Concept and Advantages of Four-Handed Dentistry PDF

Ajman University Concept and Advantages of Four-Handed Dentistry Dr. Raghad Hashim Associate Professor  Course Learning Outcomes (CLOs) CLO1– Identify the principles and advantages of four-handed dentistry. CLO2– Describe different dental delivery systems and arrangements for dental...

Ajman University Concept and Advantages of Four-Handed Dentistry Dr. Raghad Hashim Associate Professor  Course Learning Outcomes (CLOs) CLO1– Identify the principles and advantages of four-handed dentistry. CLO2– Describe different dental delivery systems and arrangements for dental clinics according to ergonomic issues. CLO3– Describe different infection control methods and universal precautions in the dental clinic. CLO4– Demonstrate observation reports on different infection control practices in clinical dental facilities.  Concept and Advantages of Four-Handed Dentistry Objectives: i) Identify the principles & categories of four-handed dentistry. ii) Explain the team's responsibilities during the treatment procedure. o The concept of “Four-handed dentistry” was born in the 1960s o Team work concept -skilled operator & assistant work together; in a safe & ergonomically designed environment Four-handed dentistry is a team concept where highly skilled individuals work together in an ergonomically designed environment. To improve productivity of the dental team, improve the quality of care for dental patients while protecting the physical well-being of the operating team. 2 hands of the dentist + 2 hands of the dental assistant Deliver high-quality service Reduce the amount of time  Advantages o Improves the team- work. o Makes the maximum use of dentists’ chair side time. o Increases the efficiency of the dentist –productivity with high-quality standards. o Decreases the muscular stress and fatigue. o Improvement of the assistant standard of work. Gives greater comfort for the patient.  The Concept of 4-Handed Dentistry o Operating in a seated position o Employing the skills of a trained assistant o Organizing every component of the practice o Simplifying all tasks to the maximum  To Practice True 4-Handed Dentistry The Principals: o Equipment must be designed o The operating team & patient are to minimize unnecessary seated comfortably in ergonomically motion designed equipment o The patient is placed in a o Motion economy is practiced. supine position. o The patient’s treatment is planned o Preset trays are utilized. in advance. o The dentist assigns more duties to a qualified auxiliary. Are you Practicing 4-Handed Dentistry ? Quick Quiz  Are you Practicing 4-Handed Dentistry ? o Dentists changing their burs or twisting and turning to reach equipment on their side of the chair …….  Are you Practicing 4-Handed Dentistry ? o If the assistant is not in charge of all instrument transfers and the equipment is not within reach of the assistant …….  Are you Practicing 4-Handed Dentistry ? o Awkward postures are often adopted due to improper seating, improper patient positioning and/or poor work techniques that will causes compression of nerves and blood vessels, leading to many symptoms  Are you Practicing 4-Handed Dentistry ? o Repeated stress from over the years accumulates and slowly causes degeneration of the spine, muscles, and joints resulting in pain  The Concepts of 4HD Defined in 4 Basic Categories o Work simplification o Motion economy o Classification of motion o Zones of activity Work Simplification Apply 4 principles: 1. Elimination 2. Combination 3. Rearrangement 4. Simplification  Work Simplification 1. Elimination: o The cuspidor –interferes with assistant position o Bracket tray – out of reach of the operator o Fixed cabinetry – extended reaching o Extra instruments on pre-set trays – seldom used  Work Simplification 2. Combination: o Functions of two instruments into one o Two steps in a procedure into one Examples ▪ Double-ended instruments ▪ Using instruments for more than one purpose –condenser ▪ Air/water syringe together ▪ Cement used as a base and cementing agent  Work Simplification 3. Rearrangement: o Instruments in the tray setup –improve efficiency o Relocate equipment close to the transfer zone –avoid excess reaching High-Velocity Evacuator tip (HVE), air/water syringe & handpieces placed nearest to assistant Backup instruments & supplies o Sequence of procedures & patient scheduling –improve time & motion o Delegate duties to auxiliaries –more productive during the procedure  4. Simplification: o Change steps in a procedure to avoid repetition in instrument transfer o Select multipurpose dental materials –eliminates Work multiple applications Simplification o Bur changes –delegate to an assistant  Motion Economy o How many times do you turn o Does your assistant transfer your body or reach for an instruments and materials? instrument?  Motion Economy o Does the assistant have o Are the handpieces and instruments within a 21-inch (53 cm) radius of the responsibilities or is unoccupied? assistant?  What is Motion Economy ❑ Ways by which energy can be conserved and strain on the body reduced by modifying specific motions Principles of motion economy: o Minimize the number of instruments used for a procedure o Position the instruments, materials & equipment in advance  What is Motion Economy Principles of motion economy (cont.) o Position instruments in a pre-set tray according to the sequence in which they will be used o Place the instruments in a mobile cabinet close to the patient  Principles of motion economy (cont.) o Place the patient in a supine position o Seat the operating team close to the patient What is Motion Economy o Use a suitable operating stool that promote good posture o Keep the work area 1-2 inches below the elbow  What is Motion Economy Principles of motion economy (cont.) o Minimize the number of eye movements o Reduce the length and number of motions o Avoid twisting & zigzag movement.  Classification of Motion Class I - movement of the fingers only Class II - fingers & wrist motion o Picking up a cotton roll o Transferring an instrument to an operator; Using an instrument  Classification of Motion Class III - fingers, wrist & elbow motion Class IV - the movement of the entire arm & shoulder o Reaching for the handpiece; o Reaching into a supply tub or mixing amalgam; activation chair container; adjusting light buttons  Classification of Motion Class V - movement of the entire torso o Turning to reach for equipment from side- most fatiguing  Zones of Activity o All treatment revolves around the patient’s mouth o The area is divided into four zones of activity: ▪ Operator’s zone ▪ Assistant’s zone ▪ Transfer zone ▪ Static zone o Zones of activity for the left-handed operator –reverse of right- handed operator Objectives of a Favourable Seated Position ▪ Access to the operative field ▪ Good visibility ▪ Comfort for the operative team ▪ Relative comfort and safety for the patient  Team responsibilities during treatment procedures Team – general guidelines: Be aware of each other’s need Develop a standardized routine for basic dental procedures Recognize the need to reposition the patient and operating team Observe the patient’s movement & respond during treatment Transfer instruments only within the transfer zone  Dentist / Operator General guidelines: ▪ Develop non-verbal signals to exchange instruments ▪ Give advance distant verbal direction to communicate –need for instrument or material Positioning guidelines: ▪ Maintain working position within the operator’s zone –avoid leg interference  Transfer guidelines: ▪ Confine eye focus to the field of operation ▪ Confine hand & arm movement to the transfer zone ▪ Avoid twisting and turning to reach instruments ▪ Exchange instruments only in the transfer zone ▪ Rely on the assistant to change burs & transfer needed instruments Clinical Assistant General guidelines: ▪ Recognize the patient’s need ▪ Recognize any change in the procedure ▪ Develop a thorough understanding of the procedure Transfer guidelines: ▪ Anticipate the operator’s need ▪ When transferring instruments, position the working end appropriately – maxilla up & mandible down ▪ Follow a safe standardized exchange procedure ▪ Change burs and maintain handpiece positioning  1 2 3 4 5 Change burs and Exchange Remove debris Maintain Keep pre-set maintain instruments only from instruments instruments and tray/cassette and handpiece in the transfer before returning materials in work area free of positioning zone them to the tray sequence of use debris  Ajman University [email protected]