• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Essentials of 4-Handed Dentistry

Essentials of 4-Handed Dentistry






Total Views
Views on SlideShare
Embed Views



0 Embeds 0

No embeds



Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

    Essentials of 4-Handed Dentistry Essentials of 4-Handed Dentistry Presentation Transcript

    • Essentials of 4-Handed Dentistry Dena 320 Lesson III Deborah Bell
    • Major Goal in the Practice of Dentistry
        • Deliver high quality service
        • Deliver service as efficiently as possible
    • Dental Procedures May Be Divided Into 3 Parts
      • Preparation
      • Patient treatment
      • Clean up
        • A second assistant may be utilized to prepare and clean up allowing first assistant to be
        • Full time chairside
        • Thus no down time between patients
    • Concepts important to teamwork dentistry
      • Done in seated position
      • Patient position
      • Work area used
      • Operatory equipment
      • Availability of second assistant
      • Instrument exchange
      • Use of oral evacuator
    • 2 Basic Issues of Interest in Dentistry
      • Minimizing stress and fatigue for the dentist
      • Increase productivity while maintaining high quality standards
    • Dentistry is stressful and fatiguing
      • Operator must maintain high level of concentration
      • Keep a high level of clinical excellence by his/her ability to
        • Meet variety of patient needs
        • Perform delicate skills with limited access
        • Manage schedule and the practice
    • 4-Handed Dentistry Reduces Stress
      • Increasing efficiency
      • Thus increasing productivity to meet demands of public
    • Concept of 4-Handed Dentistry
      • Operating in a seated position
      • Employing the skills of a trained assistant
      • Organizing every component of the practice
      • Simplifying all tasks to the maximum
    • 3 Major Aspects of 4-Handed Dentistry
      • Work simplification
      • Motion economy
      • Body mechanics
    • Motion Economy
      • Conservation of motion
        • Movements consume time and produce fatigue
      • Eliminate excess harmful motion
    • Classification of Movements
      • Class I
        • Only fingers
          • Signal for instrument transfer
      • Class II
        • Fingers and wrist
          • Use of an instrument
      • Class III
        • Finger, wrist and elbow
          • Mix amalgam, activating chair buttons
      • Class IV
        • Entire arm from shoulder
          • Adjusting light, rubber dam placement
      • Class V
        • Entire arm and twisting of the trunk
    • Class IV and V
      • Most fatiguing
      • Requires to look away from field then refocus
      • Results: eyestrain and headaches
    • Class I, II, III
      • Preferred for DA and Dr
      • Involves less muscle activity and saves time
      • Allows eye contact concentrated on operative field
    • Positioning the Patient and the Operative Team
    • Objectives of a Favorable Seated Position
      • Access to the operative field
      • Good visibility
      • Comfort for the operative team
      • Relative comfort and safety for the patient
    • Zones of Activity Patient in a supine position Using center of patients face as a clock Zones designated as time
    • Right Handed Operator
      • Operator zone
        • 7 – 12o’clock
      • Static zone
        • 12 – 2o’clock
      • Assistants zone
        • 2 – 4 o’clock
      • Transfer zone
        • 4 – 7 o’clock
    • Left – Handed Operator
      • Operator zone
        • 12 - 5 0’clock
      • Transfer zone
        • 5 – 8 o’clock
      • Assistant zone
        • 8 – 10 o’clock
      • Static zone
        • 10 – 12 o’clock
    • Positioning the Operator
      • Work environment is adapted to the operator
      • Operator positioned first then
        • Patient
        • Assistant
        • equipment
    • Characteristics of Balance Posture for Operator
      • Operators thighs parallel to floor
      • Entire surface of seat used to support weight
      • Backrest supports back without interference
      • Forearms parallel to floor when hands are in operative position
      • Elbows close to the body
      • Back and neck reasonably upright with top of shoulders parallel to floor
      • Distance of approximately 14 – 18 inches between the operator’s nose and the patients oral cavity maintained
      • Operative field is operators midline
    • Positioning the Patient in the Working Position
      • Oral Cavity at height of operator’s elbow
      • Head placed at upper end of chair and slightly to operators side of chair
      • All patients are seated from the head down
    • Steps to position a Patient
      • Adjust back approximately 60 degrees to vertical
