Study of ergonomic aspect in daily practice dentistry
of some private dental clinic in Makassar
Elizabeth Mailoa – Peter Rovani
Department of Prosthodontics – Faculty of Dentistry
Hasanuddin University
Makassar – Indonesia
Abstract
Introduction: Most practicing dentists experienced pain or discomfort in the neck and spine
region. General dentist that treat patients usually work in a rigid posture for a long period of
time, and this can lead to musculoscletal syndrome. Ergonomics systems in the field of
dentistry is not just the operator's position and design tools, but also the integration of
equipments used in dental practices. The purpose of this study is to assess the application of
ergonomics system by dentists in daily practice in order to prevent the musculoscletal
disorders. Methods: This is a descriptive study and questionnaires was used to gather
information needed. Data were processed using SPSS version 16.0. Results: All respondents
(100%) has used standard equipment that support the ergonomic design. Half of the
respondents (50%) worked in environment that was comfortable and efficient for treatment
of patients. For sitting position as an aspect of ergonomics, 51.9% was applied by the male
respondents, 75% dental specialists, and 51% of respondents have adequate knowledge to it.
For standing ergonomics aspect, it was adopted by all respondents from all groups with a
total of 75%. For ergonomics aspects of work processes (teamwork), 68.2% was applied by
the male respondents, 100% dental specialists and 57.1% of respondents have adequate
knowledge to it. About 56.8% respondents admitted experiencing occasional pain, with 25%
were back pain. Conclusion: In general, the implementation of ergonomics components in
everyday dental practice is important, and we still need to pay attention to aspects of
ergonomics in sitting position, considering that most dentists often sit while treating patients.
Key-word : dental-ergonomic,ergonomic-position;ergonomic in dentistry
1
INTRODUCTION
Most dentists who practiced experience pain or discomfort in the neck and spine.
Generally, dentists and assistants in performing treatment for patients usually are in a rather rigid
posture, with a posture like this in the long term can lead musculoskeletal syndrome.1,
2
One
cause of the syndrome at the dentist or his assistant is that dentists just pay attention to comfort
for patients treated, but do not pay attention to comfort for themselves while doing maintenance
on their patients. The dentist should consider that they are moving toward the patient, rather than
the patient who arranged the sitting position on a dental chair. 3 Most musculoskeletal disorders
occur because the dentist unknowingly be in a position that is less supportive posture when
performing maintenance on the patient. While doing preparation tooth or tooth extraction for
example, sometimes the position of the dentist leans over the patient, a sudden move, rotate the
body from side to side, and such position is performed many times in the time period long
enough, this can cause the musculoskeletal syndrome.2,
4
Although working with a neutral
posture can prevent or reduce musculoskeletal syndrome, most dentists do not realize the
importance of the benefits of ergonomics system with a good position when performing
maintenance on th patients.5 Good posture and correct require equipment good as well, such as
the ergonomic operator chair form must be able to support the spine in a good position.
.4,6
Systems ergonomics in the field of dentistry is not just the position of operators and design tools,
but integration of the equipment used in the dental office. 4
Dentistry Practitioner Profile and Process Work (Nursing) Professional dentist is one
profession that demands accuracy and tenacity in doing its job. As we all know that dentists
treating patients in their daily activities, are required to have adequate skills or skills in dealing
with each case, such as extraction, root canal therapy, dental fillings or cleaning of tartar, which
is the case and the other one needs a different treatment . Skills or skill that is meant here not
2
only how a dentist to provide convenient services for patients who were treated, but also capable
of creating an efficient working conditions for himself, so as to increase labor productivity. 3,4
During the era of the development of dentistry, practitioners generally experience lowback pain and leg pain. To overcome this and increase work efficiency, then the dentist started to
work, sitting down in the 1960s, a technique that was developed and widely accepted include the
four-handed, sit-down dentistry using the ergonomic arrangement of equipment. However, in
several recent studies suggest that complaints of pain still there, it's just today's pain that arises
occurs in the upper back, neck, shoulders, and wrists.5,7
In practice dentistry in particular the work process is associated with the existence of
facilities / equipment for ergonomic support so as to produce a good working attitude as well,
besides the work processes are also not separated from the concept of teamwork in this case the
relationship between the practitioner / operator and assistant.8 Ergonomic equipment could help
operators and assistants to work with the position and posture, arms and shoulders is good for as
long as the treatment that takes a long time with a static body position, specialized equipment in
the practice of dentistry such as dental chairs, dental chair and assistant suporting unit body of
the possibility of muscle tension.9 Nevertheless a good tool though not necessarily provide
ergonomic benefits, but a good tool should be used correctly.9,10
As mentioned above, the work process in the practice of dentistry in addition supported
by adequate facilities and ergonomics, should also be considered a concept of teamwork which is
a new technology that is integrated in a modern dental practice for several decades, later known
as four-handed dentistry where in this concept the dentist and his assistant have the skills of
each.9,10
3
METHOD
This study was conducted by using descriptive approach. The sampling of research done
by accidental sampling method. This research was conducted at several private dental clinics
located in the city of Makassar, South Sulawesi starting on 15 September 2009 until 26
September 2009. This study aims to get a view of the application of ergonomic aspects in the
practice of dentistry performed daily by some dental practitioners both general dentists and
dental specialists. The instruments used in this study was questionnaire. The data obtained are
processed with SPSS v.16.
