WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

DESIGN REQUIREMENTS FOR WORKING CHAIRS

OF A DENTAL THERAPIST

Domljan Danijela, Ph.D.

Ivica Grbac, Professor
Zoran Vlaović, Ph.D.

Zagreb University, Faculty of Forestry

Vlado Carek, Professor.

University of Zagreb, School of Dental Medicine, Croatia

Svjetlana Čolić, B.Sc.

Zagreb University, Faculty of Forestry

Croatia

domljan@sumfak.hr
ivica.grbac@zg.t-com.hr
vlaovic@sumfak.hr
carek@sfzg.hr
svjetlana.colic@gmail.hr

ABSTRACT
Special occupations, like dental therapists, due to inappropriate furniture during their
working years, don't have proper body posture which in turns brings them pain in spine, as well
as arms, back and neck.
The purpose of the research was to define the designer requirements for dental
(therapeutic) chairs, surveying methods, observing, photographing and recording real-life
situations and needs of a dental therapist in their offices. Research results have shown that the
therapeutic chair must be designed in such a way that enables maximum freedom of movement
with as less as possible of unnecessary movements and that the education of users on the
applications of possible solutions is essential. The paper provides guidelines for further
interdisciplinary research, thus providing an important contribution in maintaining and
improving the health of dentists. New findings enable entry into the areas of science and
applied researches on European and world level, which helps the wood sector and construction
and design of wood products to find their place on the international marker.

Key words: work chair for special occupations, dental therapist, work sitting, dental office,
design, healthy sitting, "healthy" furniture

33
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

1. INTRODUCTION

Throughout history, great progress is visible in the doctor's profession in question of

preservation of health, and lately, people - the patients themselves, have increased care for
themselves and their health. This is obvious through diet, healthy living, physical activity and
sports, use of materials, products (and furniture) and numerous other segments. Still, no matter
how much we believe the state of mind has changed regarding health prevention, insurance of a
healthy working environment is still a big issue in Croatia and worldwide. Insufficient number
of research on world level shows the extent of work that is ahead of researches, with the
purpose of improving and preserving the worker's health. This mostly relates to office workers,
students and special (specific) occupations, like for example dental therapists.
Regulations brought by the European Union and those that are obligatory for Croatia
once she enters the Union are just one segment in the insurance of general quality and safety of
product, and the preservation of health. Non-investigated segments relate to the course of
formation of concerned and perceptive environment (environment, furniture and equipment)
which must satisfy the user's expectations and demands and to ensure better health conditions
for work.
Paper is based on study of parameters for future design of work chairs for dental
therapist where the user-therapist is the starting point of the research. Research was taken in
cooperation with the University of Zagreb Faculty of Forestry and School of Dental Medicine
as well as Stomatological Polyclinic in Zagreb which had a primary goal to determine designer
requirements for the design of dental (therapeutic) chair, surveying methods, observing,
photographing and recording real-life situations and needs of dental therapists at their work
places in their offices.
We would hereby like to thank all the participant and experts for their participation and
implementation of research.

2. PROFESSIONAL ILLNESSES OF DENTAL THERAPISTS

Growing problem of a modern man are injuries and pain in locomotive system (spine
and joints) caused by summed microtraumas which are the result of inadequate body postures
during long-term work (Grbac and Domljan 2007). Certain worker's population, especially
those specific occupations where body is in an inadequate position during working or sitting,
are included into special risk groups. Persons like dentists, in their working lives, due to
inadequate furniture and equipment don't have appropriate body posture while working,
causing them to suffer from spine pain, as well as pains in arms, back and neck (Čolić 2010).
It is generally known fact that professional physical damages are more frequent at
dentists (Mijoč 2010). Their work demands great physical and psychological strain, but so far,
there were few attempts made to explain these issues (Tomić 2001). Analysis of professional
damages for dentists pointed out to a need to develop dental equipment and furniture which is
specially shaped in order to prevent such occurrences. Sector which deals in the production of
equipment and furniture for dental offices, in order to improve health condition of a dentist and
ease his/her work with a patient, is constantly improving this type of products, but so far, more
care has been given to the patient and not to the therapist who is for several hours a day, every
day, in the same, physically unfavourable body posture. It has been noted that the most frequent
physical damages for therapists are in locomotive and cardiovascular system of organism
(Blažić-Potočki 1992, Mijoč 2010, Čolić 2010).

