Patient and

Operator Position
INTRODUCTION
.The patient and operator position are important for the benefits of both individuals
A patient, who is comfortably seated in dental chair with right posture is going to
experience less muscular strain, less fatigue and is more cooperative during the
treatment. The same is the case with operator. If operator maintains proper position
and posture during treatment, the operator is less likely to get strained, fatigued, be
more efficient and has less chances
.of getting musculoskeletal disorders
Following points should be kept in mind in relation to dental chair
l chair
It should be able to provide comfort to the patient
It should be able to provide total body support during working
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 It is always
.preferred to have programmable operating position
CHAIR AND PATIENT POSITIONS
Dental chair and patient positions are important aspect in restorative dentistry. Modern
dental chairs are properly designed so as to provide total body support and comfort in any
. position
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, whether the dental chair base
.is parallel or slightly at an angle to the floor
The dental chair should be designed in such a way that it should provide maximum
.working area to the operator
The foot switches are preferred than hand switches so as to improve infection control.
.And the adjustable control switches should be conveniently located
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

For restorative dental procedures, the most preferred operating positions are
Upright position
Almost supine
.Reclined 45 degree
• Operator and the patient should maintain proper posture so as to have less muscular
strain, less fatigue and more efficiency:
• (A) Correct posture; (B) Incorrect posture
• Upright Position
• This is the initial position of chair from which further
• adjustments are made.
• Almost Supine
• In this, chair position is such that:
• • Patient’s head, knees and feet are approximately at same level
• • Patient is almost in a lying position as the name indicates
• • Patient’s head should not be lower than feet except in case of syncopal attack.
 Reclined 45 Degree
In this position, chair is reclined at 45° •
.Mandibular occlusal surfaces are almost at 45° to the floor •
OPERATING POSITION

Accurate operating positions are essential while doing restorative work so as to increase the
.efficiency and to decrease physical strain

The position of the patient depends upon the procedure to be performed. Most of the dental
procedures are performed with the patient in the supine position. Once the patient has been
comfortably positioned, the dentist and the assistant should sit in the proper positions for
.treatment

Usually, sitting position is preferred in modern dentistry to relieve stress on operator’s leg and
support the operator’s back. The level of teeth being treated should be same as that of operator’s
.elbow
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)
,can be 7 o’clock
,o’clock 9
,o’clock 11
and 12 o’clock and
for left handed operator, it can be
,o’clock 5
o’clock and 3
.o’clock (Fig. 9.6) 1
 Right Front Position (7 o’clock)
It helps in examination of the patient •
Working areas include •
Mandibular anterior –
Mandibular posterior teeth (Right side) –
Maxillary anterior teeth –
.To increase the ease and visibility, the patient’s head may be turned towards the operator •
 Right Position (9 o’clock)
In this position, dentist sits exactly right to the patient •
Working areas include •
Facial surfaces of maxillary right posterior teeth –
Facial surfaces of mandibular right posterior teeth –
.Occlusal surfaces of mandibular right posterior teeth –
Right Rear Position (11 o’clock)
In this position, dentist sits behind and slightly to the right of the patient and •
the left arm is positioned around patient’s head
This is preferred position for most of dental procedures •
Most areas of mouth are accessible from this position either using direct or indirect vision •
Working areas include •
Palatal and incisal (occlusal) surfaces of maxillary teeth –
.Mandibular teeth (direct vision) –
 Direct Rear Position (12 o’clock)
Dentist sits directly behind the patient and looks down over the patient’s head during procedure •
Working areas are lingual surfaces of mandibular teeth •
.This position has limited application •
CONSIDERATIONS FOR DENTISTS WHILE DOING PATIENT

While doing work in maxillary arch, maxillary occlusal surfaces should be oriented •
perpendicular to the floor
In mandibular arch, mandibular occlusal surface should be oriented 45° to the floor •
Patient’s head can be rotated backward or forward or from side to side for operators ease •
and visibility while doing work
Dentist should not sacrifice good operating posture as it will decrease visibility, •
accessibility and efficiency
.Maintain proper working distance during dental procedure •
This will result in increased cooperation and confidence from the patient
Another important point is to avoid minimize body contact with patient. Dentist should •
not rest forearms on the patient’s shoulders and hands on the face of the patient
Dentist should not use patient’s chest as an instrument trolley •
The operator should leave left hand free during most of dental procedures for •
retraction using mouth mirrors or fingers of left hand
Operator should keep changing position if procedure is of long duration to decrease •
the muscle strain and fatigue
Operating Stool
. Many types of operating stools are commercially available
An operating stool should have some features like it should
Has casters for mobility and easy movement •
Be sturdy and well balanced •
Has seat which is well padded with cushion •
.Has adjustable backrest to provide full support to the dentist •
SITTING ARRANGEMENT OF OPERATOR AND ASSISTANT (FIG. 9.12)

The dentist should sit on the back of the cushion rather than edges •
The dentist should sit on the stool such that •
Spiral column is straight or slightly bent taking the advantage of backrest –
Thighs are parallel to the floor –
.Lower legs are perpendicular to the floor –

The patient should be lowered to a position that keeps the •

treatment site as close to the dentist’s elbow level as
possible. When the patient is properly positioned, the
dentist’s eyes should be 14 to 16 inches from the treatment
. site
Nowadays, stools having backrest with curved extensions that provide additional •
.body support are also available
If seat is positioned too high, the edges will cut off supply to user’s legs resulting •
.in more fatigue and stress
Assistant should sit as close as possible to the back of the patient’s chair with feet •
.directed towards the head of the chair