ideal chair position of dentist and the patient

1. CHAIR POSITION
Presented by—
Hemam Shankar Singh
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2. CONTENTS
1. INTRODUCTION
2. CHAIR AND PATIENT POSITIONS
 UPRIGHT POSITION
 ALMOST SUPINE
 RECLINED 45 DEGREE
3. OPERATING POSITION
 RIGHT FRONT POSITION (7 O'CLOCK)
 RIGHT POSITION (9 O'CLOCK)
 RIGHT REAR POSITION (11 O'CLOCK)
 DIRECT REAR POSITION (12 O'CLOCK)
4. CONSIDERATIONS FOR DENTISTS WHILE DOING PATIENT
5. SEQUENCE FOR PRACTICING POSITIONING
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3. INTRODUCTION
CHAIR AND PATIENT POSITIONS ARE IMPORTANT
CONSIDERATIONS. MODERN DENTAL CHAIRS ARE
DESIGNED TO PROVIDE TOTAL BODY SUPPORT IN ANY
CHAIR POSITION.
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4. INTRODUCTION
• CHAIR POSITION IS A VERY IMPORTANT ASPECT IN
THE SUCCESS OF A DENTAL TREATMENT.
• THE CORRECT POSITIONING HELPS THE OPERATOR TO
HAVE A GOOD VISIBILITY AND ACCESSIBILITY OF THE
ORAL CAVITY
• PROPER POSITIONING OF THE PATIENT AND THE
OPERATOR, ILLUMINATION AND RETRACTION FOR
OPTIMAL VISIBILITY ARE THE FUNDAMENTAL PRE-
REQUISITES TO PROPER DENTAL TREATMENT
• IF OPERATOR MAINTAINS PROPER POSITION AND
POSTURE DURING TREATMENT, THE OPERATOR IS
LESS LIKELY TO GET STRAIN, FATIGUE, BE MORE
EFFICIENT AND LESS CHANCES OF GETTING
MUSCULOSKELETAL DISORDERS.
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5. FOLLOWING POINTS SHOULD BE KEPT IN MIND IN RELATION
TO DENTAL CHAIR:
 IT SHOULD BE ABLE TO PROVIDE COMFORT TO THE PATIENT
 IT SHOULD BE ABLE TO PROVIDE TOTAL BODY SUPPORT
 HEADREST OF CHAIR SHOULD BE ATTACHED FOR
SUPPORTING PATIENT'S CHIN AND REDUCING STRAIN ON
CHIN MUSCLES
 IT SHOULD BE ABLE TO PROVIDE MAXIMUM WORKING AREA
TO THE OPERATOR
 IT SHOULD BE PLACED AT THE CONVENIENT LOCATION WITH
ADJUSTABLE CONTROL SWITCHES
 FOOT SWITCHES ARE PREFERRED TO IMPROVE INFECTION
CONTROL
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6. PATIENT POSITIONS
• VL
• PATIENT SHOULD BE SEATED SO THAT ALL HIS BODY PARTS ARE WELL
SUPPORTED.
• THE PATIENT'S HEAD SHOULD ALWAYS BE SUPPORTED BY
ADJUSTABLE/ ARTICULATED HEADREST.
• PREFERABLY THE PATIENT'S HEAD SHOULD BE IN LINE WITH HIS BACK .
• THE CHAIR HEIGHT SHOULD BE KEPT LOW, BACKREST SHOULD BE
UPRIGHT AND ARMREST SHOULD BE ADJUSTABLE WHILE MAKING
THE PATIENT TO SEAT IN THE DENTAL CHAIR.
• NOW, THE CHAIR CAN BE ADJUSTED TO PLACE THE PATIENT IN
RECLINING POSITION.
• PATIENT POSITION CAN VARY WITH OPERATOR, TYPE OF PROCEDURE
AND AREA OF THE ORAL CAVITY.
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7. FOR RESTORATIVE DENTAL PROCEDURES, THE MOST
PREFERRED OPERATING POSITIONS ARE:
1. UPRIGHT POSITION
2. ALMOST SUPINE
3. RECLINED 45 DEGREE
THE MOST COMMON PATIENT POSITIONS FOR OPERATIVE
DENTISTRY ARE ALMOST SUPINE OR RECLINED 45 DEGREES. THE
CHOICE OF PATIENT POSITION VARIES WITH THE OPERATOR, THE
TYPE OF PROCEDURE, AND THE AREA OF THE MOUTH INVOLVED
IN THE OPERATION.
