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by Bethany Valachi, PT, DPT, MS, CEAS

Over the past 20 years in my in-office ergonomic consultations, I have identified 3 ergonomic problems that cause over half of all musculoskeletal pain problems in dental professionals.  One of these ‘Top Three Pain Problems’ is poor control of the occlusal plane.  Dentists and hygienists have difficulty getting the patient reclined far enough to preserve their best working posture in the 11-12 o’clock position.   Whether it is due to the patient’s fear, vestibular problem, kyphotic posture, or other etiology, the bottom line is that you sacrifice your optimal working posture and place yourself in an unsafe position when you accommodate these patients. 

The million dollar question: How do you
get the patient to tolerate these extended, reclined positions?

Control the occlusal plane—especially when treating the upper
The more the
occlusal plane of the upper arch gets
front of the vertical, the more it pulls the operator into a
forward, hunched posture.
  Most dentists and
hygienists do not extend the patient’s head far enough, for risk of causing
patient discomfort.  To maintain optimal operator posture and ease of
viewing, the occlusal plane of the upper arch should be angled behind
the vertical. 

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Double articulating
be angled steeply downward to attain this patient position.  However, most double articulating
headrests are not comfortable when angled up into the patient’s occiput and cause
tension in the cervical musculature. 
It’s no wonder the patient objects to being reclined!  However, when the cervical curve is properly
and comfortably supported with a small contoured
dental neck cushion
, it causes relaxation of the cervical musculature and
the patient is amazingly more receptive to being

Flat headrests make it more difficult to
get the occlusal plane behind the vertical when treating the upper arch. 
Most flat headrests come with a horseshoe or magnetic headrest, which generally
do not support the cervical spine adequately.  The best positioning for
the upper arch can be attained using a larger
contoured dental neck cushion.

I have found that patients love these cushions, and most dental offices find that after they trial one, they end up purchasing one for each operatory due to patient requests.  The low profile headrest can also be used for small/pedo patients on a flat headrest.

Posturedontics by Dr. Bethany Valachi is featuring an exclusive offer: Get a FREE patient-positioning DVD video with the purchase of 3 dental headrests.
(Only available through Posturedontics)


Headrest adjustment is just step #3 in a 10-step patient positioning sequence that Dr. Valachi teaches at OHSU School of Dentistry to ensure a neutral working posture that prevents work-related pain.

Learn how to properly
use neck cushions to preserve your best working posture, how to treat difficult
patients and ensure your career longevity with Dr. Valachi’s new CE Course,
for Success in Dentistry”.

Dr. Bethany Valachi, PT, DPT, MS, CEAS is author of the book, “Practice Dentistry Pain-Free”, clinical instructor of ergonomics at OHSU School of Dentistry in Portland, OR and is recognized internationally as an expert in dental ergonomics.  For over 20 years, Dr. Valachi has helped thousands of dental professionals prevent pain and extend their careers with her relevant, evidence-based dental ergonomic education.  She has published more than 60 articles in peer-reviewed dental journals and offers AGD PACE approved dental ergonomic educational materials on her website at

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