Equipment, Layout, and Posture: Your Guide to Operatory Ergonomics

How I learned when I was trying to figure out what I was doing wrong when I was in pain is I had my office manager take pictures of me while I was working when I didn't know that she was taking pictures. You can learn so much by just looking at a few photos of yourself. Welcome to the Phil Klein Dental Podcast. In this episode, we're tackling a topic that every dental professional should care about, but many don't think about until it's too late, ergonomics. From body awareness and maintaining a neutral posture to minimizing unnecessary reaching to making smart decisions about your equipment and operatory layout, ergonomics can make the difference between a long, pain-free career and one cut short by injury or chronic discomfort. Joining us is Stephanie Botts, a dental hygienist with over 17 years of experience and a certified ergonomics assessment specialist. Stephanie provides in-office and virtual ergonomics consulting and coaching, helping dental professionals learn practical strategies to optimize their work environment and protect their bodies, both in and out of the operatory. She's here to share how being mindful of good ergonomics is the key to maintaining our comfort, workflow efficiency, and career longevity. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Stephanie, it's a pleasure to have you on the show. Yes, thank you so much. I'm so happy to be here. So you talk a lot about operatory layout and ergonomics. So to begin this episode, why is this topic somewhat under the radar, or at least you feel that it is, but at the same time, it's very important for dental clinicians. Many of us, when we went to school, dental school, hygiene school, assistant, whatever, we were taught on a certain operatory layout. Usually there was just one. And there's more than one when we get out into practice. And when clinicians find themselves at an office, they may or may not be using the operatory layout that they were trained on. And the whole concept of ergonomics is really making your environment work for you so that you can be in good posture. But when you get thrown into an operatory that you're not familiar with, start to adapt to your environment. And we see a lot of reaching and twisting and hunching just because people haven't been trained on how to use that. So I think we, when I say we, I just mean dentistry collectively, we have not historically done a great job in prioritizing ergonomics. And that's why a lot of us are in pain and injured. But operatory layout is huge. And so I really hope that people will learn more about how they can make their environment work for them. So how did you get? so excited about ergonomics i mean um i've interviewed other ergonomic specialists uh katrina klein is one and she's actually a bodybuilder she's a bodybuilder so she's so in tune with all of it um and they can't see the video now but it looks like you know you're in very good shape yourself and you you take physical fitness very seriously what is it that got you excited about ergonomics in dentistry Well, it's definitely not the sexiest topic out there. I never thought that I would be passionate about ergonomics, but really my own story started with my own pain. And I was really struggling in the operatory. My issue was a low back issue. I couldn't figure it out. I was changing my workouts. I was seeing the chiropractor, going to massage therapy, all of that. But it just dawned on me one day, my pain always comes back Monday morning, right when I sit down with my first patient, there's got to be something that I'm doing wrong here. So that's when I really... remembered that ergonomics yes it's a thing and i started to relearn what i should be doing um and then i just i had a light bulb moment that i know i'm not the only one in dentistry that struggles with this so i created my company polish posture and i started helping dental clinicians and i've just been kind of off and running ever since so polish posture is that an educational training company that that trains other dental hygienists or dental offices about the the risk of not paying attention to ergonomic design and and layout and equipment? Yeah. So Polish Posture is just, it's my company. I do a lot of different things. I started out doing assessments and coaching for dental clinicians. And you mentioned bodybuilding earlier. It's, I feel like I'm like a personal trainer, but for the operatory. So I'm watching people as they're working, figuring out how they can use their op a bit better. But when you start a business, at least for me, I had this vision of where I thought I was going to go and it has gone completely. different direction and now I create content. I have a lot of how-to videos and I do a lot of speaking like what I'm going to do tonight in a little bit doing a CE. So I do a bunch of stuff but it's all centered around ergonomics for dental clinicians and office workers. Yeah I mean when you want to see yourself as a clinician that's teaching you want to get the best reach you can get. And, you know, when you first start, you probably thought, yeah, I'd love to have a business where I can go into offices. And that's a lifestyle business, as is dentistry anyway. But you're going to get a lot more leverage and scalability by doing things that you're doing. Now, you have your own podcast show, which is really exciting. And that's called