CHAIR POSITIONS
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8. UPRIGHT POSITION
THIS IS THE INITIAL POSITION OF CHAIR FROM WHICH FURTHER
ADJUSTMENTS ARE MADE
Chair position
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9. ALMOST SUPINE
• IN THIS , CHAIR POSITION IS SUCH THAT HEAD, KNEES AND FEET ARE
APPROX. AT SAME LEVEL
• PATIENT’S HEAD SHOULD NOT BE LOWER THAN FEET EXCEPT IN CASE OF
SYNCOPAL ATTACK
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10. REECLINED 45 DEGREES
IN THIS POSITION , CHAIR IS RECLINED AT 45 DEGREE
MANDIBULAR OCCLUSAL SURFACE ARE ALMOST 45 DEGREE TO THE FLOOR
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11. OPERATING POSITIONS
ONCE THE PATIENT HAS BEEN COMFORTABLY
POSITIONED, THE DENTIST AND THE
ASSISTANT SHOULD SIT THEMSELVES IN THE
PROPER POSITIONS FOR TREATMENT.
USUALLY SITTING POSITION IS PREFERRED IN
MODERM DENTISTRY TO RELIEVE STRESS ON
OPERATOR'S LEG AND SUPPORT THE
OPERATOR'S BACK.
THE LEVEL OF TEETH BEING TREATED SHOULD
BE PLACED AT SAME LEVEL AS THE LEVEL OF
OPERATOR'S ELBOW.
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12. FOR BETTER UNDERSTANDING, SITTING
POSITIONS OF OPERATOR ARE RELATED
TO A CLOCK. IN THIS CLOCK CONCEPT,
AN IMAGINARY CIRCLE IS DRAWN OVER
THE DENTAL CHAIR, KEEPING THE
PATIENT'S HEAD AT THE CENTER OF THE
CIRCLE.
THEN THE NUMBERING TO CIRCLE IS
GIVEN SIMILAR TO A CLOCK WITH THE
TOP OF THE CIRCLE AT 12 O'CLOCK.
ACCORDINGLY THE OPERATOR'S
POSITIONS
(RIGHT HANDED OPERATOR)
7 O'CLOCK, 9 O'CLOCK, 11 O'CLOCK,
AND 12 O'CLOCK
LEFT HANDED OPERATOR'S POSITIONS ,
5 O'CLOCK, 3 O'CLOCK AND 1 O'CLOCK .
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12

13. RIGHT FRONT POSITION (7 O'CLOCK)
1. IT HELPS IN EXAMINATION OF THE
PATIENT
2. WORKING AREAS INCLUDE:
a) MANDIBULAR ANTERIOR
b) MANDIBULAR POSTERIOR
TEETH (RIGHT SIDE)
c) MAXILLARY ANTERIOR TEETH
3. TO INCREASE THE EASE AND
VISIBILITY, THE PATIENT'S HEAD
MAY BE TURNED TOWARDS THE
OPERATOR.
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14. RIGHT POSITION (9 O'CLOCK)
1. IN THIS POSITION, DENTIST SITS
EXACTLY RIGHT TO THE PATIENT
2. WORKING AREAS INCLUDE:
a) FACIAL SURFACES OF
MAXILLARY RIGHT POSTERIOR
TEETH
b) FACIAL SURFACES OF
MANDIBULAR RIGHT
POSTERIOR TEETH
c) OCCLUSAL SURFACES OF
MANDIBULAR RIGHT
POSTERIOR TEETH.
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15. RIGHT REAR POSITION (11 O'CLOCK)
1. IN THIS POSITION, DENTIST SITS BEHIND
AND SLIGHTLY TO THE RIGHT OF THE
PATIENT AND THE LEFT ARM IS POSITIONED
AROUND PATIENT'S HEAD
2. THIS IS PREFERRED POSITION FOR MOST OF
DENTAL PROCEDURES
3. MOST AREAS OF MOUTH ARE ACCESSIBLE
FROM THIS POSITION EITHER USING DIRECT
OR INDIRECT VISION
4. WORKING AREAS INCLUDE:
a) PALATAL AND INCISAL (OCCLUSAL)
SURFACES OF MAXILLARY TEETH
b) MANDIBULAR TEETH (DIRECT VISION).
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16. DIRECT REAR POSITION (12 O'CLOCK)
1. DENTIST SITS DIRECTLY BEHIND THE
PATIENT AND LOOKS DOWN OVER THE
PATIENT'S HEAD DURING PROCEDURE.
2. WORKING AREAS ARE LINGUAL
SURFACES OF MANDIBULAR TEETH.