34
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

2.1. Dentists' pain and disorders while working

According to the research of Finsen et al. (1998, quoted in: Vodanović and Grgurev
2007), the largest number of muscular and skeletal disorders of dental therapists mostly attack
back and neck, more so with males. Along with the mentioned neck and back, several
inappropriate body postures are noticed which affect the appearance of different pain
syndromes and manifestations (Vodanović 2006, Vodanović and Grgurev 2007), these being
lower back pain syndrome, disorders of vertebral dynamic segment, neck-pain syndrome,
physical factors and disorders, effects of hand position on the fist grasp while in a sitting
position and other (Njemirovskij 1971, Ćatović et al. 1985, Blažić-Potočki 1992, Čolić 2010).
By observing the movements of dental therapist, it has been noted that the subjects don't
stay in the same position for long time (Njemirovskij 1971). Dentists often change his/her
position during work. These are spatially very small displacements, but are very frequent in
time, and they alternate by returning into initial position. By studying video footages, it has
been determined that there are mostly four possible working positions (Figure 1). Dentist's
posture was therefore determined by treatment which is performed on a patient and it depends
primarily on whether it is done directly or indirectly. All other variations cannot be considered
as characteristic (Njemirovskij 1971).

Figure 1. A) by standing “directly” over the lying patient; B) by sitting “directly” over the lying patient; C)
by standing “indirectly” over lying patient; D) by sitting” indirectly” over the lying patient.
(Njemirovskij 1971)

Preliminary research started on the University of Zagreb Faculty of Forestry and School
of Dental Medicine has shown that there are similar problems to this profession.
Mijoč (2010) collected information in his researches, where real-life situations were
photographed and the positions of dental therapists while working with patients in offices and
problems of this target population were recognized (Figure 2). Also, in his paper, he proposes
design of a chair which would enable half-sitting/half-standing, which is firm and stable,
adjustable in height according to every individual user so that individuals wouldn't have to
bend too much, stretch or strain while performing everyday dental procedures. In conversation
with dental therapists and by defining the requirements for an "ideal" (or: optimal) chair for this
group of users, questions arise on the dependence of working chair where dentist is seated and
a patient's chair or bed. They greatly depend on each other, and changes of patient's positions
could be considered in relation to the working body posture of a dentist (Mijoč 2010).

35
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

Figure 2. Body postures of a dental therapist while sitting down (Mijoč 2010)

This paper is a follow-up on the results of research of authors Čolić (2009), Kruljac
(2009) and Mijoč (2010) - the students of the Faculty of Forestry in Zagreb.

4. PURPOSE OF THE STUDY

The purpose of this study is to define designer requirements for the design of dental
(therapeutic) chair by methods of observing, measuring, photographing and recording real-life
situations and needs of users (dental therapists) at their work place (office).
The ultimate purpose is to define a requirement which will enable design of appropriate
products which will prevent illnesses, affect preservation and improvement of health and
enable the development of new knowledge on furniture for sitting adjusted to the needs and
habits of target group of users.

5. METHOD OF WORK AND MATERIALS

5.1. Samples
Samples (Figure 3) for the implementation of research were different models of dental
therapeutic chairs. Total of five models were mutually different in form, structure and
technology of design.
Two models of chairs were studied at the School of Dental Medicine in Zagreb, one of
which was an older model, and the other was its modern version. The subjects were sitting on
both chairs and after that, they filled-in the questionnaire.
Stomatological Polyclinic Zagreb tested three models of chairs, which were mostly used in
departments and which were also different in shape, construction and technology of design.

