Dental Stools - What’s worked buyers guide

Introduction

Every job or profession comes with risks, and dentistry is no exception. Dentists, dental assistants, and dental hygienists are all at risk of developing medical conditions due to poor posture. Many may not think this to be a significant issue; however, the longer you are in the dental field, the more exposed you are to improper seating. An increasing body of research suggests that poor posture is contributing to some dental professionals developing back, neck, or shoulder pain, and other injuries. For those effected and those who just want to optimize comfort and efficiency, ergonomic dental seating can be an important investment.

Quick List: Ergonomic Stools for Dental Professionals

This list provides you with seven of the more well-known stools within the industry. Further in-depth details will follow.

  1. Salli - Salli Systems produce split saddle stools that are designed to facilitate a more upright posture whilst putting less pressure on the saddle area.

  2. Score - Score supply single full saddles and have become well established as providing high quality mid-priced stools. They have 2 main stools in the range to fit the male and female pelvis and have a range of accessories including: back supports, upper limb supports, foot rings, etc

  3. Bambach –The Bambach brand and saddle seat were designed nearly 30 years ago by an Australian Occupational Therapist inspired by the therapy received from horseback riding. Similarly, to score Bambach offer a single non split seat which is designed to try and help you sit comfortably, naturally, upright and stable, relieving and preventing posture-related problems.

  4. Orbital - Orbital Support Systems are one of the only companies in the world to offer well designed sternal/chest support for dental professionals who work in forward leaning positions for extended periods of time. Orbital stools can also come with a range of accessories including upper limb supports.

  5. A-dec - A-dec stools are a more traditionally shaped dental stool with easy adjustment and are popular with a number of dental professionals who prefer the flatter profile seat

  6. Ghopec -Ghopec stools have a uniquely shaped downward inclined profile designed to facilitate an optimal hip angle and a better distribution of body weight when working.

Incidence of injuries Among Dentists

Dental professionals have an eye watering high level of risk for developing musculoskeletal injuries, which for many cause discomfort and pain and for some can enforce reduced work hours, a change in career or early retirement. There is a consensus that most of the issues are caused by repetitive postural stresses during their daily work.

In a study that explored the prevalence of and risk factors for low back pain among dentists, researchers looked at 60 dentists, 28 of which were males and 32 females. Most of these dentists saw up to 3 patients daily and from the data collected, it was determined that 70% of the participants experienced back pain. Additionally, of the 70%, lower back pain was dominant, as it was noted in 47.6% of the cases. 90.5% of the study subjects had a mild-to-moderate level of severity, and only 9.5% experienced a severe level of low back pain. Of note, the average age of these dentists was 27. 

Further, another piece of research looked at musculoskeletal symptoms of the neck and shoulder among dental practitioners to identify the presence of discomfort. The participants included 45 dentists, dental assistants and dental technicians all employed to the same dental clinic. The study results revealed that 75.9% of the dentists, 90.9% of the dental assistants and 40% of the dental technicians experienced occasional discomfort in the neck. This discomfort was reported in all three working positions and is observed to bemore prevalent in women. Static awkward posture, especially those with isometric contractions of the trapezius muscles (a pair of large triangular muscles extending over the back of the neck and shoulders), has been observed as a risk factor to dental occupations.

Musculoskeletal disorders affect structures like the muscles, tendons, ligaments, joints, etc. When treating a patient, dental professionals often place themselves into a poor posture for a prolonged period, which may cause them pain in the neck, shoulder, lower back, etc. From the studies read, it is evident that injury can occur in any joint, as statistics from a 2013 study show that mid-to-upper back issues are reported in around 27% of dental professionals, and 20% have wrist and thumb issues.

During the dentistry procedures, the patient is mostly sitting or lying. However, the dental professionals’ posture is mostly stretched or strained, which is thought to put more stress on the muscles and skeletal system. A Greek study reports that 30% of the dentists have chronic physical complaints, and 62% experience musculoskeletal complaints. However, only 16% of them sought medical attention. Among musculoskeletal complaints, lower back pain was the most prevalent, with almost 25% of dentists experiencing this disorder.

The primary cause behind this could be attributed to poor sitting position or posture during dental procedures. Neck and shoulder pain are a little less common. However, it is commonly observed that pain in the hand or wrist is associated with neck and shoulder pain since almost half of the people with neck pain also complained about pain in the hand/wrist. Furthermore, senior dentists reported more incidences of pain. One possible reason could be their age, as the older they get, it means they have spent more years within the dental field, which exposes them to these repetitive harmful twists and postures.