3. THIS POSITION HAS LIMITED
APPLICATION.
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17. RIGHT HANDED OPERATOR—
3 PREFERRED POSITIONS
LEFT HANDED OPERATOR—
3 PREFERRED POSITIONS
7 O’CLOCK 5 O’CLOCK
9 O’CLOCK 3 O’CLOCK
11 O’CLOCK 1 O’CLOCK
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18. 1. WHILE DOING WORK IN MAXILLARY ARCH, MAXILLARY
OCCLUSAL SURFACES SHOULD BE PERPENDICULAR TO THE
FLOOR.
2. IN MANDIBULAR ARCH, MANDIBULAR OCCLUSAL SURFACE
SHOULD BE ORIENTED 45° TO THE FLOOR.
3. PATIENT'S HEAD CAN BE ROTATED BACKWARD OR FORWARD
OR FROM SIDE TO SIDE FOR OPERATORS EASE AND VISIBILITY
WHILE DOING WORK.
4. MAINTAIN PROPER WORKING DISTANCE DURING DENTAL
PROCEDURE. THIS WILL LEAD TO INCREASE COOPERATION
AND CONFIDENCE AMONG THE PATIENT.
5. OPERATOR SHOULD NOT REST FOREARMS ON THE PATIENT'S
SHOULDERS AND HANDS ON THE FACE OF THE PATIENT.
CONSIDERATIONS WHILE DOING PATIENT
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19. 6. DENTIST SHOULD NOT USE PATIENT'S CHEST AS
A INSTRUMENT TROLLEY.
7. THE OPERATOR SHOULD LEAVE LEFT HAND FREE
DURING MOST OF DENTAL PROCEDURES FOR
RETRACTION USING MOUTH MIRRORS OR FINGERS
OF LEFT HAND.
8. OPERATOR SHOULD KEEP CHANGING POSITION
IF PROCEDURE IS OF LONG DURATION TO
DECREASE THE MUSCLE STRAIN AND FATIGUE.
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20. FOR SUCCESSFUL INSTRUMENTATION, IT IS IMPORTANT TO
PROCEED IN A STEP-BY-STEP MANNER. A USEFUL SAYING TO HELP
YOU REMEMBER THE STEP-BY-STEP APPROACH IS “ME, MY
PATIENT, MY LIGHT, MY NON-DOMINANT HAND, MY DOMINANT
HAND.”
SEQUENCE FOR PRACTICING POSITIONING
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21. SEQUENCE FOR ESTABLISHING POSITION
1 ME.
ASSUME THE CLOCK POSITION FOR THE TREATMENT AREA
2 MY PATIENT.
ESTABLISH PATIENT CHAIR AND HEAD POSITION.
3
MY EQUIPMENT.
ADJUST THE UNIT LIGHT. PAUSE AND SELF-CHECK THE CLINICIAN,
PATIENT, AND EQUIPMENT POSITION.
4
MY NONDOMINANT HAND.
PLACE THE FINGERTIPS OF MY NONDOMINANT HAND AS SHOWN
IN THE ILLUSTRATION FOR THE CLOCK POSITION.
5
MY DOMINANT HAND.
PLACE THE FINGERTIPS OF MY DOMINANT HAND AS SHOWN IN
THE ILLUSTRATION FOR THE CLOCK POSITION.
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22. • WHEN WORKING ON ANTERIOR SEXTANTS,
YOUR LEFT HAND (NON-DOMINANT HAND)
AND YOUR RIGHT HAND (DOMINANT HAND)
ARE POSITIONED ON OPPOSITE SIDES OF THE
PATIENT’S MOUTH.
• ANTERIOR SURFACES TOWARD MY NON-
DOMINANT HAND—THE COLORED ANTERIOR
SURFACES IN THIS ILLUSTRATION.
• ANTERIOR SURFACES AWAY FROM MY NON-
DOMINANT HAND—THE WHITE ANTERIOR
SURFACES IN THIS ILLUSTRATION.
POSITIONING TERMINOLOGY
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23. POSTERIOR ASPECTS FACING TOWARD ME—THE
COLORED POSTERIOR SURFACES IN THIS
ILLUSTRATION.
• MAXILLARY RIGHT POSTERIOR SEXTANT,
FACIAL SURFACES
• MAXILLARY LEFT POSTERIOR SEXTANT,
LINGUAL SURFACES
• MANDIBULAR RIGHT POSTERIOR SEXTANT,
FACIAL SURFACES
• MANDIBULAR LEFT POSTERIOR SEXTANT,
LINGUAL SURFACES
POSITIONING TERMINOLOGY
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24. POSTERIOR ASPECTS FACING AWAY FROM ME—
THE COLORED POSTERIOR SURFACES IN THIS
ILLUSTRATION.
