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Working in a Rear-Delivery System

I work in a rear-delivery system, which is causing side and back problems. Any suggestions how to do chair set up to prevent such issues?

The rear-delivery system’s design is for four-handed dentistry with an assistant to retrieve and transfer instruments. Working in a rear-delivery operatory without an assistant requires the dental hygienist to twist the torso, lean, and reach to access instruments.

Start with adjusting the equipment to accommodate your needs. Position the clinician chair/stool with your hips higher than your knees with a slight declination of the thighs for optimal positioning of the lower curve of the spine.

A saddle stool can provide better access with more clearance around the patient than a traditional chair. Proper adjustment of the stool promotes proper back lordosis and reduces back pain. Assess the working position of equipment. Does the supine position of the patient chair provide ample access around the patient ’s head? Rotating the patient chair can provide more clearance and access from 7 to 1 o’clock for right-handed clinicians and 11 to 5 o’clock for left-handed clinicians.

Does the operatory have space to add a cart or an alternative delivery system? Repositioning the equipment can reduce awkward body mechanics to deliver optimal patient care.

Assess your posture and body signs of pain and fatigue throughout the day and adjust equipment, patient positioning, and clinician positioning to reduce symptoms. Altering work practices to reduce twisting of the torso and over-reaching for instruments may help mitigate side and back pain.

Using the nondominant hand to retrieve instruments can reduce torso twisting and over-reaching. Consider not only your body mechanics but also the patient’s positioning. Extend the patient’s headrest If you need to get closer to your patient for access at 9 o’clock. Don’t forget to adjust the patient’s head position by turning and tilting the head with the chin up or down for improved access to the working area and a better neutral working posture. Decrease static posture by alternating standing and sitting throughout the day.

Physical therapists and other healthcare providers recommend stretching throughout the workday to reduce muscle tightness and stress and to improve circulation.1 Taking short breaks throughout the day and stretching reduces physical and mental stress. Including other activities, such as yoga and breathing exercises, can help reduce pain, strengthen the core, and calm the mind.2 Career longevity can increase with stretching and relaxation activities throughout the day.

Chronic pain lasting more than a few weeks should be assessed by a healthcare provider to determine the root cause of the issue and develop a treatment plan to eliminate pain.


1. Kim S, Jo D, Han S. Effects of stretching intervention on musculoskeletal pain in dental professionals. J Occup Health. 2023;65:e12413.

2. Nishat R, Bhuyan L, Nezam S, Singh S, Jaiswal MM, Singh R. The precedence and viability of yoga in the lives of D3-dental students, dental practitioners, and dental patients. J Family Med Prim Care. 2019;10;8:3808–3813.

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele P. Carr, RDH, MA, EdD, on ethics and risk management; Denise Muesch Helm, RDH, EdD, on fluoride; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpen­ing; Kathleen O. Hodges, RDH, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Martha McComas, RDH, MS, on patient education; Michael W. Roberts, DDS, MScD, and Robert D. Elliott, DMD, MS, FAAPD, PA, on pediatric dentistry; Purnima Kumar DDS, PhD, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to​​asktheexpert to submit your question. to submit your question.

From Dimensions in Dental Hygiene. September 2023; 21(8):46.

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