What Types of Injuries do Dentists Encounter?

Dental professionals who experience recurrent and prolonged pain, stiffness, or swelling in the neck, shoulders, wrists, back, legs, lower back, and feet, often develop musculoskeletal disorders. Some injuries or discomfort are seen more often than others, such as shoulder and neck pain and back pain. In fact, these are the two primary categories of injuries that affect dental professionals.

Lower Back Pain

Lower back pain is one of the most commonly observed dental occupational complications. The lower back or the lumbar region, is the area starting below your ribcage. This area is lined with several anatomical structures such as ligaments, muscles, nerves, joints, and bones. Because of its structure, the lower back is immensely prone to injury. While several factors can be held accountable for lower back pain, in dentistry, posture is thought to play an important role.Often initial episodes of back pain will resolve over time, but if it is prolonged, or keeps happening the issue can become more challenging to manage.

Back pain for many, as seen in the study results may not be severe; however, it still indicates structural damage or stress. The pain may range from a dull ache to a shooting sensation, making it difficult for dental professionals to move or even stand straight for prolonged periods. It can also affect one’s life in general, compromising their quality of life. While a pain reliever is recommended to provide temporary relief in this situation, dental professionals are often encouraged to get ergonomic seating after a proper medical checkup. 

Neck Pain

Neck pain is another complication that can result from poor posture while conducting dental procedures. The muscles within the neck are thought to strained when the dental professional leans over patients or hunches over a desktop for too long. This injury is sometimes accompanied by numbness in the arms and hands, severe headache, muscle spasms, decreased head mobility. Neck pain also reduces their productivity, as it diminishes their focus on the tasks at hand since pain is distracting, especially when it is intense. 

Shoulder Pain

As we have previously established, repeated improper posture for prolonged periods may be one of the primary causes of most musculoskeletal injuries in dental professionals. As such it is likely that your shoulder pain is resultant of poor posture. The almost stationary outstretched or bent position that the arms are kept in, places strain on the muscles, ligaments and other structures, over time resulting in changes, weakening and damage. In a study review aimed at examining the prevalence of musculoskeletal diseases and pain among dental professionals in Western countries, researchers examined 41 studies sourced from databases, such as MEDLINE, CINAHL, LIVIVO, Science Direct, PubMed and Web of Science. The results of this review asserted that the prevalence rate of shoulder pain among the participants was 43.1%. Therefore, the investigators recommended that suitable interventions for preventing musculoskeletal diseases and pain among dental professionals are needed.

Why do Dental Professionals get these Injuries?

Three of the primary factors that are thought tocontribute to a muscle imbalance and injury include:

  1. Distorted positioning around patients and colleagues
  2. Forward flexion and twisting
  3. Sustained fixed postures for extended periods of time

Inadequate positioning

Dental practitioners may assume awkward and inadequate positions, including obtaining an optimal view of the patient’s teeth, accommodating a coworker, or providing the patient with a comfortable position. Reaching for and handling instruments and equipment can also place dental professionals in these positions. When these inadequate positions are assumed, additional pressure is exerted on the spinal disks when raising, lowering, or handling objects while the back is curved or twisted as opposed to being in a natural or ergonomic position.

Sustained fixed postures

Dental professionals don't work in standard lean back seated postures. Instead, mostmust hold their trunks in either neutral or at worse sustained forwards and slightly twisted static positions. These unusual postureswon’t necessarily cause problems immediately but are thought to cause issues when repeated over long periods of a career. In addition, the prolonged passing and handing of instruments can put additional micro stresses on the upper limbs.

Forward flexion and twisting

Tasks requiring repeated or sustained bending, forward flexion or twisting of the wrists, shoulders, back or hips can also put prolonged micro stress on muscles, joints, and other structures. Activities requiring frequent or prolonged work over shoulder height can be particularly stressful.

Why is Dental Seating So Important?

Dental stools have significant importance in maintaining the musculoskeletal health of dental staff. Proper dental seating is thought to help reduce problems like lower back pain, neck and shoulder pain. Moreover, there is a growing consensus that better ergonomic dental seating will improve productivity and quality of life at work.

Types of Ergonomic Dental Stool Seating Styles

Different types of stools influence the position of the lumbar region and the muscles during dental work. Here is a list of different types of stools that could be used by dental professionals to assist them with posture and support during long working hours.