Straight Up with Steph for our audience. So check that out. Is that offered on Apple and Spotify? It's everywhere that will take podcasts. Yeah, it's up on YouTube as well. Yeah. Straight Up With Steph is the name of it. So check that out. And that's great that you're doing podcasting. I think it's a phenomenal way to get the message across. So tell us what are some of the most common ergonomic mistakes that you see in dental laboratories that many clinicians don't even realize they're making? Um, I, one that comes to mind that I see a lot and I used to do this too, is reaching and we're going to have to reach for things like that's kind of what we do. But what we want to avoid is this full arm extended reach where we're just, our arm is straight out in front of us and we're reaching for something that just puts a lot of strain on the shoulder, the elbow, the neck. And that is something that is a hundred percent preventable just with a little bit of pre-planning, you know, bring all your stuff, whatever you're using most often really close to you. So it's a nice. nice, easy reach. I've done assessments where I see, I can usually tell if someone's a reacher within the first few minutes and they're reaching hundreds or thousands of times a day and it's completely unnecessary. So that's one. And then we've got twisting. That's another thing, hunching, leaning, this forward head position. There's a lot of mistakes, but with just a little bit of training and body awareness, they are totally preventable. So do you see individuals that are working in the dental profession on the dental team, whether it's a dentist hygienist assistant that are complaining of persistent consistent pain that's disrupting their workday and how do you assess what the problem is because you talk about operatory layout and I think that's very important but how do you find out what's really the culprit to their condition Yeah. So I do lunch and learns too. And if I ask the team who, who all is in pain, it's rare that not every single person raises their hand, which makes me sad, you know, it doesn't have to be that way. But when I'm working with people with assessments, I usually send them an intake form and then they can put down areas that they're in chronic pain or issues that they have. And I usually keep that in mind as I'm doing the assessment. If someone's got, um, let's just say elbow pain, if they've got chronic tennis elbow or tendonitis. there, a lot of times, surprisingly, it's traced back to how tightly they're gripping their instruments or how much they're having to reach for things. So it's usually a puzzle that I'm kind of putting together as I'm assessing them. Yeah. So most operatories weren't originally, as you mentioned, designed with the actual users in mind. I mean, I remember when I first started practicing, I don't want to tell you how long ago that was, but the chair was functional. would lay down and you'd be able to look in their mouth. And I developed all sorts of back problems as an endodontist, but my ergonomic behavior was probably the worst it could possibly be. I kind of got out before the microscope became mainstream, which has really helped with the ergo situations with endodontists. But talk about how new designs are finally being developed that's based on the anthropometric data of women. And tell us what that is actually and why that matters Sure. So historically, dental equipment, whether it's the chair, our stools, the cabinetry, operatories, have been based around the anthropometric, I always get tripped up on that word, measurements of men. So they take 100 men, they take their average height, arm length, torso length, and average that out. And then they design the equipment around that. But if we look at who's actually using that equipment, I don't know about you, but every dental practice I've been in has been primarily women. And that's what we're seeing in our workforce now. The majority of assistants and hygienists are women. And then now in dental schools, more than half of dental students are women. Why are we using equipment that isn't actually made for us? The average height of a man is 5'9". The average height of a woman is 5'3 to 5'4". So you can see the discrepancy there. It just doesn't really make sense. So now we're seeing equipment that's actually being designed for women, which is great. But if we take a patient chair, for example, a lot of times the chair is designed around the patient's comfort in mind. It's nice and thick. It's cushy. It's got these huge armrests. The headrest is huge and really thick, which, yeah. maybe it's great for the patient, but those are very hard to work around as the clinician. So I think now a lot of equipment companies are starting to focus on the actual user, which makes sense. So when it comes to equipment and operatory layout, what are some of the things we must have in order to maintain our ergonomic health and what should we be avoiding? Yeah, for the patient chair, we'll just start with that. What we want to avoid is something that's really thick, these really thick, cushy backrests. We want to avoid that because if we're raising up the patient, which is what happens with those thick chairs, that's encroaching on our space. And then we start to, you know, shrug our shoulders or we've got our arms out and chicken wing, which isn't good. We also want to make sure that the... the chair tapers up towards the head