• MAXILLARY LEFT POSTERIOR SEXTANT,
FACIAL SURFACES
• MAXILLARY RIGHT POSTERIOR SEXTANT,
LINGUAL SURFACES
• MANDIBULAR LEFT POSTERIOR SEXTANT,
FACIAL SURFACES
• MANDIBULAR RIGHT POSTERIOR SEXTANT,
LINGUAL SURFACES
POSITIONING TERMINOLOGY
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25. ARCH TREATMENT AREA CLOCK
POSITION
HEAD POSITION
MANDIBULAR
ARCH
ANTERIOR SURFACES TOWARD MY NON-
DOMINANT HAND
8–9 SLIGHTLY TOWARD,
CHIN DOWN
ANTERIOR SURFACES AWAY FROM MY NON-
DOMINANT HAND
12 SLIGHTLY TOWARD,
CHIN DOWN
MAXILLARY
ARCH
ANTERIOR SURFACES TOWARD MY NON-
DOMINANT HAND
8–9 SLIGHTLY TOWARD,
CHIN UP
ANTERIOR SURFACES AWAY FROM MY NON
DOMINANT HAND
12 SLIGHTLY TOWARD,
CHIN UP
MANDIBULAR
ARCH
POSTERIOR ASPECTS FACING TOWARD ME
(RIGHT FACIAL AND LEFT LINGUAL)
9 SLIGHTLY AWAY, CHIN
DOWN
POSTERIOR ASPECTS FACING AWAY FROM ME
(RIGHT LINGUAL AND LEFT FACIAL)
10–11 TOWARD, CHIN DOWN
MAXILLARY
ARCH
POSTERIOR ASPECTS FACING AWAY FROM ME
(RIGHT LINGUAL AND LEFT FACIAL)
10–11 TOWARD, CHIN UP
POSTERIOR ASPECTS FACING
TOWARD ME (RIGHT FACIAL AND LEFT
LINGUAL)
9 SLIGHTLY AWAY, CHIN
UP
POSITION FOR THE RIGHT-HANDED
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26. POSITIONING FOR THE ANTERIOR
Anterior Surfaces TOWARD My Non-dominant Hand
7 TO 9 O’CLOCK (8:00 OPTION SHOWN)
TURNED SLIGHTLY TOWARD THE CLINICIAN
CHIN-DOWN POSITION
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27. POSITIONING FOR THE ANTERIOR
Anterior Surfaces TOWARD My Non-dominant Hand
7 TO 9 O’CLOCK (9:00 OPTION SHOWN)
TURNED SLIGHTLY TOWARD THE CLINICIAN
CHIN-UP POSITION
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28. POSITIONING FOR THE ANTERIOR
Anterior Surfaces AWAY From My Non-dominant Hand
12 O’CLOCK POSITION
TURNED SLIGHTLY TOWARD THE CLINICIAN
CHIN-DOWN POSITION 28

29. POSITIONING FOR THE ANTERIOR
Anterior Surfaces AWAY From My Non-dominant Hand
12 O’CLOCK POSITION
TURNED SLIGHTLY TOWARD THE CLINICIAN
CHIN-UP POSITION
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30. POSITIONING FOR THE POSTERIOR
Posterior Aspects Facing TOWARD Me
9 O’CLOCK (OPTION 1 FOR 9:00)
TURNED SLIGHTLY AWAY FROM THE CLINICIAN
CHIN-DOWN POSITION
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31. POSITIONING FOR THE POSTERIOR
Posterior Aspects Facing TOWARD Me
9 O’CLOCK (OPTION 2 FOR 9:00)
TURNED SLIGHTLY AWAY FROM THE CLINICIAN
CHIN-UP POSITION
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32. POSITIONING FOR THE POSTERIOR
Posterior Aspects Facing AWAY From Me
10 TO 11 0’CLOCK
TURNED TOWARD THE CLINICIAN
CHIN-DOWN POSITION
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33. POSITIONING FOR THE POSTERIOR
Posterior Aspects Facing AWAY From Me
10 TO 11 0’CLOCK
TURNED TOWARD THE CLINICIAN
CHIN-UP POSITION
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34. CONCLUSION
Proper use of the chair positions as according to the
relative operating areas helps the operator to complete the
procedure without delayed. it also reduces the chances of
causing musculoskeletal disorders.
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