Patient Comfort, Practitioner Health: Selecting the Right Ergonomic Dental Chair

And the thing that's really the worst for us is that we contract our entire body in an awkward position and sit there for a prolonged amount of time. When you're standing, you're much less likely to do that because at that point you can actually get in closer. You can marry your hip with the side of that patient's chair or that patient's shoulder and you can get in closer. Welcome to the Phil Klein Dental Podcast. In today's episode, we're going to be talking about something we all use every single day, and that's a dental chair. Without the dental chair, the patient would be sitting on the floor while you do the work. And actually, that's the way it used to be prior to the 1700s. The patient would sit on the floor, and the patient's head would be braced between the knees of the operator. Just imagine that scene. Since that time, thank goodness, there have been many advancements in dental chairs, including a new chair by DentalEase that allows you to practice dentistry standing up. And there are some huge advantages to that, which we'll learn about. Today, we're going to be delving a little bit deeper into the dental chair. What makes it ergonomic? What are the things we should be looking for in a dental chair when we're in the process of purchasing one or maybe... expanding our office and purchasing three more. These are things that are very important and relate directly to the longevity of your career. Our guest is Katrina Klein. She is a registered dental hygienist for 16 years, national speaker, author, competitive bodybuilder, which is very cool, and certified personal trainer. She's the founder of ErgoFit Life. where ergonomics and fitness are a lifestyle to prevent, reduce, or eliminate pain. And all of us who have experienced pain in our neck, back, shoulder, hands, wrist, and you name it, totally understand how pain can be debilitating and make your day in the office quite miserable. And to help us avoid all those problems, I'm proud to introduce our guest, Katrina Klein. Katrina, thanks for joining our show. Thanks for having me. It's always a pleasure. We're really happy to have you on the show and what you talk about and what you teach and it's just so important in the longevity of a dental practitioner, whether it's a dentist, a hygienist, or even a staff member who's helping out in the operatory. There's so many variables involved with maintaining good ergonomic behavior. So on that note, how much of a role does the dental chair play in the realm of ergonomics for the dental team member it's huge it's a major major player when it comes to operating in an ergonomic fashion because where that patient sits is the first problem that we run into right because if they are if we can't get to the oral cavity how are we supposed to do our work and so there are some major things that come into it not just the features on the chair where it's also where the patient chair is placed in the room with respect to the access that you have to 12 o'clock, whether or not you can move it when there's a wheelchair patient in the room, for example, or, you know, transferability, whether you can actually get to the midline because the chair is the size of a lazy boy or what have, there's a ton of different things that impact our ability to even gain access. And so that patient chair is a major factor. And it's one that I see a lot when I go and I do coaching with dentists or hygienists or assistants. They're leaning forward. They're hunching over all these things. The loops help keep your body away from a certain part. But if the patient is so far away from you because the midline is 25 inches away, you have to make up for that somehow. And it's either with indirect vision, moving the patient head. Or moving your body. And what do we do the most of? We move our body. We contort ourself to where that patient is at. So it is a major player. And it also happens to be probably the most expensive. The most expensive item is these chairs. And so how we set ourself up is... know that we want to make the patient comfortable, but you know what makes the patient really comfortable? The ability of the operator to be efficient so they can get out of there. Yeah, no, that's true. No, that's 100%. I mean, the patient wants their teeth taken care of and their gums very healthy when they go to the hygienist for their recare appointments, but they're ultimately looking to go into that dental office and get out as fast as possible. Yes. And also the mood of the operator is going to be a lot more elevated, happier. when they're comfortable. And on the flip side, if the operator is having pain and discomfort, the patient's surely going to pick that up. And that's not the kind of impression we want to send to our patients. Yeah. So for sure, the manufacturers of dental chairs are aware of the ergonomic issue. They've addressed these issues. They've made some changes. Tell us about some of the changes and tell us how it evolved. Like where did we start and where are we now? You know, we went from basically barbershop style chairs and someone had this bright idea to put the patient into supine. what they were finding is they did two changes. One, they made the operator sit down and they put the patient into a supine, which essentially canceled the benefit of the supine out by making the operator sit. But what they found is the operator then had to hunch over quite a bit more because the chair was very deep. And so the very first ergonomic, and I