Neutral Posture Isn’t Optional — It’s Essential for a Thriving Dental Team

If you’ve practiced dentistry, you understand how hard it is on your body. We feel it in ourselves and see it in our teams. Sometimes, even students develop pain or injury before they’ve graduated! Now, more than ever, it’s important to take care of ourselves and our teams. It’s becoming increasingly challenging to find and retain team members in dentistry, and many practices are struggling with staffing shortages. What if we could take better care of them (and ourselves), so we can continue practicing in the field we love?

The prevalence of musculoskeletal pain and disorders (MSDs) in dental clinicians is well documented in the literature — ranging from 64% to 96%.[1][2] Apply those numbers to your own team: this means most of the people in your office are likely in pain. According to research, high pain rates are due to repetitive movements, bending, twisting, reaching, incorrect operator and patient positioning, and performing static, repetitive tasks.[1][2] Infrequent breaks and insufficient rest time also contribute to the development of MSDs.[3]

Practicing clinical dentistry places incredible strain on the musculoskeletal system. As the research shows, dental clinicians are at high risk for developing MSDs. In fact, these disorders are one of the leading causes of disability in the United States.[4] According to studies, a dentist has a 50% chance of early retirement due to ill health.[5] One-third of dentists who retire early are forced to do so because of a musculoskeletal injury.[6] Again — apply this to the dentists you know. It’s shocking to consider that half of them may retire before they’re ready.

With this knowledge, it’s critical that dentists understand ergonomic principles if they hope to enjoy long, healthy careers. Ergonomics is essential for the entire dental team — especially in this current climate of staffing shortages and clinicians leaving the workforce, often due to injury. When we keep our team members healthy and happy, it translates into a thriving practice.

While there are many aspects of ergonomics in dentistry, this article focuses on one foundational principle: neutral posture. Dental clinicians must treat neutral posture as their “home base” — the anchor from which all other movements and setups are adjusted. Once this is understood, the patient chair, operatory layout, and even instruments can be optimized around this posture.

Start by establishing neutral posture before adjusting the patient or chair. Ideally, the clinician should use a fully adjustable operator stool — with lumbar support, seat pan, and chair height customizable to individual needs. Sit on the stool, pull the lumbar support forward into the low back curve, and adjust the height as needed. Ideally, the thighs should slope downward slightly, with hips at about a 105–125° angle. Opening this hip angle decreases muscle activity in the low back and reduces spinal disc pressure.[6]

Next, establish a neutral spinal posture: press the chin back to align the ear with the shoulder, roll the shoulders back and down, tilt the head forward no more than 20°, and bend the elbows at 90° with arms close to your sides. (Watch a video on stool adjustments [here].)

Only after this posture is set should the clinician adjust the patient chair, patient head position, and surrounding supplies to help maintain that posture. Many seasoned clinicians develop a forward head position — when the ear juts forward of the shoulder — after years of poor posture. This condition is not only painful but often considered aesthetically undesirable. The best prevention is body awareness and the use of ergonomic loupes to keep the head properly aligned.

Other factors — such as clock positions, patient positioning, operatory design, and ergonomic tools — also affect physical and mental well-being. But if clinicians begin with neutral posture, they’re already ahead of the game.

References

1. Hayes M, Cockrell D, Smith DR. A systematic review of musculoskeletal disorders among dental professionals. Int J Dent Hyg. 2009;7(3):159–165. doi:10.1111/j.1601-5037.2009.00395
2. Ohlendorf D, Maltry L, Hänel J, et al. SOPEZ: Study for the optimization of ergonomics in the dental practice—musculoskeletal disorders in dentists and dental assistants: a study protocol. J Occup Med Toxicol. 2020;15:22. https://doi.org/10.1186/s12995-020-00273-0
3. McLean L, Tingley M, Scott R, Rickards J. Computer terminal work and the benefit of microbreaks. Applied Ergonomics. 2001;32:225–237.
4. World Health Organization. Musculoskeletal Disorders. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (Published February 2021, Accessed July 2021).
5. Hoevenaars JG. [Dentist and disability: a matter of occupational disease?]. Nederlands Tijdschrift Voor Tandheelkunde. 2002 Jun;109(6):207–211. PMID: 12092335.
6. Valachi B. Practice Dentistry Pain-Free. Portland, OR: Posturedontics Press; 2008.