Flat Stools

Flat stools are some of the most common types of stools. They have a simple flat seat that averages 15-24 inches in height. Some professionals prefer the flat profile seat. Some however find the flat stool results in their pelvis rotating backwards and encourages a more flexed posture. One of the most popular flat dental stools used is the A-Dec stool.

Saddle Stools

For some people a dental saddle stool can provide more comfort and ergonomic benefits than flat dental stools. The saddle shape drops the pelvis forwards and encourages a more upright position. It allows you to sit in both resting and moving positions and offers a higher seating position, so your thighs are likely to slope downwards. These and other benefits have been supported by some small research studies.

A saddle dental chair is sometimes recommended for people with back pain because studies suggest that it may reduce pressure on the vertebral column and lumbar region, which then alleviates aches and soreness due to poor sitting posture. Saddle chairs boast an unconventional design, which allows its user to assume a tripod-like position with the hips apart and slightly flexed. Saddle stools are made with a flat triangle-shaped seat and it is this design that keeps the pelvis in an ergonomic position. Some of the most popular saddle stools for dentists include: Salli Saddle stools and Score saddle stools.

Active Movement Stools

Active movement stools look and feel like most dental stools. The key difference is that they can be unlocked during sitting so that the user can gently move the seat during work. This feature is marketed as a way of staying healthier during sitting but the long term effects of this type of sitting are simply not known.

The key feature of this stool is its instability, as it can reduce stationary positions that are linked with inducing musculoskeletal trauma. Active movement stools are normally designed with safety and balancing features, adjustable height, and swivel. Some of the most popular active movement stools for dental professionals include the Score balance stools and Salli swing chairs.

Concave Stools

Concave stools are light and padded, with their seat being the shape of a concave lens. They are designed to provide comfort and back and armrest. Its convex design may be helpful for dental professionals who are experiencing tingling or numbness of muscles in the hip and lower back areas. Convex stools are marketed as promoting vertebral alignment, which may allow dental professionals to work in comfort for extended periods without experiencing pain or discomfort.  Some of these stools are also designed with support for the back or arms to help maintain a healthy posture. 

Stools with Backrests

It is not entirely clear why, but some dental professionals want and appear to need a lumbar support on their ergonomic dental stool. Manufacturers have responded to this, and most ranges will now include a backrest addon to at least one or two of their main models.

Whilst dentists will often be in positions where they move away from a backrest some will still like them as a stretching support for when they are resting or will tuck the backrest as far forwards as possible and consciously try and sit back on their stool for certain activities. The backrests tend to be padded or upholstered for comfort and while some may have a concave design, others have a traditional flat shape. Additionally, dental stools with backrests are typically height adjustable to aid in efficiently carrying out its primary function of lumbar support.

Stools with Chest or Sternum Support

Dental professionals remain seated and slightly leaning forwards for a significant portion of their work. This anterior position and resultant low grade forces on the spine may increase the risk for potential injuries and chronic discomfort. A relatively small studyindicated that using ergonomic dental stools with mid-sternum or chest support can be beneficial for alleviating lower-back muscle activation. For the study, 30 dental students were recruited, and their lower back extensors were assessed.

These conditions were set up for the experiment:

  1. Ten students sat upright at 90 degrees of hip flexion on a standard stool.
  2. Ten were leaning forward at 80 degrees of hip flexion on the same stool.
  3. Ten of them were asked to lean forward at 80 degrees of hip flexion but on an ergonomic stool with chest support. 

The results of the study showed that students sitting on the stool with chest support had reduced muscular activity compared to the ones sitting on the standard stool. The reduction in muscle activation was estimated to be 33-50%. This study validated theories that dental stools with chest support can potentially benefit the musculoskeletal system. Stools with chest or sternum support are designed with height adjustability and a padded surface to reduce pressure on the chest. For more information on stools with a chest support please see the Orbital dental stool range.

Ergonomic Dental Stools with Upper Limb Support

Upper limb support was once one of the least acknowledged aspects of dental ergonomics. However, due to the significant number of upper limb injuries evidenced in the dental profession, more a more individuals are asking for a dental stool with upper limb supports.

Consequently, scientists have explored and are still looking at the benefits of upper limb support in dental procedures. At the same time a range of different upper limb supports have been developed including static rear arms supports (which are like office chair arms), curved padded arm supports that can be moved around to different positions and dynamic arm supports that move with the moving arm. To learn more about arm supports for dental chairs please click here.

