Dr. Hicham Nuaimi*, Dr. Burhan Kombarji and Dr. Hakan kamalak


Dentistry has high-risk profession for the development of musculoskeletal disorders, as it demands high convieniance that leads to appended posture. The objective of this review is to focus on the extent of musculoskeletal problems related to the dental clinicians around the global and how to mange it. In addition to that, inhibition dental work injuries and the inception of occupational disease and MSD management.


Researchs show that more than 75% of dental clinican complain of pain in the upper body and back during the entire dental world. Ergonomics is the science of adjusting the design of equipment and tools, in order to be comfortable and effective human use, (Mangharam and McGlothan, 1998). Chair hight effects on blood circulation to your legs and feet. Minimize stress on your spine by moving the chair back closer to or farther away from the seat, in order to the upper arms are aligned with the long axis of your body. Dental Ergonomic was modified sitting posture just to reduce the high incidence of pain related to work among dentists, So that researchers work hard to improve working comfort and reduce musculoskeletal disorders (MSD), (Sanders and Turcotte, 1997).

Corrosponding author: Dr. Hicham Nuaimi, BDS, PGDip Restorative, PGDip Implantology, Mclin in Operative and Esthetic, Lecturer at Ishik University/ Iraq.


MSD in dentistry are multifactorial reseans, proper patient positioning techniques may lead toward chronic pain or potential injury (Sunell and Rucker, 2003). In fact, it has been shown that dental clinicans who take the time to carefully have significantly fewer headaches, (Rundcrantz,, 1990).

MSD in dentistry is slowly progress, insidious process. (Ratzon, 2000) showed that approximatly two out of three dental professionals had occupational pain, in addition (Burke, 1997) concluded that nearly a third of dentists who were early retired because of a musculoskeletal disorder.

Is there an ideal positioning of the body?

  1. Neutral Body position is performed work activities and associated with decreased risk of musculoskeletal injury, which characterized by, (as shown in Fig.1).



  • Forearms have to be parallel to the floor
  • Balance your body
  • Hip has to be angle of 90°
  • Seat height positioned low enough so that you are able to rest the heels of your feet on the floor ,(as shown in Fig 2)*



   2- Neutral Neck Position is Charcterised by as shown in (Fig 3):

  • Head have to be tilted between (0 – 15)°
  • The line from eyes to the treatment area should be as near to vertical as possible
  • Avoid head tipped too far forward
  • Avoid head tilted to one side



    3- Neutral Back Position is characterized by as shown in Fig 4:

  • Body tilted slightly forward from the waist or hips
  • Trunk flexion of 0° to 20°
  • Avoid leaning of the spine



    4- Neutral Upper Arm Position is characterized by, as shown in Fig.5:

  • Upper arms have to be parallel to the long axis of the body
  • Elbows have to be held slightly away from body.
  • Avoid angled elbow greater than 20°from the body



     5-Neutral Forearm Position is characterised by, as shown in Fig. 6 :

  • Hands have to be Parallel to the floor level
  • Rising forearm more than 60° from horizontal level should be avoided.



Is there Neutral posture for patient?

The clinician have to be able to attain access to the patient mouth and the dental unit without bending or holding his elbows above waist level, in order to to avoid fatigue and injury. The patient level has to be lower until the tip of the patient’s nose is below the clinician’s waist level. Clinician’s elbow angle has to be at 90°. Avoid 
placing your legs under the back of the patient chair—in this position the patient will be too high and you will need to raise your arms to reach the patient’s mouth.

Is there Neutral posture for using dental Equipment?    

Position for Mandibular Teeth:

a) Dental Light.

Position the dental light should be directed above the patient’s head. In this position, the light beams will shine directly down into the patient’s mouth.

b) Dental Tray.

It should be positioned as low as possible so that the clinician can easily view the instruments resting on it to be reachable

c) Patient Chair.

       Position the patient chair so that your elbow angle is at a 90-degree angle    when your fingers rest on the mandibular teeth.

Position for Maxillary Teeth

a) Dental Light.

Position the dental light should be directed above the patient’s chest. In this position, the light beams shine should be tilted while still keeping it within easy reach.

Is there an error posture?

  1. The most common error were seen when Placing patients too higher in relation to clinician due to periodontal therapy.
  2. Clinician who hold his elbows up in a stressful position to reach the patient’s mouth.


Dental clinicians are at high risk for upward MSDs due to improper positioning that can lead to permanent tissue injury and chronic pain that lead to dysfunction. Clinicians should achieve a self-evaluation to control whether they are placing themselves at greater risk by failing to approve and maintain neutral positions.

Using of ergonomic equipment may be supportive to reduce muscle strain and fatigue, (Pollack, 1999). Realizing positive changes, including regularly stretching and standing up throughout the day, may help to minimize or eliminate MSDs. Conserving good physical health is essential to practicing without pain, both of which contribute to improved quality of life.


  1. Achieve a variety of sections during the workday.
  2. Shorten patient’s recall intermission
  3. Alternate procedures implemented during the day.
  4. Stretching has to be gentle and gradual 
with normal breath.
  5. Stretches may be active for 10 seconds
  6. If you suffer from a MSD try to consult your Physician to avoid unfamiliar postures.


Special thanks to Dental United Company ( (Warsaw/ Poland) for their financial support to achieve this work that is focusing on dental clinician and staff for their ideal postures and their errors. Figures were used from Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation by book/7th Edition (Jill Nield-Gehrig).


Burke F, Main J, Freeman R. (1997). The practice of dentistry: an assessment of reasons for premature retirement. Br Dent;182 (7):250-4.

Mangharam, J., & McGlothan, J. (1998). Ergonomics and Dentistry: A literature review. IN: Murphy, D.C. (Editor), (1998). Ergonomics and the Dental Care Worker. Washington, DC: American Public Health Association.

Pollack R. (1999). The Ergo Factor: The Most Common Equipment and Design Flaws and How to Avoid Them. Dentistry Today February, 112-121.

Ratzon N, Yaros T, Mizlik A, Kanner T. Musculoskeletal symptoms among dentists in relation to work posture. Work 2000; 15:153-8.

Rucker L, Boyd M. 1998. Optimizing dental operator working environments. In: Murphy DC, ed. Ergonomics and the dental care worker. Washington, DC: American Public Health Association, 301-18.

Rundcrantz B, Johnsson B, Moritz U. (1990) Cervical pain and discomfort among dentists. Epidemiological, clinical and therapeutic aspects. Swed Dent J;14:71-80.

Sanders, M & Turcotte, C. (1997). Ergonomic strategies for dental professionals. Work 8, 55-72.

Sunell, S. & Rucker, L. (2003). Ergonomic Risk Factors Associated with Clinical Dental Hygiene Practice. Probe. 37, (4):159-166.

Dental United Hicham

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