RESULT
In this study, about 88 dental practitioners participated . 84 (95,4 % ) general dentists and
specialists as much as 4 people (4.5%). Based on the acquired gender is the highest proportion
of women with the number of 66 respondents (75%). Based on age, with respondents aged
between 25 - 40 years at most involved at around 56.8% .
Based on the level of knowledge, which is assessed is how voluntary respondents know
about ergonomics, and implementation aspects, as much as 55.7% of respondents have sufficient
knowledge, based on length of working hours per day obtained the largest proportion of 61.4%
of respondents with long hours of work per day is 3-4 hours. ( table 1 )
Tabel 1 Distribution of Respondents Based on working hours
Working Hour
3-4 jam
5-6 jam
> 6 jam
Total
Total
54
26
8
88
Percent (%)
61,4
29,5
9,1
100,0
Source : prime data
4
Based on the application of ergonomic working position sitting only about 38.6% of
respondents who apply them in daily practice, while 61.4% of respondents more often in a
hunched position when caring for patients. Table 2 shows that of 88 respondents, knowledgeable
enough about the ergonomics as many as 49 people (55.7%). Meanwhile, less knowledgeable
about ergonomics as many as 39 people (44.3%).
Tabel 2 Distribution of Respondents According to
Knowledgeable About Ergonomics
The Level of ergonomic knowledge
Knowledgeable Enough
Less knowdgeable
Total
Total
49
39
88
Percent (%)
55,7
44,3
100,0
Source : prime data
Based on the application of ergonomic working position standing 75% of respondents
standing in a straight posture and body supported by both legs while doing his job caring for
patients.
Graph 1 shows that respondents with enough knowledge to apply more ergonomic
aspects of work standing in a position
Graph 1: Distribution of Respondents Based on Knowledge and Working standing position
Knowledgeable of ergonomic
5
Graph2 : Distribution of Respondents Based on Knowledge and Work Sitting Position
Knowledgeable of ergonomic
The results based on the work process (the availability of tools and concepts of team
work), got all respondents (100%) has been working with dental equipment design standard in
ergonomic support, while 55.7% of respondents work with the help of an assistant.
Half of respondents (50%) work in a comfortable working environment and efficient to treat
patients.
In this study also acquired as much as 56.8% of respondents claimed to sometimes have
complaints of pain, with 25% of complaints of back pain, limb pain 23.9% and 8% of neck pain.
So when we see the application of ergonomic aspects based on respondent characteristics (age,
sex, educational level, knowledgeable of ergonomic, working hours and years of service) then
the result is, based on the aspect of ergonomics sitting positions: 51.9% applied by the male
respondents, 75% of dental specialists, 51% of respondents with adequate knowledge, 37% of
respondents with a long working 3-4 hours / day, 62.5% of > 10 years, and 64.7% with more
than 40 years old.
6
Aspect ergonomic standing position: applied by all respondents from all groups of
characteristics with a total of 75%.
Ergonomic aspects of work processes (team work): applied by 68.2% male respondents, 100%
dental specialists, 57.1% of respondents with adequate knowledge, 87.5% of respondents with
work duration more than 6 hours/day, 87, 5% more than 10 years, and 94.1% with more than 40
years of age.
