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.

Don’t overlook the application of these concepts in the dental business office. Though this course is designed primarily for the clinical area of the dental practice, take time to evaluate the practices in the business office as the staff there, too, may find many of these principles can easily be 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:

1. Use ergonomically designed equipment to minimize unnecessary motion.
Ergonomic Equipment
2. Place the patient in supine position.
Patient in supine position
3. Seat the operating team and patient comfortably in ergonomically designed equipment.
seat operating team and patient comfortably
4. Practice motion economy.
Practice motion economy
5. Seat the operating team as close to the patient as possible with the legs of the assistant parallel to the patient chair.
Seat the operating team as close to the patient as possible with the legs of the assistant parallel to the patient chair.
6. Utilize preset trays.
  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.
Preset Trays
7. Position equipment, instruments, and materials in advance.
Position equipment, instruments, and materials in advance
8. The dentist assigns all legally delegable duties to qualified clinical assistants based on the state’s guidelines.
Patient treatment is discussed with the patient
9. Patient treatment is discussed with the patient and planned in advance in a logical sequence.
Equipment must be ergonomically designed to minimize unnecessary motion