develop the posture muscles required to hold your body up is better than anything that you can do otherwise. The equipment, yes, you need the equipment, you need to stretch, you need to do all the things, but you gotta have the muscular integrity to hold yourself up. We'll be getting right back to our episode in a second, but first... If you're looking to simplify posterior restorations with a single-shade solution, check out Admira Fusion Extra. This omni-chromatic nano-hybrid covers all 16 Vita Classical shades with a single shade. It achieves this without compromising strength, handling, or radio opacity, providing fast, strong, and aesthetic posterior fillings. Join thousands of dentists who trust VOCO for proven performance, superior aesthetics, and lasting results. Explore VOCO's full range of composite materials and request a sample at voco.dental. Yeah, for sure. That's interesting because I recently watched something on Netflix, I think it was called Blue Zone, and it talked about populations that lived for long periods of time. I mean, they lived, a lot of them over 100. And one of the factors common across all these different locations... were older people that were squatting a lot and that would end up bending down, whether it was gardening or cooking or whatever they did, working in the field to get food. They were bending their knees and they were standing up multiple times in an hour. Down, up, down, up. And they were basically doing squats and they didn't look at it that way. And they built up the strength well into their 90s, late 90s, to carry their body around and function normally. A lot of people that are overweight and don't exercise in this country, we have a lot of people like that, unfortunately. As they get older, they fall because they just don't have the ability to get out of a chair. But dentistry, as I mentioned, what you're saying, Katrina, is so appropriate to preventing injury and having a long, healthy, enjoyable career. I know for me, it was L4, lumbar 4 or 5, I don't remember. But I had a herniated disc doing endo because I was leaning over the patient. And a lot of that is because, you know, more than likely you were sitting on a flat pan seat instead of a saddle stool, which we now know saddle stools are absolutely the way to go. And because we perch on the end of that saddle seat, or excuse me, on that flat pan seat, we lean forward. There's just no other way for our body to biomechanically do that movement. And that's one reason I constantly recommend saddle seats. We've got to get our lumbar spine and our hip complex to be in neutral as much as we can. You know, we talk about things like muscle mass and longevity and posture and all these things, you know, and our whole well-being, our health. I mean, talk about diabetes, insulin resistance, massive problem right now. You know where insulin receptors are held? In your muscle tissue. Well, if we don't have any muscle, we don't have any insulin receptors. I mean, it just goes, it goes so, we could go so far into it, but longevity, be it in a dental office as a clinician or just as a human trying to enjoy your period of time, the short period of time that we get to be on this planet, do we want to enjoy it or do we want to just suffer through it? Right, no, absolutely. What's the best way to reach you, Katrina, so that our audience could get information? I know you're very open to... providing information and help and you do stuff online and i know you can't visit every office in the world you're just one person you probably need to clone yourself but before you before you get to that stage how do people reach out to you to get some advice um i'm always available via email or gofitlife at gmail.com um i have Instagram, which is ErgoFitLife underscore Katrina. I have a Facebook group, ErgoFitLife, and also a Facebook page, ErgoFitLife. You can even friend me on Facebook. I don't mind. I like to hang out with dental people. I'm a dental nerd. So let's be friends. Let's hang out. I'm here to answer all questions. Yeah, and we'll put the description. We'll put that in the description of this podcast, some of those links and that information on how to reach Katrina. Katrina, thank you very much again for your great input, and we'll look forward to having you on future programs. Thank you. Thank you.