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The Concepts of Four-handed Dentistry Including Ergonomic Instrument Transfer and Exercises for Stress Reduction
Basic Tenets of Four-handed Dentistry

Course Author(s): Betty Ladley Finkbeiner, CDA-Emeritus, BS, MS

Basic Tenets of Four-handed Dentistry

Many dental teams claim they practice four‑handed dentistry, yet they still suffer the results of physical stress due to the use of inappropriate equipment and techniques that fall short of meeting the basic tenets of the true four‑handed dentistry concept. Dentists can still be observed changing their own burs, reaching for an instrument, refocusing their eyes after looking away, or twisting and turning to reach equipment on their side of the chair. If the clinical assistant is not in charge of all instrument transfers, and the equipment is not within reach of the assistant, true four‑handed dentistry cannot be practiced.

The application of these concepts must not be overlooked in the dental business office. Though this course is designed primarily for the clinical area of the dental practice, business assistants should take time to evaluate their movement and efficiency practices possibly finding many of these principles easily applied to the business office.

The concept of true four‑handed dentistry is based on a set of criteria that define the conditions under which efficiency can be attained. To practice true four‑handed dentistry, the following criteria must be met:2

  1. Use ergonomically designed equipment to minimize unnecessary motion. This is a showroom photograph for patients and barriers would need to be placed for patient treatment.
  1. Place the patient in supine position. Does the patient have on safety glasses? Technically the doctor should have on a gown not a sweater and lab coat.
  1. Seat the operating team and patient comfortably using ergonomically-designed equipment.
  1. Practice motion economy.
  1. Seat the operating team as close to the patient as possible with the legs of the assistant parallel to the patient chair. Seated dentistry is important for the assistant to relieve stress, strain, and fatigue.
  1. Seat the operating team as close to the patient as possible with the legs of the assistant parallel to the patient chair. Seated dentistry is important for the assistant to relieve stress, strain, and fatigue.

    1. Minimize the number of instruments to be used.
    2. Place instruments in sequence of use.
    3. Place in order from left to right or top to bottom as preferred.
  1. Position equipment, instruments, and materials in advance.
  1. The dentist assigns all legally delegable duties to qualified clinical assistants based on the state’s guidelines.
  1. Patient treatment is discussed with the patient and planned in a logical sequence.
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