Figure 3. Chair samples (photo: Čolić 2010)

36
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

5.2. Subjects and testing ground

Research was done on total of 52 dental therapists. Group of subjects consisted of 33
females and 19 males, in average age of 50.4 years, weight of 75.5 kg and height 172.05 cm.
Research was done at the University of Zagreb School of Dental Medicine and Stomatological
Polyclinic in Zagreb in period from July to October 2010.

5.3. Research methods

5.3.1 Questionnaire

The questionnaire contained 28 questions divided into two groups.

The first part of questions related to the application of working chair, the time of sitting,
position while sitting and pains the dentists feel. Their opinions in the area of needs and
demands on the design of chair are of great importance for defining instructions for the design
and formation and construction of this type of products. The possibility was to circle one of the
proposed answers below every question which best describes their opinion and needs.
The second section relates to the comfort during use where factors of uncomfort and
comfort are listed. The subjects also had the opportunity to circle one of the proposed answers
which describes their feeling, impression or effect in the best possible way.

5.3.2 Observation and photographing

Photographed subjects and samples were observed, in order to see the real situation and
working positions of dental therapist. The relationship of the subject and the sample as well as
the subject and patient rise to surface with this method, and numerous shortcoming and
irregularities can be seen in the body posture of a dental therapist, which in the long-run most
certainly causes health issues.

6. RESEARCH RESULTS

In the study the authors stress out some of the most significant results in subjects's
answers and collected photodocuments, based on which guidelines were brought for further
research and design of therapist chair.

6.1. Results of questionnaire

Results of subject's answers show that in relation to the frequency of use of work chair
during office hours, 35% of subjects use the chair whole the time, 30% use it over an hour,
while 10% don't use it at all. This is mostly older population of workers who didn't get the habit
of sitting in a chair during their working years.
Subjects occasionally (56%) change working positions, while as much as 38% change
them always. The range of positions is from standing, sitting, bending and leaning to walking.
Chart 1 show the most frequent body postures of subjects while working.

37
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

Common body posture during work

standing with bent torso, hands

3
toward patient

standing along patient body

14
(laterally)

standing above patient head

5
(frontal)

sitting with using backrest 5

sitting and leaning forward 45

sitting without using backrest 16

0 10 20 30 40 50
%

Chart 1. The most common body posture of dental therapist while working

Greater number of subjects (94%) occasionally feels pain while working, mostly in their
back (45%), shoulders and neck (41%). They also express muscle pain as well (80%). Feet
swelling sometimes appear at 37% of subjects, while as much as 59% have no such problems.
Most of subjects (80%) think that the seat has appropriate hardness. 56% of subjects feel
uneven pressure of seat on tights and backside, while as much as 42% never have that feeling.
As much as 62% of subjects occasionally feel stiff while working and are sitting restlessly, and
88% occasional feel tired and uncomfortable.
The subjectivity of the sense of uncomfort and comfort is seen in the answers to
questions about whether they feel rested (occasionally, 85%) and relaxed (occasionally, 80%).
72% of subjects feel comfortable while sitting in a chair.
In answers to questions which relate to the subject's propositions and future requests on
the design of chair, subjects are moderately satisfied by existing solutions they use (90%), and
think that it is desirable that the chair follows the movement of subject (81%) and that it has the
option of adjusting the height of seat and back (100%).

6.2. Results of observing and photographing

Photo-documentation and analysis of body postures of dental therapists at the
University of Zagreb School of Dental Medicine point to reality and alarming state of the
problem (Figure 4).

38
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

Figure 4. Body postures of dental therapists while standing (photo: Čolić, 2010)

For the purpose of reducing the risk of pain in arms, back, joints, neck and eyes, besides
the properly designed dental chairs, there is also a series of influencing factors which were
discovered through photographing and by talking to subjects, namely:
• proper position of shoulders
• appropriate hand rest
• placing of light near the cavity without blocking the view of the dentist
• use of surgical magnifier
• help of an assistant (four hands work)
• resting of elbows during patient treatment
• equipment which allows the dentist's feet to be placed directly below the patient during
treatment, etc.