say that with quotation fingers, was to make the chair not so deep. So it was more shallow. So you could get your legs up and underneath that chair without having to be so far back. And then they started talking about, okay, well, let's change the narrowness. Let's make it so we can get in closer and make the armrests not hard plastic. You know, you remember those old Pelton and Crane chairs, which, by the way, were wonderful chairs, except that the arms were wood. And you couldn't move them. They were just there. And so the operator, again, couldn't get they couldn't get in close. And so they went to the slingback arms. And so anything we could do to get the patient closer or get the operator closer to the patient. And then the revolution of patient comfort became a thing. And we started widening the chair backs and putting massagers in the chair backs and making them extra cushiony, which reversed all of the benefits. Yeah. And that was really that was a marketing. selling point for the office to kind of show the patient that you know we're here to make you so comfortable and this this is an environment that's not stressful you know it takes the subliminal stress out of the whole operatory when you're sitting in your living room chair with the pillow top softness and plushness of the chair the seating area but what was the result of that We lost because we don't have to provide them with a lazy boy in order to make the visit comfortable. I mean, if we're being completely honest here, what we're doing is still pretty barbaric and you can't take the drill out of the operatory. You know, I mean, actually, I know of a dentist who is, but but really, mostly we're still doing what we're doing. And ultimately, our comfort and our ability to use our instruments correctly in the mouth is what gives them comfort. They just want to not be in pain in the procedure and a massager on their back isn't going to make them more comfortable. It's going to give them something else to be distracted about, sure, but that's not going to get their mind off of their teeth being drilled. Yeah, that's what I think. I think someone who's really fearful of the dentist is not going to walk into a dental operatory and see the quilted or this plush. seating system that this chair has built into it and say, yeah, this is going to be great. I'm just going to relax and go into a Zen-like mode here. It's not going to happen. But listening to music and headsets, those kinds of things do help. So I think it's just, you know, one manufacturer probably came out with the idea and the other ones had to do the same because otherwise the sales rep selling the other brand would say, hey, to the doctor, you know, for the same price, look at the comfort your patient's getting and the patient appreciates this. hear more to talk about you know the safety and longevity of the actual dentist and hygienist and assistant because without a good chair you know you're destined to have problems with your with your back and your shoulders and your wrist and just keeping everything aligned and you can end up seeing your chiropractor a lot more than you want to so when we're talking about a modern dental chair i know most chairs have similar features, and they claim to have similar benefits. But is there any particular chair that has something that should be looked at or considered when a dentist is looking to purchase one or more chairs to the practice? So certain ergonomic features that I would look for are chairs that A, have that narrow back, as well as the shallow depth. Those are big things, but also the ability to have a height that you can stand while practicing. Now, for me, I'm five foot one, so just about any chair I can stand for. But if I remember, you're pretty tall. so not every chair can do that so i only know of of really one chair that goes up to i believe 36 inches um and and that's by uh dental ease that's their uh 6400 and it goes up to 35 36 inches high and so someone who is above say 5'9", 5'10", can practice standing in order to get a variation in posture. And so to me, that's huge because so much of our postural problem is a lack of variation. We need to be able to get into different positions, quickly change. clock positions when we're in operation mode or actively doing something in the mouth. And then in operatories where you can't get to 12 o'clock quite so easily, be able to navigate into that space without having to put a whole dental operator stool in that space. So that's another kind of a big thing. So those three things to me are so huge. You know, having that narrow back. shallow depth and then also the height. The only other big thing that I would say is the dual articulating headrest. We need to be able to move that headrest back. When I do assessments in dental offices and I work with dental teams, the first thing that I see in almost every chair, we've got that headrest tilted forward, which puts the chin on their chest essentially. And then we're not just leaning forward, but we're craning our heads forward and doing some contortionist type thing while holding either a very sharp instrument or a drill handpiece in our hand. That doesn't make them any more comfortable. It makes us less comfortable and the whole process is just not good. articulating headrest the ability to stand in a narrow back and then last i would say is the shallow for when you are sitting so that you can get underneath uh with your legs and i was gonna mention yeah the depth you're talking about is how thick the actual back the back and that