ANNE NUGENT GUIGNON, RDH, MPH, provides
popular programs, including topics on biofilms,
power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of
the 2004 Mentor of the Year Award and the
2009 ADHA Irene Newman Award, Anne has
practiced clinical dental hygiene in Houston
B Y ANNE NUGENT GUIGNON, RDH, MPH
With our aging population, we’re going to face more situations where clinicians will need to accommodate patients
both physically and mentally just to get the job done.
There is a profound difference between a drama queen
(or king) and someone who actually can’t lean back, whose
neck is wracked with arthritis so badly they can’t turn to
the right or left, or our precious patients who can’t remember what they ate for breakfast two hours ago. Factor in a
plus-size patient who needs a doublewide wheel chair and
can barely fit into a standard dental chair, or the post-stroke
patient who can’t stand independently and needs assistance
to move in and out of the dental chair.
A recent discussion in an online chat group revolved
around patients who could not be reclined or demanded
treatment in a fully upright position. Understandably, the
conversation got a bit heated. Trying to work on an upright
patient is an ergonomic nightmare. There are some strategies, however, that may improve your survival and even help
you reach the desired clinical outcomes.
First of all, there are patients who absolutely can’t be
reclined. In this case, you’ll probably have to stand. Just do
the best you can and document the situation in the record.
For the history buffs, sit-down dentistry began 45 years ago.
So for years, clinicians stood and moved around the patient
chair. It can be done.
Then there are the “
deceptions.” Ask the doctor to come
in at the beginning of the appointment. Patients rarely complain to the
doctor, so use that to your advantage. Or consider pre-positioning the back before they ever walk into the
room. The patient is going to assume wherever the back is
positioned is the upright starting point, but you now have
cleverly gained a 10- to 15-degree advantage. Or, how about
claiming “back trouble” or that you won’t be able to provide optimal care? Unless someone really can’t recline, who
would opt for less than ideal care?
About 20% of the general population suffers from back
pain. Despite all of the recliner-like design features, dental
chairs are built for the clinical setting and really can really
aggravate back pain. Offer your patient a small pillow for
lumbar support. A cylindrical pillow placed under the knees
readjusts the hip/pelvis angle, relieving lower back stress.
Massage pads are comforting, and the vibration is calming
to many. U-shaped neck pillows provide remarkable support
for those with neck tremors or osteoporosis.
Crescent Dental has a great head support pillow that
reverses for the maxilla and the mandible, making it much
easier to access the specific arch. Crescent also has a specific neck support designed for those with osteoporosis in
Patients with benign positional vertigo (BPPV), an inner ear condition, find it very uncomfortable to recline or
reposition their head quickly. The inner ear has fluid-filled
semi-circular canals, which signal your body position to the
brain. BPPV occurs when free-floating calcium deposits in
the inner ear send confusing messages to the brain. Patients
with chronic sinusitis issues also find it uncomfortable to be
put too far back.
Back to the Internet group. Members wondered how pa-