7. DISCUSSION

Common appearance of professional illnesses of dental therapists demands special

attention. Dentist should work equally in time and by alternating positions, from standing,
sitting to all necessary interpositions. Body posture needs to be proper, and forced and
unnatural positions need to be avoided. Alternating the positions is important because of
muscle relaxing, and also because of elimination of cramps and damages to the locomotive
apparatus. Since the body of a dental therapist is exposed to everyday stress, it is necessary to
design furniture elements and equipment which relax the body and contribute to the
improvement of health of a therapist.
Received answers can be explained in several ways, however they enable sufficient
guidelines for defining the requirements for design of dental therapists' chairs. It is important to
mention that in further research, psychologists dealing in this type of problems shall be
included in the processing of questionnaires, with the purpose of receiving better results.
Dentists can be included into the group of "workers" who mostly work in the combination of
sitting-standing postures in their offices. This is supported by processed answers and photos.
Namely, the subjects spend mostly 8 hours a day in their office, and most of them sit on a chair
almost all working hours. More than half of dentists change during working hours their
positions due to uncomfortable and soft seat. It is noted that chairs do not fill in all the
structural, functional, aesthetic, health and ergonomic conditions which are necessary for a
concentrated and productive dentist's work. Since the subjects sometimes point to pain and
physical difficulties, the existing solutions demand further adjustments, mostly regarding the
functionality and health of users.

39
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

All of the above led to the defining of requirements for the design of product which
dental therapists will be able to use in a certain way, with the purpose that the product does not
affect health, that is stimulates pleasure and comfort during application and stay in doctor's
offices.
By discussing it with dentists, conclusion has been made that most of the older dentists
are not used to sitting while working, while younger generation is being taught how to work
while sitting in chairs.

7.1. Design requirements

Therapeutic chair must be designed in such a way that it enables maximum freedom of
movement with as less unnecessary movements as possible. Patient must be positioned in ways
that will make him/her comfortable during working, and dentist shall enable efficient
implementation of surgery with minimal musculatory load. Instruments, manual and machines,
must have their handles designed in a way that will enable optimal hand grasp with as little
squeezing as possible. It is desirable to avoid long-term work with devices that create
vibrations. It is essential, in the design requirements, to single out the aesthetic, ergonomic,
construction, medical and other requirements with shorter guidelines:
Aesthetic requirements. Chair must be appealing, innovative, functional, easily adaptable to
space and purpose, made from the combination of natural and artificial materials which are
easily maintained. Materials used for chair design must be safe, quality, non-poisonous and
easily available and must provide warmth and comfort during use through its colour and tactile
characteristics. They should prevent undesirable sliding of body (backside) by appropriate
coating material over the seat, with special care given to the light and easy maintenance.
Ergonomic requirements. The most important relationship is the one between the user -
product - surrounding. Chair should be easily adjustable according to the individual needs of
dental therapists and their antropometric dimensions (adjustable according to height and angle
of back), and should have hand rests and feet rests. Seat should have cushions, and the angle of
back should be adjustable and larger than 90°. Back should follow natural line of human spine
so that there are no unnecessary strains during sitting.
Structural requirements. Structure should be firm and stable in order to avoid the possibility
of fall during reclining of body towards front/back, to the left/right. Screws and other binding
elements should be countersunk in order to prevent injuries, and the borders should be specially
processed, because they are the ones that are most exposed to friction. It is possible to look at
several options (moving of seat, back, hand rest etc.) of structural solutions, which are
especially related to shaped and functional requirements.
Medical requirements. It is important that further research include experts from psychological
medicine, orthopaedics, anthropology and biological anthropometry, dentistry, anatomy and
other areas and institutions of high education in order to design an optimal product.
Technical and technological requirements. Chairs should be designed according to standards
and functional dimensions. Technological options of potential producers must be taken into
consideration for this type of products and solutions should be adjusted to real possibilities, and
different types of materials should be taken into considerations, not just from the point of view
of mentioned structural and aesthetic requirements, but from the technical-technological
(firmness, elasticity, density and other mechanical properties of material; other physical
properties etc.) and to execute the optimisation of solution. In this regard, it is important to
adhere to the rules and standards which are already being followed by valid laboratories for
testing of furniture in Croatia, and this will undoubtedly come more into attentions by Croatia's
entering into EU, especially regarding the technical and general quality of products.