      • Raise chair to height patient can easily be seated
      • Raise arm of chair
      • Once patient is seated
        • Armrest down
        • Raise chair approximately 10 inches to allow Dr. to position himself
      • Tilt seat portion back so foot rest is raised approximately 6 to 8 inches
      • Lower back of the chair until patient is about ½ way toward a horizontal position
        • Pause to allow patient to adjust
      • Continue lower chair back until following relationships exist
        • Imaginary line from patients chin to the top of ankles is parallel with floor
    • Once seated – Observe Patient
      • Lying flat with little bending at waist
      • Similar to sleep position
      • Legs slightly lower than head – if higher might cause – pt. Anxiety/circulation problems.
      • Patient in supine position
        • Plane of the patients forehead is also parallel with the floor
      • Lower chair to operators lap
        • Approximately 1 inch above knees of operator
    • Supine Position
      • Universal position for all working positions
      • Patient is lying down facing upwards
      • Slight modifications only allowed as patients needs are assessed
    • Patient Dismissal
      • Patient dismissal should be accomplished by reversing the steps of seating the patient
      • Remember to pause for the patient on the way up as well
      • Most important patient dismissal precaution
        • Encourage the patient to remain seated to reestablish their equilibrium
    • Positioning the Assistant
      • Must be able to see and have favorable access to be able to
        • Retract tissues
        • Evacuate fluids
        • View to anticipate needs of operator
        • Maintain clear field
    • Position of Assistant
      • 3 o’clock position for all quadrants
        • Right handed operator
      • 9 o’clock position for all quadrants
        • Left handed operator
      • Stool positioned so edge toward the top of patients head is in line with the patients oral cavity
      • Stool as close to chair as possible
      • Stool elevated to top of assistants head is 4 – 6 inches higher than the dentist
      • Back erect
      • Body support arm adjusted to support upper body just under rib cage
      • If stool positioned properly mobile cart can be pulled over lap
        • Approximately 2 inches below elbows
    • Work Simplification
      • Major advantage – Doctors Health
      • Definition – finding an easier way to do a task more efficiently – less pt. Treatment time spent
      • Work simplification studies indicate 4 areas to make dentistry delivery easier
      • Rearrangement of instruments and equipment
      • Combination
      • Elimination
      • Thus simplification
    • Rearrangement
      • Position all instruments and equipment in favorable spot to the team not vice versa to minimize movements of team
    • Elimination
      • Eliminating unnecessary movements, procedural steps, instruments and equipment
      • Saves time and efforts
    • Examples of Elimination
      • Unnecessary bur changes
        • 2 handpieces
      • Unnecessary instrument exchange
        • Use instrument to max. before returning
      • Use supplies and materials that can save time
        • Premeasured capsules
      • Eliminate seldom used items
        • Plan for usual not unusual
    • Combination
      • Combining steps
      • Combining purpose of equipment and instruments
      • Combining uses
    • Examples of Combination
      • Double ended instruments
      • Using instruments for more than one purpose
      • Air/water syringe together
      • Cements used as base and cementing agent
    • Simplification
      • Last because this should occur after all rearranging, eliminating and combining activities have been completed
      • Basic idea – to minimize number of variables in all aspects of the practice
      • Streamlining process geared to promote predictable routines in the work pattern
    • Standardization of Work Procedures
      • Contributes to effective teamwork by being able to anticipate the dentist’s needs
      • Contributes to efficiency/production
    • Examples of Standardization for Work Simplification
      • Arrange steps into smooth sequence
      • Use preset trays in order of use from left to right
      • More than one op.
        • Each treatment room identical in equipment
          • And materials
    • Sit Down Dentistry
      • Body mechanics/task performance studies
        • Seated worker uses 27% less energy
        • Seated worker has 17% greater life expectancy
        • Production increases from 33 – 78%
      • Seated in a balance posture concept
      • ½ the efficiency of a D.A. Is the result of working with a well-organized dentist who practices 4-handed dentistry
      • THE
      • END