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The clinical dynamics of four-handed dentistry is an ergonomic chairside concept performed by a well-trained dental team in an organized manner. This concept provides a synergistic approach to dental practice that ensures far greater production than two persons working individually in an unorganized manner.
Four-handed dentistry is not a new concept but became inherent in the 1960s to overcome a manpower shortage. Demands were made on the dental profession to provide more services to more people due to the creation of third-party payment. From this time until the 1980s, dental schools taught dental students to work with dental assistants in clinics supported by federal monies provided through Dental Auxiliary Utilization (DAU) grants. Eventually, the grants were phased out. As cost containment became a major factor in dental school budgets, the concepts of four-handed dentistry were diminished, and these clinics were dosed in many dental schools.
Ergonomics, the study of the physical relationship between people and their environment, has garnered interest as dentists in the 21st century seek to be more productive and decrease stress. To be effective, ergonomics should not just be discussed; it must be practiced. More important is the concept of participatory ergonomics, ergonomics based on participation of all persons involved in a process. The participants in dentistry are all members of the dental health team, whose safety and job performance depend on their ability to use the skills and concepts from the science of ergonomics. The dentist alone should not make decisions about choice and placement of equipment but, rather, should gain input from the dental auxiliaries who will be using this equipment.
Today's generation of dentists is still faced with the need to increase productivity and reduce stress. However, the impact of regulatory agencies, managed care, and quality assurance has placed even greater demands on the practicing dentist to implement efficient clinical practice methods to ensure a safe, comfortable environment for the entire team. Hence, the rebirth of four-handed dentistry.
In this illustrated manual, the reader will learn the basic tenets of four-handed dentistry necessary to implement efficient procedures for a productive, stress-free clinical environment. The manual begins with the selection and placement of equipment to maintain good ergonomic concepts and presents safe, efficient instrument exchange and oral evacuation techniques that can be applied to common clinical procedures.
The author of this manual "grew up" with four-handed dentistry. She studied under a dynamic research team at the University of Alabama and was mentored by the late James B. Bush, DDS, and Joseph Chasteen, DDS, who both served as Directors of the Dental Auxiliary Utilization Program at the University of Michigan. She has team taught the concepts of four-handed dentistry to dental assistants and dental students as well as practicing dentists who have sought to make significant changes in their dental practices.
As a member of a dynamic health care profession, you, the dentist, dental assistant, or dental hygienist are to be congratulated for taking the first step in planning for a productive, stress-free practice environment. Acknowledgments
I extend special thanks to family and friends for their continued support. To my husband Charles, I extend my greatest appreciation for being so kind and patient through all stages of my writing. To Kathy Weber, my friend and colleague; Tom Weber, Vice President of Gushing Malloy, Ann Arbor, Michigan; Michael Muscari of Health Science Products, Birmingham, Alabama; and Phyllis Grzegorczyk, Dean of Allied Health and Public Service at Washtenaw Community College, Ann Arbor, Michigan. I extend special appreciation for their continued support of my ideas and for their input on this project.
I also express appreciation to Kristina Spague, a former student and colleague who brings a continued breath of youth to my teaching. Thanks to Mary Govoni, of Clinical Dynamics, and Joseph Chasteen, DDS, from the University of Washington School of Dentistry, for reviewing and critiquing the manuscript. Thanks, too, to Lyn Garry and Sue Null for their help with the photos. To the Dental Assisting Class of 2000, I extend my thanks for being so patient with me during the school year.
A special thanks to Linda Stakley, my secretary, who continues to make me look good in all of my word processing efforts and without whom I could not be a professional.
Uniquely focused, comprehensive, and extensively illustrated, this review of sit-down, fourhanded dentistry is an ideal how-to manual for the entire dental health team. This book can be used as a brief supplement for dental assisting courses as well as a professional reference for dental practitioners. The emphasis throughout is on the implementation of efficient procedures for a productive, stress-free clinical environment that will improve productivity and reduce strain.
This handbook begins with an overview of the principles of four-handed dentistry and motion economy, treatment room design, types of delivery systems, and basic equipment selection. It then details the basic techniques used to promote ergonomic concepts during routine dental treatment, such as seating, instrument transfer, and oral evacuation.