of the patient. So it's got a narrow back up towards the head of the patient so that we have room to like fit our legs and get nice and close. These really wide back chairs that have these huge wings on the back, those are really hard to work around. And then our operator stool as well. I'm a big proponent of saddle type stools. They do work for most people. There's some that can't tolerate them, but a lot of times that the actual operator stool is. just too big for the clinician and then that's when we see them squirming around or they're like perched on the very edge of the stool which isn't helpful so now companies are being more mindful with designing those things and when you talk about the saddle type stool is that difficult to get used to Yeah. And what I recommend is slowly, I mean, if you go from a regular stool to a saddle stool, a hundred percent, you're going to feel like you're on a horse all day and it's not going to make you want to sit on it again. So you alternate, you kind of ease into it, maybe sit on it for 10 or 20 minutes, then either stand or use your old stool and then slowly start using it more. And what is that doing for you? That saddle stool? ergonomically what is it doing to your body your muscles your skeleton so when we're sitting on a regular operator stool a flat stool it causes our pelvis to kind of tuck under and roll under which flattens out the lumbar curve which isn't good a lot of times when we experience low back pain it's because those discs are starting to get pinched because that curve is flattening out a saddle stool actually is designed to support our pelvis so that it doesn't tuck under and then it's an it's hard to describe unless you've actually sat on one. But when you sit on one, there's like no work to it. It just keeps you completely supported in an upright, neutral posture. So it's designed to support your pelvis in a way a lot of people don't even need a backrest anymore. And it preserves that lumbar curve, which is what we want. And what do you think about treating patients from the standing position? Or intermittent standing position where you go from the saddle stool to standing and back and forth. What's your thought on that? I love it. I would love clinicians to try to aim for a 50-50 split of sitting and standing. You know, we see those standing desks now for office workers. There's a reason for that. Our body is meant to move. It's not meant to sit still all day. I mean, I'm sure you experience that as an endodontist. That's the hardest thing with endo is because you're stuck in this position for like hours sometimes. So I do recommend, at least for me. I'm kind of clumsy. And so if I stand and try to use the foot pedal, it's not pretty. So what I recommend is trying to sit for things that you need the foot pedal for and then stand for other things. Injections, hand scaling, scanning, taking impressions. Those are great times to stand. And I assume, Stephanie, that not all chairs are created equal. Obviously, some chairs are capable of being raised up high enough where it's conducive to practicing dentistry, standing up where some chairs. just can't do that. So you really should do your homework, I guess, when you're looking for a new chair. I think people need to do their due diligence, even with some of the newer chairs, depending on the manufacturer, it might not go up as high. I mean, if you're over six feet tall, that's something you really need to look at. Some of the older chairs though, I've heard dental clinicians are like, I'm trying to stand, but it literally will not go up that high. And I don't, unfortunately, I don't have a great solution for that. Besides getting a new chair. Right. So What would you say to a dentist who's looking to be an associate dentist somewhere with the option of purchasing the practice? But the practice is kind of old. You know, the equipment is not set up ergonomically. The layout of the stuff is not right. The equipment itself doesn't fit the criteria that you're always talking about when it comes to good ergonomics. In that situation, I think the person who's thinking of taking over the practice should very early on bring in a consultant, at least to get an understanding of what... they're looking at as far as ergonomics and where they need to go both in time and cost to get that office in shape so that they could have some longevity in their career. Yeah, I think it's very important at least to get someone's opinion, right? As far as maybe you're just going to start out with one operatory that you're doing restorative or maybe another one that you're doing hygiene. So I understand like these things are very expensive. And so just maybe having a punch list of things you can do right now and things maybe that you can wait on. Also really thinking of how that operatory is going to be used. Because it's not cookie cutter. And that's a mistake I see a lot of offices make is they have one operatory layout for all of their ops, no matter what those ops are going to be used for. But there's some layouts that are good for forehanded dentistry. Some are good for like hygiene where you just have a single clinician and you don't want to be putting your team at risk, you know, because you're just doing one design. But yeah, Midmark, they do have a program where they can evaluate your practice. obviously recommend things for you, whether it's a de novo practice or something existing, but