Introduction

Consider a typical schedule in the dental practice and ask yourself at the end of the day, “Am I physically tired tonight? Have I felt stressed during the day?" Then consider if the staff is being inundated by regulatory agency requirements and are also feeling exhausted at the end of the day: "If there were some other way I could practice all day and overcome my daily fatigue, would I want to do this?” Think about a single procedure and count the number of times you must raise your head to look for an instrument - five, ten, or even more? Then ask yourself how many times you had to extend your arm to reach for some piece of equipment? How often do you need to refocus your eyes from the oral cavity to an instrument, or to a mixing pad with a dental material on it?

Do you want to modify your practice style and work smarter and not harder? Then this course is for you. This course will focus on the principles of true four‑handed dentistry and how these concepts can bring about change in thinking that promotes organization, practices ergonomics, and can increase productivity all that result in reducing stress and strain on the dental team.

True four‑handed dentistry is the methodology of a team comprised of highly skilled clinical practitioners working together in an ergonomically designed environment to improve productivity of the dental team and improve the quality of care for dental patients while protecting the physical well-being of the operating team. More simply stated, to watch a dental team practice true four‑handed dentistry is like watching a soccer game. Each team member keeps his or her eye on the ball or site of the procedure and is prepared to perform the next assignment at the proper time until the task is completed. In the case of soccer, the ball is passed, a goal is scored, or the other team regains the ball. In the dental procedure, the treatment is completed with success.

Four‑handed dentistry is simply not transferring instruments from one person to another nor is it “hurry-up” dentistry. True four‑handed dentistry is the way to work smarter, not harder. Many dental teams over the years have learned to exchange instruments with each other but have not studied the research that defined the tenets of true four‑handed dentistry. To realize the true concepts of four‑handed dentistry, one should study the experts whose work pioneered this movement. Drs. Richard Brauer and Richard Barton of the University of North Carolina, Dr. Shailer Peterson of the University of Tennessee, Dr. G.E. Wuerhmann, Dr. Glen Robinson, Gertude Sinnet, and Ed Mc Divitt of the University of Alabama, Dr. James Bush of the University of MI and later Dr. Joseph Chasteen of the University of MI were all pioneers whose valuable research laid the foundation to what today still forms the basis for true four‑handed dentistry. The reader of this course would benefit much by returning to the literature of one or more of these experts to learn how these concepts were developed.

Despite the keen interest in the issue of ergonomics in the dental workplace by the Occupational Safety and Health Administration (OSHA), few dental schools teach the concepts of true four‑handed dentistry as part of the curriculum. A few dental schools have allocated funds in their budgets to provide some skilled clinical assistants to work at chairside with the dental students throughout an entire procedure, but this tends not to be a mandate for all dental schools today. Assistants may be on staff in a dental school but not all of these persons have had training in true four‑handed dentistry and often are not full time employees whose primary assignments are to work with the dental student full time at chairside to maximize productivity and minimize stress. Thus, today many dental graduates learn four‑handed dentistry on the job, from formally trained dental assistants, or from assistants who themselves have been trained on the job.