Ergonomic aspects of work environment: 63.6% applied by the male respondents, 100%
dental specialists, 65.3% of respondents with adequate knowledge, 65.4% of respondents with
working long 5-6 hours /day, 100% of the time it works 8-10 years & more than 10 years, and
100% with more than 40 years of age.
DISCUSSION
Increasing knowledge about the benefits of an object or information that is available is
expected to increase the use of objects or information. With the knowledge of good dental
practitioners in every aspect of ergonomics in general and specifically in the field, so hopefully
they can understand the intent and purpose of the application of ergonomic aspects during the
work. The results of this study showed that 55.1% of respondents (27 people) with enough
knowledge about the aspects of ergonomics, has applied aspects of ergonomics in terms of sitting
working position. While in terms of standing working position, both groups of respondents have
a percentage above average, with most respondents apply the ergonomic aspects of work in
standing position, the total percentage was 75%. In terms of percentage of the working process is
obtained which is also not much different between respondents who included a group of
knowledge sufficient and less, as many as 57.1% of respondents with knowledge sufficient to
work with the help of an assistant, and as many as 53.8% of respondents with less knowledge
7
level is also working with the help of assistants. In terms of working environment, as much as
65.3% of respondents with adequate knowledge (32 respondents) who felt he had to work in a
comfortable and efficient.
Similarly in terms of implementation aspects of ergonomics, working hours per day that
many will cause lack of concentration and productivity in carrying out the work. This is then
triggered less attention to the implementation aspects of ergonomics. Based on hours of work,
the group of respondents the most widely applied ergonomics aspects in terms of sitting working
position is a group that works for 3-4 hours per day that is as much as 37% (20 respondents).
While in terms of standing working position, all groups have a percentage above average, most
respondents apply ergonomics aspects of work in standing position, the total percentage was
75%. In terms of work processes (fourhanded-dentistry) groups of respondents the most widely
applied aspects of ergonomics is groups that work > 6 hours per day with a percentage of 87.5%
(7 respondents). In terms of working environment, the percentage of the application of
ergonomic aspects most be obtained from the respondents with long hours of work 5-6 hours per
day that is as much as 65.4% (17 respondents).
The longer a practitioner of dentistry work in the field, it is increasingly expected to have a
heightened vigilance against the risk of accidents and occupational disease that may arise during
the performance of their duties. The result of this analysis, a fairly high percentage of the
application of ergonomic aspects in terms of sitting working position obtained from respondents
with 8-10 years old working lives as much as 100%, and respondents with a long period of > 10
years as much as 62.5% (10 respondents), while in terms of standing working position, the four
groups have a percentage above average, most respondents apply the ergonomic aspects of work
in standing position, the total percentage was 75%. In terms of work processes (fourhanded
8
dentistry), showed the longer the period of the respondent, the greater the percentage of the
application of ergonomic aspects in terms of work processes, seen from the results obtained from
the percentage of respondents with a group of 8-10 years working lives as much as 100% and
from groups working period > 10 years as many as 87.5% (14 respondents). In terms of work
environment, respondents 80-10 years of service with the group and > 10 years had a percentage
of 100%.
From the data obtained showed that most respondents apply ergonomics aspects in terms
of sitting working position is included in the group of respondents more than 40 years of age
with a percentage of 64.7% (34 respondents). While in terms of standing working position,
respondents from the age groups have a percentage above average, most respondents apply
ergonomics aspects of work in standing position, the total percentage was 75%. In terms of work
processes (fourhanded-dentistry), respondents most work with the help of an assistant (team
work) is included in the group of respondents more than 40 years old with a percentage of 94.1%
(16 respondents). In terms of working environment, the implementation ergonomic aspects of the
most widely implemented by the respondents of the age group 36-40 years and > 40 years old
that is as much as 100%. The above results illustrate that with increasing age more and more
practitioners learn from experience so that more attention to performance and effectiveness in
carrying out the task, one with the increasing application of ergonomic aspects of patient care in
performing their duties.
