Essentials of 4-Handed Dentistry
Download
Report
Transcript Essentials of 4-Handed Dentistry
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