they have a whole team that can analyze everything for you and recommend some good stuff. So one of their priorities is ergonomics. And that's why I've chosen to partner with them because they really take that seriously. Yeah, great choice in partnering with Midmark. They've been around a long time. They're a great company. Many dentists I know have been using Midmark equipment and services, including their... expert advice to get them in the right direction. Getting back to the point you made earlier about how this whole thing about designing an operatory is not cookie cutter. Every operatory is not the same. It depends on what you want to do in that operatory. Give us an example of this. Something I see a lot is you'll have four or five ops that are used for whatever, surgical, restorative, hygiene, but they're all set up in a rear delivery system where you've got everything behind like in that 12 o'clock position. That's great if there is an assistant and a dentist working together where it's very easy to transfer instruments and everything's right there. But if you think about a hygienist working in something like that, everything is usually behind the patient and off to one side. So if I'm a right hand, it's hard to talk about this when there's like not video, but if I'm a right handed hygienist and everything I need is off to the left, what am I going to do? I'm going to be twisting across my body, trying to reach for those things. Twisting and reaching is no good. And it's not efficient. I'm just wasting time. So that's what I mean when it's like we need to be more thoughtful with how the operatory is going to be used. For a dental hygienist or for single clinicians, I recommend a split operatory design. And then if something is actually going to be used truly for forehanded dentistry, rear delivery is a great option. But you can also use split. So it just kind of depends. Yeah, what is split? Tell us what that is. Splits when you have a bracket table. So just imagine me. I'm a right-handed clinician and I'm at the 12 o'clock position. Okay, the chair is in front of me. Split means I've got a bracket table off to my right that's attached to the chair that I can move around. And there's also a delivery like a bracket table and usually suction and air water off to my left as well. It's balanced so that I can have things on my right and I can also have things on my left. That's also good for four-handed dentistry as well. Yeah, so there are obviously a lot of options, again like anything else it has to be well planned and you really need someone that has the expertise yeah yeah you definitely want to make sure that there's that foundation of ergonomics there i think a mistake a lot of people go into or get into is maybe with the cheapest one or at least expensive one or the prettiest one. And aesthetics is, we do care about aesthetics, obviously, but that's not something that's really going to protect your body at the end of the day. So we have to think long-term. And I think we collectively as a society aren't good at that, aren't good at like, who's going to protect my future self? You know, we have to right now. And that's why ergonomics is so important. Yeah. And dentistry is one of those professions where if you don't pay attention to ergonomics, you're going to have a shorter career. I mean, there's just no doubt about it. What about working out and keeping your body strong? That's important too. Oh, absolutely. Yeah. And a lot of dental clinicians, that's something I talk about in one of my longer CE that I give, but we, um, we're usually tight. We've got a lot of tension because of what we do and we think we need to stretch. And so we just stretch all day long. Stretching is important. Yes, but we have got to strengthen. And I'm not talking about like bodybuilding or getting jacked. I'm talking about built like strengthening these smaller stabilizer muscles in our shoulder and our core, um, in our pelvis even to make sure that we can. can hold these positions that we need to be in all day. So we've really got to focus on strengthening too. And that requires weights or can you do that without weights? So resistance training is anything that is, that provides resistance. So it could be body weight. It could be using bands. I am, I'm relatively strong, but I am constantly humbled by these little bands. You know, they can be really hard or you can pick up some kettlebells or dumbbells. Some people even do yoga, you know, that I don't know. I'm, I'm not sure if yoga could. Technically be considered strengthening. I prefer you know lifting weights and and using bands and stuff like that So you're in the gym often Yes. And it's a mental health thing too. You know, it helps my brain. It makes me strong. Also, as we get older, whether you're a man or a woman, we start to lose muscle, whether we want to or not. And that affects our bone density and our mental health and everything. So it really is just something good to get into just for longevity. Without a doubt, it affects mental health. I mean, I still play tennis. I played tennis early this morning before work. I'm so glad I can continue to play tennis. It's not super. competitively but I but I play singles and I could only do that because I keep myself in shape and that's very very mentally satisfying to me that I know that my body's working and oh yeah yeah I'm sure you can tell the difference too if you if you