back that back needs to be as thin as possible so that your knees your legs when you're sitting down and and you're from your knee to your hip is that supposed to be parallel to the floor when you're sitting okay what's that position so that was the next thing i was to say if you are using a saddle stool properly your knees are going to be significantly below your hips and so like 135 degree angle if you were look looking from the side and so if your knees are down that far The thickness of the chair isn't really as important because you don't have to get so far. You don't have to get your knees directly underneath their back, touching their back. You can get all the way up close to a patient and have your knees on the ground or feet flat on the floor, knees where they're supposed to be, your body's where it's supposed to be, your back is in the right lumbar position, and you're right up next to there. If you're using a saddle stool and using it correctly, the height or the thickness isn't quite as important, but still important. Because ultimately some portion of your thigh is going to be underneath that patient back. So I don't see dentists often using saddle stools. I see staff using it, but I don't see dentists. Am I missing something? You know... i think that um the information has been out there for a long time but what do they teach us in when we're in school we're sitting on that round flat saddle or that round flat seat pan or you know the free one that you get when you buy a patient chair and they'll give you those free all day long and so if you're a brand new dentist or you're even buying someone's practice You're in debt up to your eyeballs. And so buying a new operator stool when you've already been trained how to use a regular stool, whether it's best for you or not, is probably not high on your list. It should be, especially if you're experiencing back pain. But what do we think about when we have back pain? We think, oh man, my loops, right? We don't think about the chair we're sitting on, even though we sit in our saddle stool or our operator chair for potentially eight hours a day. So eventually they get that free stool and they realize this is not the best. stool for me and they get, they end up putting it somewhere in the lab or wherever, just as a place to sit on in the break room or something. Staff room, supply room. Yeah. Yeah. And eventually you try, but then, then there's also the thing is, okay, so I went and I bought this saddle stool, hopefully not the next day delivery one, because you want something that's going to fit your body. And then sometimes we get stools that don't fit us. And so if you're not getting a stool that fits you, and then you aren't taught how to adjust it to make it fit you or sit in it correctly. It's training, it's education like anything else. If I can come in and I can see that the headrest on these patient chairs, it's a dual articulating headrest, but nobody's ever taught the operator, the assistant, the hygienist how to put the headrest back. Well, the tool was there the whole time. It's just nobody taught them how to use it. And that's not uncommon in dentistry. I mean, they install CBCT machines in dental offices and they don't really do much to train you on how to use it. And these are $80,000 machines. So there's a lot to learn about the equipment we're using in our dental practices. But many dentists are very focused on dentistry, the clinical part, and running the business. And they look at a stool as something they sit in, and they don't particularly focus too much on the ergonomic ramifications of having a stool that may not be adequate. But let me ask you this, Katrina. What are some of the obvious red flags that dentists and dental team members should be aware of? when they're self-evaluating. Hopefully, they are self-evaluating. This way, by knowing those red flags, they can correct them early on and hopefully change paths so that they're not heading down the pathway of injury and a shortened career. Well, first of all, I highly, highly recommend self-evaluation. So, you know, what I recommend is getting someone in the office to take photos of you when you don't know that they're doing it so that you can go back and look at it. Because most of us, if you look at a picture of yourself practicing and you've got your head lunged forward and down, you've got your, I call it a chicken wing, you know, your elbow up in the air, you're leaning over to the side, all those things are huge red flags. You know, if you've got the patient where your forearms are not parallel, well to the ground. That means the patient's too high or too low. And I've seen every variation in between. Those are your red flags. And a lot of the times, you know, in dentistry, we're pretty intelligent folks. You know, if you have someone take a picture and you don't know it, that you're being taken, you're being looked at, you can look at that picture later and go, oh. And if you can't figure out, you know, what am I doing wrong here? Then yeah, give me a call and I'll help you out. But, you know, a lot of times we can just do a little bit of self-correction. Like, oh man, I didn't realize I was leaning to the left or I didn't realize my elbow was up in the air. I didn't realize. And so just having a little bit of self-awareness or asking someone that you can trust in the office to take a photo of you practicing and then also not posting it on Instagram. Yeah, right. Of course. So let me ask you this. What does standing up do for you? Now, I know this new chair, the