QUARTERLY BEAT
APRIL 2026
Whole-Body Monitoring Dental procedures may focus on the head, but prolonged positioning affects the entire body. A patient’s comfort and safety must be considered from nose to tail.
My approach: After induction and intubation, I begin with the patient in sternal recumbency to capture maxillary intraoral radiographs. I then rotate to dorsal recumbency, where most of the procedure takes place. As needed, I make small adjustments with partial head or chest rotations to access specific areas—without repositioning the entire patient. (Fig 2.)
Figure 2. Photos courtesy of Stefanie Perry, CVT, VTS (Dentistry)
• Head & Neck: Avoid overextension, cushion against hard or cold surfaces, and take care with patients who have cervical disc disease. • Eyes: Prevent contact with surfaces, lubricate at least every 30 minutes, and protect from debris or irrigation. • Thorax: Ensure patients with respiratory disease, obesity, or reduced lung function have room for chest wall expansion. • Spine: Limit twisting or torque in patients with intervertebral disc disease. Use bean bags or surgical positioners to support their body weight and prevent twisting. • Pelvis: Avoid full “frog-leg” positioning, which worsens hip arthritis and causes pain. Support on either side of the pelvis with positioners will prevent that. (Fig 4) • Stifles: Minimize tension, particularly in patients with osteoarthritis or a history of surgery. Avoid prolonged flexion of the knee if possible.
Other Positioning Points Gauze or absorbent packs: Any material used to block irrigation from the throat must be changed regularly when soaked or when debris collects. These cause a hazard by trapping fluid when they’ve absorbed too much, and the material could be mistakenly left after recovery. Any material should be tied to the endotracheal tube as a double check that it is removed. Head and neck positioning can replace this with diligent attention to positioning. Head and neck angle: The patient’s nose should be pointed toward the floor to keep irrigation flowing out of the mouth. Towels or other material to support the neck and help keep the nose down will make the neck more comfortable and prevent the position from accidentally changing. (Fig 3)
Workflow Efficiency If patient safety isn’t reason enough, consider efficiency. A comprehensive oral health assessment and treatment (COHAT) is time-intensive, and every minute counts. Each time a patient is rotated laterally, equipment must be adjusted, monitors repositioned, and anesthesia re-stabilized—all of which add up to lost time. With dorsal recumbency, radiographs can still be performed by rotating only the head and neck. This not only spares patients unnecessary full-body movement but also allows staff to maintain consistency in monitoring and heat support. On busy days, those saved minutes per procedure quickly accumulate.
Figure 4. This patient has additional special needs as a forelimb amputee and additional positioning equipment prevents undue stress to his spinal column, shoulders, and pelvis. Photo courtesy of Stefanie Perry, CVT, VTS (Dentistry).
Figure 3. Photo courtesy of Stefanie Perry
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