get sick or if you're traveling or whatever and you can't work out as much it you can tell a difference in your mood yeah there's no there's a there's a level of happiness that you experience when you're in shape and you feel fit that is really really important your body you just have to feel fit and you have a better you have a higher energy level you're more optimistic about things you want to do things you get excited about doing things you're not like dragging yourself to go places because you just feel like you're ready to go and do something and it has to do with uh staying in shape and i think that applies to the dental profession for sure so Let's wrap up this podcast with efficiency. So anyone that runs a dental practice wants to optimize efficiency in all aspects of their practice. And the reason for this is pretty obvious. Any set of systems in a business that is designed for efficiency will run better. People will be less stressed, those that use these systems. And ultimately, for the dental practice, it will provide... I believe, better dentistry, and it'll make more money, right? So enter ergonomics, which is what we're talking about here. How big a role does ergonomics play in this overall efficiency thing related to a dental practice? Yeah. So when people think ergonomics, they always think posture, right? But there's so many other things that go into it. Just think of in your operatory, if I'm, let's say I'm a dental assistant and all of a sudden I realize I don't have my etch in front of me. What am I going to have to do? It's so embarrassing when you have to get up out of the op to go get something, but you're running around looking for this etch, rooting around drawers, don't know where it is, go in the back to reach in a cabinet, don't know which cabinet it's in. That's a lot of movement, reaching, maybe getting up on a step stool. get into those cabinets. And it's a lot of time that you're wasting too. So if we just plan ahead a little bit by having good systems, as far as our trays being organized, our system in that wherever your supplies are, making sure everything is nice and organized there, you're not going to have to get up out of your chair and waste time. And you're not going to be, you know, your team's not going to be reaching and twisting and rooting around drawers, trying to look for what they need. Yeah. And not being in that neutral position, right? That's where the danger comes in. Right, right. This reaching across from us, reaching overhead is especially problematic. But if we go back to the equipment, not necessarily being designed for women, that goes for cabinetry as well. So I've, and I'm five nine, so I'm on the taller side and I even have to get up on a step stool sometimes to reach into these really deep cabinets to get what I need. So it's just, usually it just takes a little bit of pre-planning, maybe getting some bins or organization systems to keep everything nice and tidy. And it's just going to help your day. Clutter too is huge. I don't know if you've noticed this, but if there's clutter around, usually you don't feel good. It's kind of stressful. And it's the same thing in the dental practice. Yeah, I feel that way. My wife doesn't always feel that way, but I feel that way. So I'm always cleaning up after the house. So I do want to ask you, and I said in closing before, but this is the real closing, to make a recommendation to our audience. How would they best assess themselves so that they could... be reasonably confident that they're practicing dentistry in the most ergonomic way that they can and to be able to identify when they're not? What's the best way to do that? Well, I think, and I'll just give away a secret. This probably isn't good for my business, but I'm going to... to say it anyway. How I learned when I was trying to figure out what I was doing wrong when I was in pain is I had my office manager take pictures of me while I was working when I didn't know that she was taking pictures. You can learn so much by just looking at a few photos of yourself. People cross their legs. They've got their head forward. They're twisting constantly, whatever it is. So, you know, have one of your friends at the practice take some candid photos of you when you're practicing. You don't need an expert to learn a lot from those photos, but really. it's great to work with someone who has at least a little bit of knowledge of ergonomics. I'm here. There's other people. You mentioned Katrina earlier. There's other people out there too that can really help just give you some feedback as far as things that you're doing right and things that you can improve on. Yeah, that sounds good. What is the best way to reach you, Stephanie, if a dental office is looking for your expertise? Sure. So probably the best place is my website, which is polishedposture.net. I put out a lot of content, how-to videos, newsletter, blog, my podcast. I try to do everything for as no cost as I can. But of course, I'm doing those assessments and coaching as well. Well, Stephanie, thank you so much for being on our show. Good luck with your podcast program. Check it out, everybody. And check out Stephanie on vivalearning.com because she's got some great webinars on vivalearning.com that covers a lot of good stuff. So please visit us and just look up bots, B-O-T-T-S, and you'll find her content. Thanks a lot, Stephanie. Have a great evening. Thank you, Phil.