Ergonomics and specific equipment in pediatric dentistry
Introduction :
A pediatric dentist’s dental office should be organized in such a way as to easily put the child at ease in order to facilitate the dental care process.
- Ergonomics in pediatric dentistry:
1.1. Definition of ergonomics:
Ergonomics is “the scientific study of the relationship between man and his means, methods and working environments”
1.2. Ergonomics in OP:
- The atmosphere created in the waiting room should greatly influence the child’s behavior; this environment should not be aggressive
The working posture:
The principle of working side by side during dental care is based on the interaction between space and working methods that dentists and assistants implement. The entire workspace has a great influence on the way of working. If it is well adapted, it remarkably improves the performance between dentists and assistants and that of the dentist only if he works alone. This article indicates the basic rules, universally recognized for almost half a century, of ergonomics in the workplace, but which are in fact very little known by all dentists.
Space : The workspace is just as important as the working methods. On the practitioner’s side, it must allow working in positions at 9, 10, 11, 12 o’clock and thus looking into the mouth from different directions without twisting the back, neck or turning the head. For the 12 o’clock position, only when the view into the mouth makes this position necessary, there must be at least 60 cm of free space behind the headrest of the chair.
The useful at hand: It is essential to have the suction, instruments, unit, work surface and storage drawers for frequently used equipment within reach. This allows the dentist and assistant to remain seated near the patient and the latter to actively participate in the procedure by suctioning, separating, rinsing, drying and also to pass the instruments and equipment to the dentist directly from hand to hand. Thus, the dentist maintains a real concentration on his work in the patient’s mouth while considerably reducing the energy and time required for the procedure.
What is a good working posture ? Work in a mid-body position without twisting or leaning your body, neck or head. Tilt your eyes downward as comfortably as possible while keeping your head as straight as possible. Use glasses or magnifiers that allow you to support a downward viewing angle. Never lean down but raise your patient to an eye-object distance of about 35 cm. The taller you are, the more you will tilt your forearm upward. Elements of a side-by-side workspace
Patient chair : It is essential that the chair back can tilt horizontally. This allows treatment to be performed on a patient lying down. The chair back must be relatively short so that the headrest can be placed under the patient’s head and neck, especially for small people. The patient can move his head forward, backward, to the right or to the left. This allows the dentist, in a good working posture, to reach the area to be treated by combining his position with the position of the patient’s head without forgetting the gap between the soft tissues. In the case where the dentist uses a mirror, he is able to see even distally to the last molars located on the upper or lower jaw. (Example where observation is difficult to achieve). The base of the chair must be narrow in order to leave enough space to place the control pedal below which will be activated by your right foot. A control pedal on the right side of the chair often leads to poor working posture. The dentist must be able to work sitting upright and looking straight into the patient’s mouth while being at a distance of about 35 cm, which will ensure that he sees accurately. For tall dentists, the height of the backrest horizontally should be about 90 cm. For these dentists, it is advisable to work with instruments in an inclined version in order to compensate for the inclination of the forearm.
The stool : a more flexible seat. For both dentists and assistants, the stool must promote a flexible working position so as to have the thighs inclined and to maintain a correct lumbar curvature even when they lean slightly to look into the patient’s mouth. The ischium (back of the pelvis) is maintained horizontally, with the front part of the seat inclined forward.
The unit: It must be placed centrally above the patient, 25-30 cm from the patient’s mouth so that the dentist can take the equipment without looking away (using peripheral vision). A correctly positioned unit allows the weight of the instruments to be well distributed in order to improve the sensitivity of the dentist’s hands during precision work. The assistant can thus select the air/water syringe and the various elements of the unit, change the burs and hand the instrument tray to the dentist.
The suction : is placed near the unit so that the assistant can grasp it with her right hand as well as the air/water syringe with her left hand for a quick and effective treatment. This double grip is shown in (fig. 6). This manipulation is also used to dry the mirror when the dentist uses the spray. The positions of the unit and the suction must allow the assistant to easily and quickly grasp the instruments. As can be seen in the photo, the instrument tray is placed on the assistant’s right side because there is simply not enough space between the assistant and the unit to put it down. If a dentist works, sometimes or systematically, alone, it is useful to have a suction with a single position directed towards the left side of the patient’s head.