Forrest 6400 from Dentalys, allows you to go up. And I think it's 36 and a half inches as far as raising the entire seat base. What does that do for the operator that it's so important to look at a chair like that? So the reason why standing dentistry originally didn't work is because the patient wasn't supine. Their oral cavity was faced forward. And so the only way to gain access was with indirect vision. So when we put that patient supine, you can actually stand, remain standing, and now you can do what we call micro-shifting in ergonomics. You can move your body. from one the weight of your body from one foot to the other you could easily get to a different clock position that variation and posture gets you out of a static load position and so what we have a tendency to do and the thing that's really the worst for us is that we contract our entire body in an awkward position and sit there for a prolonged amount of time. When you're standing, you're much less likely to do that because at that point, you can actually get in closer. You can marry your hip with the side of that patient chair or that patient shoulder, and you can get in closer. And so, and you can get in close with a saddle. I'm not saying you can't do that, but having that variation in posture. And what I recommend is for hygienists to go every other patient stand and then sit, stand and sit. And then for doctors, you know, when you have a quick appointment. You have an anterior restoration to do. You have, you know, extraction on the, you know, anywhere bicuspid and forward. You know, a lot of doctors prefer to do surgery that way. It gives your body an opportunity to recover. Yeah, no, that makes total sense. What are they standing on? Is there some sort of, let's say it's a tile floor in the operatory. Should there be some cushioned rubber mat? Ideally. Yeah, ideally. But we move so much. that most likely, you know, if they're wearing cushiony enough shoes, I mean, just like a, you know, a waiter or a waitress is going to be wearing cushiony shoes, right? We're not going to go in there with our ballet flats and try to navigate the whole day on your feet that way. I recommend compression socks because the more you stand, the more you love to stand because it feels good on your back. And that was the second thing I was going to say is when you stand. you're in a normal neutral position it's the way that your body was made you have that natural lumbar curvature and all of the discs and vertebrae stack up evenly and pressure all the way up and so when we don't do this leaning thing where we're leaning at the hips or leaning over at the shoulders and we're hunching over that creates what we call bulging discs because all the pressure goes on either the mesial or the distal end of those vertebrae and it pushes that disc that's kind of spongy so that's interesting Katrina because all my life i've always thought that when you stand for prolonged periods of time it compresses your disc in your lower back, your lumbar region, and that's bad, and then you should sit down and get some good lumbar support. But I assume I've been wrong about that. You are, but I love that you bring that up. It depends on the way that you're sitting. If you're doing what we call passive sitting, so you're in your lazy boy at home, you're not engaging your muscles. All those spinal erector muscles, all of the intervertebral muscles, the musculature that's going and wrapping itself to support the spinal cord isn't engaged when you're just sitting at home or you're at the kitchen table or whatever. When we are working and we're either leaning either straight up or forward, all of those muscles are engaged. So it's actually the opposite. When we are leaning forward, those discs to push out even further when we're not in neutral. It's the way that we move our body out of neutral that really makes a problem. Like if you're leaning for every 10 degrees that you lean forward, you're asking those muscles to engage even more, right? And so that load and that pressure on the disc to go one way or the other, depending on which part of the spine you're in, gets more and more so if you were to lean completely forward that's a lot of pressure on those discs right but then you come back up and if you're if you're standing completely neutral there's zero pressure apart from just your normal body weight you put 10 degrees forward and now there's pressure right but the thing is when you're when you're standing though you could just move your feet and then you're once again aligned so you don't have that that leverage problem, that being further away from the center, from that center point. No, that makes sense. Because you're engaging the left side or the right side. You can lean a little forward on the toes, a little back on the heels. You can move the feet in different directions so that you can kind of center that weight. All the things that we do when we micro shift, we're just shifting body weight. But by shifting your body weight, you're engaging and activating different muscles and relaxing other muscles. So is that why my hairstylist, which is really my barber, I just go to a... clips in Austin, whoever's there. I do have a favorite person and they're on their feet all day. And as one that practiced endodontics for 15 years in a pretty active office, I sat in a chair. Obviously, I didn't treat people standing up, but I had back problems because I probably did everything wrong ergonomically. But she told me that she never has a back problem and she stands all