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1 What Is Ergonomics?

Let’s start with some definitions of key terms. The terms “human‐factors engineering” and “ergonomics” are used interchangeably on the North American continent. In Europe, Japan, and most of the rest of the world, the prevalent term used is ergonomics. Merriam‐Webster (n.d.) defines ergonomics as “(1) an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely ‐ called the biotechnology, human engineering, human factors”; and “(2) the design characteristics of an object resulting especially from the application of the science of ergonomics.” The Britannica Online Encyclopedia defines human‐factors engineering as ergonomics or human engineering (Holstein & Chapanis, 2018). The term “human‐factors engineering” is used equally to designate a body of knowledge, a process, and a profession. Human engineering is a science dealing with the application of information on physical and psychological characteristics to the design of devices and systems for human use.

The word “ergonomics” is derived from the ancient Greek ergon, which means work, and nomos, which means law. Ergonomics can also be seen as the science concerned with how to fit a job to a person’s anatomical, physiological, and psychological characteristics in a way that will enhance human efficiency and thus contribute to a safer working environment. The discipline of ergonomics was formalized after the end of World War II. The science of ergonomics looks for ways to make work easier on a worker’s body by using a combination of techniques and equipment that will prevent injuries while maintaining efficiency.

Human‐factors engineers have tried to show that with appropriate techniques it is possible to identify human‐made mismatches and thus to find workable solutions to these mismatches through the use of methods developed in the behavioral sciences. Design decisions and approaches cannot be reached without a lot of trial and error. The telephone and the typewriter keyboard are but two out of thousands of examples that might have been selected to show how human‐factors engineering has been consciously applied to solve technological problems. Today, we can just look at the many advances in the US space program, automotive industry, computer technology, and more. More broadly, in every sector globally there is a realization that physical problems occur because of workplace setups that can cause misalignment of the human anatomy, and thus physical pain and mental misery. The list continues to expand as the world moves at a faster and faster pace and there is a realization that ergonomics is essential in daily life.

In the January 2021 edition of Costco Connection, there is a short article on how to prevent and recover from bad work habits. We are reminded to commit to healthy work habits such as sitting tall and getting up every hour to move that body. We must begin to listen to our bodies. Researchers have used a number of methods to measure these musculoskeletal disorders (MSDs) or imbalances, yet these are really just subjective. Gravity is the one force that affects all existence and behavior on earth. Defining and maintaining a steady center of gravity is therefore important and the most significant natural step in accomplishing any given task. Each individual has their own unique center of gravity. We can collaborate with other people and disciplines in order to achieve a better understanding of what needs to happen to avoid an MSD, but ultimately it is our individual responsibility to learn to treat our body with kindness.

The practice of dentistry today

From the vantage point of the twenty‐first century we can see a continuous pattern of musculoskeletal strain and awkward postures among dental providers and their auxiliaries. A combination of unsupported postures, excessive movements, and repetitive motions explains the evolution of MSDs in the practice of dentistry. Sitting down has not been the golden panacea that it was once thought to be. The human spine and its musculature constitute a living structure that benefits from movement. Our spinal disks must have motion in order to be nourished. Any attempt to constrain the spine will be met with failure and pain. Low back pain is one of the leading MSDs for dental practitioners. This is directly related to too much sitting.

After teaching ergonomics to dental students for many years, I began to see that something more was needed in the dental curriculum to address this problem. We need to look for better practitioner positioning as we practice. Within the last decade, 47 percent of US dental schools have indicated that ergonomics is a very important part of the dental curriculum. Some dental schools have made ergonomics an elective if the dental curriculum cannot be expanded further, so that the study of ergonomics is at least available to dental and dental hygiene students. Students of dentistry and dental hygiene should begin to envision ergonomic awareness as an angel (the subconscious mind) that lifts us (the practitioners) into a balanced posture when our conscious minds do not remember to do so (Figure 1.1). This is an imperative part of the dental curriculum. It is never too early to raise students’ awareness of ergonomic principles for dental practitioners and the consequences that can result from practicing without using this ergonomic knowledge. It is important as a preventive measure as well. It is a known fact that we stimulate the same brain regions when we visualize doing something as when we actually do it physically. It is so very important for dental students and hygienists to learn their individual neutral position when working on a patient. This is how ergonomics needs to be taught. Once an understanding of it is generally accepted and understood, the process of incorporating knowledge of ergonomics into the dental curriculum will be a lot easier and much more natural to each student. Thomas Edison said, “There is a better way for everything. Find it!” It is the quality, not the quantity of life that matters.

One must remember that the body is a machine consisting of optics, mechanics, chemistry, and electronics. The key factor in maintaining musculoskeletal health is maintaining the body’s neutral position as much as possible during the day. What is this neutral position? The neutral position (or comfort zone) is defined as the position of an appendage that is neither moved away from nor directed toward the body’s midline, nor laterally twisted (Figure 1.2). There is always a neutral zone for every joint and muscle. An individual must keep their entire musculature evenly balanced. Our posture and how we habitually use our body the most are what can lead our body and spine to begin to shorten and to curve into unhealthy patterns. Keeping the spine healthy at every age is crucial to the general health and longevity of the physical body.

Figure 1.1 Ergonomic awareness.

Figure 1.2 Neutral position.

Figure 1.3 Neutral position for the registered dental hygienist.

How a dental practitioner stands, walks, and uses their feet can lock patterns into the feet, ankles, knees, and hips. The key is movement – this is the goal of the practitioner. We must keep the body in motion as much as we can during our daily dental work. The neutral position is key and encompasses a deeper journey for the practitioner, in that the sides of the body are released (Figure 1.3), thus freeing the “stuck ribs” that ultimately shorten the body, resulting in the ribcage and head becoming “weighed down” on the lower body. The abdominal muscles must be strong, as they play such an important role in connection to the health of the back and spine. Strong gluteal muscles are important as well to help the individual attain this personal neutral position.