From the data obtained showed that most respondents apply the ergonomic aspects of work in
terms of sitting position is the male respondents with percentage 59.1% (13 respondents), while
female respondents only give a percentage of 31.8% (21 respondents). While in terms of
standing working position, respondents from both groups have a percentage above average, most
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respondents apply ergonomics aspects of work in standing position, the total percentage was
75%. Under the terms of the work process (fourhanded-dentistry), respondents most widely
applied aspects of ergonomics is the male respondents premises percentage of 68.2% (15
respondents), while the percentage of female respondents gave 51.5% (34 respondents). In terms
of work environment, respondents are most widely applied aspects of ergonomics is the male
respondents as much as 63.6% (14 respondents), while 45.5% female respondents who apply
ergonomics aspects in terms of working environment.
From this study which participated by 88 respondents, obtained a total percentage of
practitioners working in a sitting position that ergonomics are just as much as 38.6%, while
61.4% of respondents more likely to be in a position bent at work sitting. This is consistent with
the literature of Furlong and Rucker who said that sometimes the operator or practitioners of
dentistry, are unknowingly be in a position that is less supportive posture when performing
maintenance on the patient. While doing preparation tooth or tooth extraction for example,
sometimes the position of the dentist leans over the patient and the position of this kind done
many times in the time period long enough.
From the research that participated by 88 respondents, found the percentage of
respondents who work in a standing position that ergonomics is 75% (66 respondents). These
circumstances support the literature from Valachi who stated that several recent studies suggest
still pain persists, it's just today's pain that arises occurs in the upper back, neck, shoulders, and
wrists. In practice dentistry in particular the daily work process is associated with the existence
of facilities / equipment for ergonomic support so as to produce a good working attitude as well,
besides the work processes are also not separated from the concept of teamwork in this case the
relationship between the practitioner / operator and assistant. From the results of research with
10
participated by 88 respondents, it was found that all respondents (100%), working with facilities
supported by the existence of ergonomics. While based on the concept of team work, gained as
much as 55.7% (49 respondents) who works with the help of a trained assistant, while 44.3% (39
respondents) work without the help of an assistant.
Ergonomic work environment is an aspect that can not be dismissed, according to the
literature by Manji a comfortable working environment can also improve performance in this
work improve workforce performance in this regard, practitioners in the field of dentistry. In
addition, an efficient environment in the sense, the placement of equipment table, easily
accessible, good air circulation and adequate lighting are also strongly support the effectiveness
of practitioners, as well as patients treated. In this study that participated by 88 respondents, half
of them (50%) admitted work in a comfortable working environment and efficient to perform
patient care, while the other half felt the environment in which they work not quite comfortable
and efficient for patient care.
As has been described previously a dentist job demands tenacity and thoroughness, it
sometimes makes the dentist unknowingly be in a position that is not ergonomic in a long time,
especially when dealing with certain cases, the study found as many as 56.8% respondents who
claimed to sometimes have complaints of pain after the procedure the patient in a fairly long
period, 25% of complaints of back pain, limb pain 23.9% and 8% of pain in the neck.
CONCLUSION

The level of knowledge about a person's information will be very influential in the
application or the application of the information itself in this case in particular is the aspect
of ergonomics. It can be seen from the results of research in which respondents with a higher
level of knowledge sufficient percentage of every aspect of ergonomics is reviewed.
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
Long hours of work per day quite influential in the application of ergonomic aspects, in
which respondents with longer working hours 3-4 hours to maintain an ergonomic sitting
position, while respondents who worked >; 6 hours, more work with the help of an assistant.

Respondents with longer working lives more aware of the importance of applying
ergonomic aspects of work, so that the research found that respondents with a period of>
10 years showed the greatest percentage in the application of ergonomic aspects of the
research dipartisipasi by 88 respondents, found the percentage of respondents who worked
in a standing position that ergonomics is 75% (66 respondents). This indicates that most
dental practitioners have implemented ergonomics aspects of work based on the position of
standing Practitioners who work in a sitting position that ergonomics are just as much as
38.6%, while 61.4% of respondents more often in the position of bending while working
duduk.Hal This indicates that many dental practitioners who have not applied the
ergonomics aspects of work based on the position of sitting.

In a study which participated by 88 respondents, half of them (50%) admitted to work in a
comfortable working environment and efficient to perform patient care, while the other half
felt the environment in which they work not quite comfortable and efficient for patient care
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