day. And so the answer is because she's constantly compensating with her feet and keeping everything in alignment where we can't do that when you're sitting. I mean, you could roll the chair a little bit. That helps. Right. Well, I will tell you this. I'll tell you a funny, a little, a short story. I hurt my ankle a while back and I went and I got some PRP injections done in it to repair it. And right after that injections, I had to spend a week only using my saddle stool. My body. and my back included were more sore that week than any other time in my career because I had no variation in posture. I was just sitting. And so even though I was sitting correctly, I was sitting in my saddle stool, which is a, it's a tremendous tool. It keeps your hips neutral. It keeps the lumbar spine neutral. It's great for the back, but my body is so accustomed to having ideal circumstances of sitting, standing, sitting, standing that I was more fatigued. So it just, it's amazing when you stand because you're not just standing, you're moving that ability to compensate with micro shifting lends to so much. And so, yeah, definitely standing during dentistry, not full-time. I don't think that's necessary. I think having the ability to sit is also essential as long as you're doing it in a saddle stool. You know, how does that affect forehand of dentistry though, if a doctor decides to stand? It can be problematic if you've got someone who is super, super tall and you've got an assistant who is really, really short or vice versa. I've seen it both ways and that can be problematic. That's where you end up with, you know, I've had one doctor I work with had these big aerobics uh stepping devices you know they were like the little step things and they're like three feet wide or whatever and that's what his assistant used because they were wide enough and deep enough so that she could get around and be safe on there but also be able to see and then we've also had i know that for example crown seating makes these extra tall cylinders for their assistant chairs, you can get taller assistant chairs. That does make it hard though for them with being able to get out of that chair to go get something. So a lot of the times I recommend that assistants stand. Yeah. And let me ask you about the programming. Let's pivot a little bit and talk about the technology of the chair. Tell us about chairs that have this ability to be programmed. A lot of them do. They're settings, presets. Tell us about that. So auto programming is, I think, a very underutilized resource you know we we have to get the patient back no matter where they're at no matter how tall they are how big they are, how short they are, whatever. We have to get them into supine. And so if you have a button on there that's reprogrammed to the amount of supine-ness, that's not a word, but we're going to call it a word today, for how far back you need them, you can tell the patient, okay, I'm going to go ahead and lean you back now. The chair knows how far back you need to go, but don't worry, I can bring you up from there if you need it. So, and I always say, so that we can... safely so that I can do this procedure for you safely. And when you enter that word into the conversation, What do you mean safely? Because my instruments were designed to be used in a specific way so that I can gain access to your mouth. If I can't see in there, it's a sharp instrument. So like you want it to be safe. I mean, and I as a hygienist, I say, you know, these are these things are pretty sharp. Ha ha ha. I'm laughing. They're laughing. But it's it's not, you know, it's what it is. That's a great that's a great approach. I think that's a great conversation because they're willing to deal with just about anything when you're telling them that. You know, you have sharp instruments and the safest way to go is to be in this position. I assume in most cases, when you present it that way, Katrina, they're not going to resist and they'll take the position you put them in. If I say it's what's safe for me, I have back problems, blah, blah, blah. They care, but they don't really care. They just want to get their work done and get out, you know? So what's in it for them? You'll be more comfortable. You'll be more safe. you're going to get a better restoration. That's what's in it for them. It doesn't mean the rest isn't also true, but let's get them on board with what we know they are going to agree to. And so having that pre-programmable button is great for that because you get them at the bottom, you get them into completely supine. Don't worry though, I can get you back up because I'm your friend, right? Like I'm the good guy. And you bring them up an inch from the bottom. And then, is that okay? No, no, it's okay. I'll bring up a little bit more. And I can guarantee you that going from the top and doing an inch at a time versus the bottom and going back up from an inch at a time, you're always going to be in a better place. They're always going to be much more further down. And most of these chairs that are on the market today have these programmable capabilities. Yes, they do. They do. They're having that and using it. And if there are different dentists using the same operatory, they can just have a number assigned to them, each of them. And also... They can have a sitting and standing positions as well, pre-programmed, I assume. Yeah, they can push their number. And I usually will go in where there are multiple people using it. And I'll have one for sitting, one for standing, and then one for, you