Ergonomics and specific equipment in pediatric dentistry
- Materials specific to pediatric dentistry:
- consultation tray:
The instruments that make up the work tray are the same used by adults, however the use of colored handles will give a less aggressive appearance to the instrument.
- The mouth opener, very often used in uncooperative children
2.2 Radiological examination in pediatric dentistry:
a. conventional imaging:
- Silver films must be of the fastest category, i.e. ISO E or ISO F. They give images of diagnostic value almost equivalent to that of class D films for an exposure reduced by half.
- In younger children, using a flap film holder (Hager Herken) stuck perpendicular to the film can make it easier to hold it in the mouth.
- These shots are taken with ISO child size films:
- Size 0 (2×3cm) in temporary dentition and at the start of mixed dentition.
- After the age of 8, standard ISO size 2 (3×4cm) films can be used.
- In order to protect young patients from radiation, the exposure dose should be as low as possible. In very young adults, exposure should be reduced by 50% compared to that of adults and, in subjects aged 3 to 15, by 25%.
- It is recommended that the child wear a thyroid collar.
2.3. Anesthesia:
- There is no specific equipment, the use of single-use, sterile syringes gives a reassuring aspect.
- For the past 10 years, new systems have been automatically delivering the anesthetic solution at a low flow rate and in a constant manner, thus helping to minimize pain and respect the injection speed.
Ergonomics and specific equipment in pediatric dentistry
| Anesthesia | Material |
| Infiltration | |
| Periapical | Needles: 16-21-25 mmDiameter: 30 or 40/100 |
| Intrapapillary | Needle: 16mmDiameter: 30 or 40/100 |
| Local regional | Suction syringeNeedles: 25 to 38 mm depending on ageDiameter: 50/100 |
| Intraosseous technique | |
| Intraligamentary | Pen syringeNeedles 8-12-16mm Diameter: 30/100 |
| Intraseptal | Needles: 13mmDiameter: 30/100Needle: 8mmDiameter: 40 or 50/100 |
| transcortical | Electronic injection system type quick-sleeper Needle: 12mm Diameter: 40 or 30/100 for temporary teeth Specific needles with asymmetrical bevel to facilitate bone perforation for permanent teeth |
2.4. Conscious sedation:
The mixture is administered with a latex-free nasal or naso-buccal mask, connected to an administration circuit (Modified Bath Circuit for Dentistry, Intersurgical) comprising a single-use antibacterial filter and a system for evacuating exhaled gases via a flexible tube to the outside (window or suction circuit).
The bottles are made of steel or aluminum; with different capacities (5 to 15 liters).
The selection of the type of mask is made according to the patient’s ventilation mode and their ability to cooperate. They are of different sizes so as to adapt to any facial morphology.
The balloon integrated into the evacuation administration circuit serves as a control for ventilation and allows the flow rate to be adjusted.
2.5. The operating field:
- It is necessary to have
- A hole punch pliers
- From a crampon holder clamp
- Latex or non-latex dam sheet, available in several colors and thicknesses and in several sizes (temporary and permanent dentures)
- From metal or plastic U-shaped dam frame
- Waxed dental floss to help pass interproximal contacts
- Wedges type rubber wire which, placed interdentally, can possibly replace the clamps when the mouth opening is very reduced
- Of crampons
Table: Cleats used in pediatric dentistry
| Tooth | Crampon without fins | Crampons with fins |
| 2nd temporary molars | Ivory W14Ivory W8A | |
| 1st temporary molars | Ivory 00 | Ivory W1 |
| Permanent or temporary incisors | Ivory W9Ivory 212 | |
| Permanent molars | Ivory 14 Ivory 14A Ivory 14AD Ivory 12A Ivory 27 |
2.6. Materials for dental extractions:
- Syndesmotomes (sickle or straight) and elevators are not different. Only the forceps used for temporary teeth are different from those used for permanent teeth. The handles are shorter. The jaws are more curved to adapt to the coronal morphology of the deciduous teeth.
- Conclusion
- The dentist is faced with treating children on a daily basis; organizing his or her practice in a calming manner will help to put the child at ease;
- And the use of child-specific materials will facilitate treatment