Dental surgery clinical skills in almost all dental schools around the world get the operator to work around the phantom head. Unfortunately the skills that develop usually have the operator working in a distorted posture. They fail to utilise four-handed chairside ergonomic principles, placing all members of the dental team at risk of working in a distorted posture (Paul E, 1981; Paul E, 1983).

One’s body will not tolerate such stresses being placed upon the spine. Ergonomic research coming out of the United States is showing how common symptoms start to develop in dental students, while research in England and Canada is taking the first steps in showing what happens when the back breaks down and how the posture of the dentist is severely compromised if working in the manner illustrated in Figure 2 (Rising DW et al, 2005; Marklin RW, Cherney K, 2005).

However, this does not have to be inevitable. Correct integration of the dental nurse into the team allows both the dentist and the nurse to work in an ergonomic manner, keeping their spines in a neutral posture.

The most common reason for premature retirement from the dental profession has been shown to be due to musculoskeletal disorders (particularly in the neck), and it is in this way that the failure of this basic clinical posture necessity manifests itself at its most serious (Burke FTJ, Main JR, Freeman R, 1997).

I believe that dental ergonomics should be integrated into the curriculum for all members of the dental team, and I do hope that the IDNA will start to take the necessary steps to safeguard its members.


Burke FTJ, Main JR, Freeman R (1997) The practice of dentistry: An assessment of reasons of premature retirement. BDJ 182: 250-254

Marklin RW, Cherney K (2005) Working posture of dentists and dental hygienists. J Calif Dent      Assoc 33: 133-136

Paul E (1981) Are you sitting comfortably? Dental Update 8: 559-566

Paul E (1983) Four-handed dentistry: Principles and techniques Dental Update 10(3): 155-7, 159-160, 162-164

Rising DW, Bennet BC, Hursh K, Plesh O (2005) Reports of body pain in a dental  student population. JADA 136: 81-86