know, the other alternate person. And then, of course, you have what I call the eject button. And this is, you know, you get out of here. Right, right. You're free. Time to leave. Time to leave. So let's get back to the Forest 6400 by Dental Ease. In addition to the advantage of being able to raise that chair 36 and a half inches, which allows pretty tall people to operate standing up, it also has something called CareGlide, which I think is very unique. And they have some really good videos on it. Tell us about CareGlide because it seems like an invaluable feature for special needs patients. So the CareGlide in this particular chair, you push a button and it actually will glide the chair. It'll slide it over to the left, to the right, you know, rear and forward so that you can get a wheelchair patient in there and there's room for it. So you can transfer that patient more easily and or you can swivel the chair, move it out of the way and practice with the patient in the chair up close to your equipment so that it's ergonomically beneficial for you. As a left-handed clinician, this is a really good thing because most operatories are set up where the patient chair is initially put in the center of the room, but then because right-handed operators go in and push it over, there's almost no room on the left-hand side of the chair. So as a left-handed clinician, I can go in and just slide it over five or six inches and it's not a big deal. And I feel like... just something that you can do to change your operatory in such a profound way. A lot of the times these people that set up the rooms, they're not dental clinicians. They're not even sales reps. They just put the chair in the dead center of the room and leave no room for you at 12 o'clock. Plenty of room with the patient chair in the foot area, but nothing for you. And so you can use that chair glide to kind of move the patient around a little bit, not the patient, the patient chair around a little bit so that you can navigate in your space. I mean, how wonderful is that? seen some videos of it. It's pretty impressive. And I don't think any other chair has this. I've not heard of another one, no. Yeah. So it was very interesting. It's a nice feature. I would take that over the massage thing. Yeah, no, for sure. For sure. Plus, how many times do you get somebody in the room that is, I'm going to say, out of the ordinary proportion? size, where you need to adjust. A large person, a very large person, yeah. Yeah, or even a very, very small person, you know, that needs maybe another person in the room to hold them there, you know, to kind of make sure they don't wiggle off the chair or whatever. If you need to move your room around without having to take three people to move this 300-pound patient chair, you don't have to. You have a push of a button. So in the last part of this podcast, Katrina, I wanted to ask you for some recommendations that you can give to our audience, good tips and tricks for testing out A dental chair before you buy it because you don't want to purchase a dental chair and then realize this is not working for you What's the best way to do that? Obviously you can't ask for a sample like you do in composites or glass ionomers or bonding agents because Those are consumable tiny little objects that they send you in the mail. What's the best way to go forward? Honestly, trade shows are a really great place to do that. You know, Chicago Midwinter, Yankee, you know, they're all over the place. The state association meetings, the bigger ones like, you know, CDA Presents and things like that. The vendors are all there. They're paying to be there so that you can try out their chairs. What about visiting a showroom, for instance, a distributor showroom like Shine, Patterson or Banco, etc., or even the manufacturer's showroom? I'm sure Dentalys has showrooms where you can really experience. the uh dental chair yeah absolutely and i i've actually been to the dental ease one believe it or not they have a couple of them throughout the company but you could go to any of these chair manufacturers they'll have mock operatories set up where you can actually go in there and sit down and feel it on your body because Not everybody is the same. And so you need something that will adapt to you. You know, as a really tall clinician, you're going to need more, more ability to get that chair up, for example, than someone who's 5'1". So as we close out this podcast, Katrina, and it's been excellent, tell us the best way to get a hold of you if we have a question, because I know you are very open to reaching out to our audience, which is great. You also have some great videos on ergonomics and everything else. So all of the videos and things that I have are out on social media. Everything is ErgoFitLife. It's E-R-G-O-F-I-T-L-I-F-E. So ErgoFitLife, whether you're on Facebook, I've got a group that I post in almost daily with free tips and things on everything, posture and ergonomics and fitness and all the things. On Instagram, it's ErgoFitLife underscore Katrina. My email is always a great place to reach me, ergofitlife at gmail .com. If you look up Ergo Fit Life, you'll find me. All right, awesome. Well, listen, you know, we really appreciate it. And again, feel free to reach out to Katrina. She's got a wealth of information on ergonomics, and she's a bodybuilder. What can I say? There's nobody else that's going to be able to answer your questions better than her. All right, you take care. Have a great evening, and thank you so much, Katrina. Thank you.