Visual ambiance for dental practices.
Argesanu, Veronica ; Popa, Anca ; Jula, Mihaela 等
1. INTRODUCTION
Research in dental ergonomics is addressed on how the environment
(office, dental laboratory, the interpersonal relationships) influence
the dental team and the patient. In this respect studies have been
conducted regarding noise level of illumination, chemical and microbial pollutants, and studies of the psychology of group relations (Argesanu,
2004).
Physical stress is an important factor for dental work, while
maintaining the integrity of the eye's morpho-functionality, is a
major requirement.
Light energy is the main stimulus for the visual analyzer.
Environmental factors that determine the practical applications are
visual lighting and color of the workplace environment; plain said
visual ambiance.
2. VISUAL ENVIRONMENT
2.1 The integrity of visual acuity can be affected by close and
frequent or long operations, lighting the oral cavity with shadows and
brightness. Thus visual eye fatigue and even overall eye fatigue can be
installed. In order to prevent these undesirable aspects it is necessary
to adapt lighting to qualitative and quantitative requirements, bearing
in mind that it is not an end in itself but is intended to facilitate
the view of the problem areas.
2.2 Quantitative requirements of a dental office on the level of
light required viewing, set by standards ISO AFNOR, ranging between the
brightness value of 100 LUX in terms of relaxation and up to 20,000 LUX
for high fidelity interventions. DIN standards regarding lighting in
practice dentistry, fixed the following qualitative requirements:
* uniform distribution of light in all office and lab areas to
avoid contrasts
* providing a visual acuity in the right area of preparation and
the reminder of the cabinet, likewise in the laboratory for the work day
(type and gantoproteic device)
* achieving a spectral composition similar to that of natural light
which the eye supports better and reproduce true natural colors
Light sources are classified according to their nature: Natural
sources and artificial sources can be incandescent and fluorescent.
Incandescent sources give a light with shades of yellow and red and
create a warm and comfortable ambiance to dental practices or
laboratories.
Fluorescent sources use the discharge of rare gases into vacuum:
neon, silver, halogens and mercury vapor; which are preferred for
economic reasons, have reduced brightness and in certain proportions can
provide a light with a spectral composition similar to that of natural
light.
2.3 Visual acuity is the limit angle under which the visual
analyzer has the ability to distinguish two different points. It varies
with age, reducing it gradually with aging. Increase lighting causes
constant improvement of visual acuity.
So eyesight is affected by illumination in that it decreases
sharply as the environment is darker. It shows that you should not only
illuminate the field operator and leave the rest of the room in darkness
or shadows but obtain an overall good lighting of the whole room.
Visual environment relates to other characteristics of the cabinet,
laboratory and facilities there in: architecture, composition, design
proportions.
3. VISUAL FATIGUE
Visual fatigue is manifested by symptoms felt in the fight of the
conscious visual analyzer to clarify the picture through ineffective
adjustments. Visual fatigue of the dentist is due to inadequate lighting
of the operating field, frequent visual adaptations caused by the
incorrect operating acts, a big difference between lighting in the
operating field and the rest of the work place, extended working time
and work in direct eye contact (mirroring). Visual fatigue is manifested
through symptoms felt in the struggle of the visual analyzer to clarify
the picture by more or less effective adjusting, perception of color
breakdown, diplopic, vertigo, disturbance of assessing spatial
relationships.
4. ILLUMINATION OF THE MOUTH CAVITY
In the analysis of the positions of the medic and medical aid, we
can consider as a reference a virtual clock dial, with the oral cavity
of the patient in the center of the dial. Starting from this
representation we show suggestive positions operators can use (Fig. 1).
This figure of the clock dial (the plane of reference) was the
subject of an international ISO conference and then was adopted by the
AFNOR (Association Francaise de Normalisation).
In Romania, the International Congress of Ergonomics (1974)
discussed the problem of ergonomic position. Meanwhile, questions have
been debated extensively worldwide and today the international standards
that legislate the conditions of activity in different areas and of
different products were recommended and have a very precise regime,
bulletins by ISO, working conditions in dentistry. Romania joined the
international body, adopted their standards and took to putting them in
practice. Physicians themselves are required to comply with these rules,
understand them and not considering them as an imposition from outside.