Brands we recommend

So, the first thing to say is that is that we are biased towards brands we have worked with and have feedback on and so it is important to know that there are other brands out there was well. We also have specifically focused on mid-high end dental stools with longer warranties and more functionality that are expected to last 10+ years.

Salli

Salli is a small company located in Finland that produces saddle stools. Salli has built a company on its split saddle seat design which offers an alternative for dental professionals who like saddle seats but don’t like single solid seats because of the pressure it puts on their saddle area. Salli seats have a 10 year warranty and are most commonly used to help with low back pain.

Score

Score is a popular brand within the dental stools industry. Score dental stools work well for most dental professionals but its most popular stool is the Score Amazone stool which is a small seat designed for females. Its stools all have a 5 year warranty and are made in Holland. Owing to the variation in people’s height, Score saddle stools come in three different heights, and each one has its own range of adjustment.

A-dec

Ken and Joan Austin founded A-dec in 1964, and it is one of the most trusted names in the market for providing dental chairs. A-dec’s chairs are designed to provide dependable, ergonomic solutions and are tested for use by dental professionals. Under normal use, the service life of A-dec chairs is almost twenty (20) years, provided that the user ensures proper maintenance and service. This lifetime can be affected due to factors like the extent of use, environment, frequency of cleaning, wear and tear, etc. The three most popular products by the company are:

  1. A-Dec 500 dental chair   
  2. A-Dec 400 dental chair
  3. A-Dec 300 dental chair

Ghopec

Ghopec is a German furniture company that produces ergonomic furniture for dental professionals. Ghopec has really become known for its downwards sloping seat which is designed to provide its user with a more open hip angleduring working. Additionally, it has two levers for adjusting the height and support area for the pelvis.

Of note, the term GHOPEC is an acronym for Gaining Height on Professional Ergonomic Chair. With Ghopec, the aim is to ergonomically reduce pressure off soft tissues when seated, especially for prolonged periods. The company bases its design on evening out unwanted pressure on the pelvic area that you actually sit on. To perfect its chair design, Ghopec also looks to evidence from several pieces of research that suggest an upright posture can only be achieved by extending the body with the sternum raised and the shoulders directly above the hip joints.

Bambach

The Bambach brand and saddle seat were founded nearly 30 years ago by an Australian Occupational Therapist, named Mary Gale who was inspired by the therapy received from horseback riding. Mary identified the need for a seat that could replicate the saddle sitting position and allow individuals to possibly enjoy improved posture in an easily accessible and affordable manner.

The Bambach is best known for supplying saddle shaped seating to improve sitting posture and like the score and salli stools it is highly maneuverable.

The idea behind the saddle is to keep your pelvis in the same position as when you ‘re standing. This ensures that your spine is in a natural ‘S‘shape when you sit, allowing you to sit more  upright.

Orbital

Orbital Support Systems are best known for developing one of the only precision engineered sternal/chest supports to help with the problems associated with forwards leaning. Most dental professionals who invest in orbital chest supports will also get upper limb supports to offload their upper limbs during the day. The orbital chairs sit at the top end of the market in terms of cost but for some people they are life changing in terms of comfort levels and the amount of time they can work for. To learn more about Aeris chairs please see our Orbital Whats worked buyers guide.

Aeris

Aeris dubs this as a time to reinvent the way we work and live and they are doing that by designing an innovative stool to promote mobility. Aeris' unique technology has brought an ergonomic chair that follows the movements of your body. Its unrestricted mobility in all dimensions promotes deeper breathing, increases circulation and metabolism, making it a genuine self-investment. The company has based its design on the prevalence of noncommunicable diseases, such as diabetes and hypertension. However, its design is also applicable to the dental space.

Aeris uses a 3D concept in the development of its stools. This 3D concept focuses on  movement in all three dimensions, that is back and forth, left and right and unique to Aeris, the movement into the third dimension, namely up and down. This 3D concept can help to deepen breathing, stimulate metabolism, build muscles and keep the intervertebral discs healthy. The latter benefit is especially useful for dental professionals. 

Aeris uses a convex-shaped seat to promote an upright posture and prevent the exertion of pressure on specific points, resulting in relief rather than tension. The goal of Aeris is to keep the body moving. To learn more about the aeris brand please see our Aeris whats worked buyers guide.

References

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