40
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

Economic requirements. From the economic point of view, price level must be determined for
certain type (solution) of product. Lifetime of product, flexibility of delivery, market
inventiveness and usability are what is important. It is possible to design a competitive product
for domestic and foreign market by obeying by the set parameters.

8. CONCLUSION

It can be deducted from the results of this research and from previously conducted
researches as well, that there isn't a dentist, who didn't feel some type of pain or health
problems during his working life, which appeared as a consequence of dealing in the dental
profession. Why such disorders arise and how to stop them in due time, prevent and treat are
the imposing questions, and which should most definitely be taken into consideration while
solving the problem of product design, in this case, furniture for target audience - dental
therapists.
Special care must be given to the patient chair as well. Professionals from various
interdisciplinary areas should be included in further studies, who would in equal measure be
devoted to the finding of needs, requirements and design of dentist's chair as well as patient's,
and to the development of prevention and new knowledge on furniture for sitting which are
adjusted to the needs and habits of dentists and patients.
Study has been presented as pre-study of the given subject-matter and opens up numerous
options in further interdisciplinary research of the problems of sitting and the target group of
users - dental therapists. Interdisciplinary studies are also of great importance with financial
support in the projects of EU which deal in similar problems. New findings enable entry into
the areas of science and applied research on the European and world level, which helps the
wood sector and sector of construction and design of wood products to find their place on the
international marker.

REFERENCES

1. Blažić-Potočki, Z. (1992): Professional dental injuries during operation (Profesionalna

oštećenja stomatologa pri radu), master thesis. University of Zagreb School of Dental
Medicine, Zagreb (in Croatian)
2. Ćatović, A., Kosovel, Z., Muftić, O. (1985): Influence of arm position on a handful of
operations in a seated position of the dentist (Utjecaj položaja ruke na zahvate šakom kod
sjedećeg položaja stomatologa), Acta stomatologica croatica, 19 (4): 277-281.
3. Čolić, S. (2010): Design of the working chair for the dentist-therapist (Oblikovanje radnog
stolca za stomatologa-terapeuta), graduate work. University of Zagreb Faculty of Forestry,
Zagreb
4. Čolić, S. (2009): Occupational diseases of dentists. Dental chair. (Profesionalna oboljenja
stomatologa. Stomatološki stolac.), seminar. University of Zagreb Faculty of Forestry,
Zagreb (in Croatian)
5. Grbac, I., Domljan, D. (2007): Namještaj i zdrav život, Sigurnost, 49 (3): 263-279.
6. Kruljac, A. (2009): Dental chair, (Stomatološka stolica), seminar. University of Zagreb
Faculty of Forestry, Zagreb (in Croatian)
7. Mijoč, A. (2010): Design of working chairs for dentists (Oblikovanje radne stolice za
stomatologe), final work, Sveučilište u Zagrebu Šumarski fakultet, Zagreb (in Croatian)
8. Njemirovskij, Z. (1971): A new way of working in dental medicine practice (Novi način
rada u zubnoliječničkoj praksi), Acta stomatologica Croatica, 6(2): 82-92.

41
 WOOD IS GOOD – EU PREACCESSION CHALENGES OF THE SECTOR

9. Tomić, I. (2001): Occupational diseases of the spine in dentistry (Profesionalno oboljenje

kralješnice u stomatologiji), graduate work. University of Zagreb School of Dental
Medicine, Zagreb (in Croatian)
10. Vodanović, M. (2006): Ergonomics and the occupational disease of dentists (Ergonomija i
profesionalne bolesti stomatologa). Hrvatski stomatološki vjesnik, 13 (4): 29-34.
11. Vodanović M., Grgurev I. (2007): Occupational diseases of dentists: the syndrome of neck
pain syndrome and pain of the cross (Profesionalne bolesti stomatologa: sindrom bolnog
vrata i sindrom bolnih križa). Hrvatski stomatološki vjesnik, 14 ( 4): 57-60.

42