[FIGURE 1 OMITTED]
It is permissible for the ergonomic position of the medical aid and
physician to work seated on a wheelchair, which provides free movement
for both doctor and nurse. Any other position is misconduct and has a
negative effect on the health of the operator.
The seated position has many advantages, being the "human
natural position", with low energy consumption. Unlike orthostatic,
where blood and fluids tend to accumulate in the lower members, in the
sitting position the muscles are relaxed and low hydrostatic pressure in
veins provides a low resistance to blood return to heart.
The seated position, shows through studies that have been conducted
that it helps to stabilize your body's joints to maintain a
comfortable, stable position, with minimal muscle contraction, the ideal
position for fine movements and accurate operations.
Existing studies show that not all concerns were focused on the
dentist, but there have been authors who have focused attention on
patient comfort, because we need to organize work so as to make
treatment session as easy and pleasant for the patient.
The authors argue that the priority of achieving comfort for the
doctor is based on the fact that he works a daily practice of 8 hours
and more, while the patient is a quarter hour or up to one hour in
office, then return to their own activity, they can relax, sport, etc.
Organization of work-based dental ergonomic is considering putting
the patient in a more ergonomic position for the doctor, but at the same
time ensure a degree of patient comfort, because relaxation to favorably
influence the efficiency of business operator.
Ergonomic position of the patient is performed in an anatomical
chair, the patient being placed on a spindle which makes an angle of
20[degrees] with the ground. As I said, is a stable body weight is
distributed evenly, no ischemic problems, vomiting reflex is avoided,
the doctor can work in a calm atmosphere and a perfect relaxing skeletal
muscle.
The patient is in position, with his head in the center circle.
Then, the areas of the dial are places that can hold the doctor or
medical aid, in close proximity of the patient. It is classic when
seated, practitioners work to adopt positions based on private
preferences.
It is mandatory that the lights can follow movement and is well
known that the patient is immobile in position 6. A dentist placed 8-9
PM will be practically focused on the mouth, with a correct posture in
the dental armchair.
[FIGURE 2 OMITTED]
According to literature, (Hokverda, 2008), the direction of the
light beam should be parallel with the dentist looking to prevent the
shadows and thus protect eye health. This is accomplished by moving the
lamp on 3 perpendicular directions. Improving lighting can be made by a
mechatronic system that has (Popa, 2002):
* motion on 3 perpendicular planes
* telescopic arm
* adequate lighting with small lamp leading to a good focus of the
working area
In order to improve the image there can be added
* screen displays with clear images
* HI - FI camera
5. CONCLUSION
In recent time the safe conduct at the work place has taken a
prominent role, patient and operator comforts being taken into
consideration in the construction and furnishing of a dentistry
practice. The most important aspects are those regarding lighting and
working posture thus avoiding discomfort for both patient and
practitioner.
6. REFERENCES
Argesanu V. (2004). Ergonomics of the equipment and medical
departments, editura, Eurostampa, 2004
Burdea, et al. Robotic system for dental subtraction radiography.
Proc. Of the IEEE Intl. Conference on Robotics and Automation. pp
2056-2062. Sacramento, USA, ISBN 0-8186-2163-X
Hokwerda, Oene (2008). Jerome Rotgans Dental ergonomics = health
for the dental team, 2008
Hokwerda, Oene & de Ruijter, Rolf. Adopting a healthy sitting
working postureduring patient treatment
http://www.optergo.com/uk/images/Adopting.pdf
Irimie, S. (2008). Ergonomie industriala. Editura AGIR. Bucuresti.
2008
Popa A. (2002). Digital control of mechatronical systems, ed
Orizonturi Universitare, Timisoara 2002
Virtanen, T. (2001). Ergonomic Survey of Dental Care. Proc. Of NES 33rd Annual Congress pp 398-401, ISBN 951-445222-4, Tampere, 2001
***R.A.G. de Ruijter Significance of the "Ergonomic
requirements for dental equipment". 2007, http://www.esde.
org/docs/ significance_of_the_requirements