Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Dimensions of four-handed
dentistry
The original intent of four-handed dentistry
was to increase the productivity of the
dentist while minimizing the stress and
fatigue associated with practicing dentistry
2. combine
3. rearrange
4. simplify
1. Eliminate
In analyzing the individual steps in any given
procedure, it is often possible to reduce the number
of instruments, equipment and movements used to
accomplish a particular task. Example:
-reduction of instruments for amalgam application
(eliminating a number of instrument transfer)
Benefits:
- longer time for patient treatment
- shorter time of daily activities for dental team
2. Combine
When the functions performed by two
instruments or two pieces of equipment can be
incorporated into one instrument or one piece of
equipment
- double-ended instruments (reduce the number of
instr. To be purchased and sterilized and
transferred)
- rubber-dam (pre-prepared and combining all
steps of application into one outside the mouth:
clamp, rubber dam and frame)
- reduction of cotton pellets for mouth
3.Rearrange 4.Simplify
-
6.
7.
4 zones of activity
DENTISTS ZONE
8-12 oclock for righthanded dentist
12-4 oclock for left handeddentist
STATIC ZONE
Instrumentarium
12-2 oclock for righthanded dentist
10-12 oclock for left-handed
dentist
ASSISTANTS ZONE
it allows the assistant to sit in direct line with the operating field in a 3
oclock position, with her legs parallel to the dental chair backrest, it is
in this zone that the assistants mobile cabinet is located, allowing
immediate and easy access to used instruments
5.
6.
When placing the patient in the supine position or returning the patient to the
upright position, always lower and raise the backrest slowly so as not to induce
dizziness
Be certain that medical history is free from contraindications to place patient in a
supine position
Remove any dental prostheses and wrap them in a moist environment
Patients who wear eye glasses should be asked to take them off, as debris is
sometimes splashed onto the face as a result of the ultra speed handpiece.
Patients who do not wear glasses should be provided with a pair of plastic safety
glasses or ask to close their eyes during cutting procedures. Dentists and
assistant should wear eye glasses when working. Bacterial splash is a constant
hazard for dental personnel.
To prevent patient from swallowing or aspirating any foreign bodies, use a rubber
dam. Proper evacuation and careful working procedure will do much to reduce
this potential hazard
Place a cushioned inset under the patients neck or small lump of the back. It is
usually done when a short patient is moved to the top of the chair and loses a
lumbar support provided by the chair contour.
Oral Evacuation
The primary goals of high volume evacuation:
1. Prevent rapid accumulation of debris and fluids
in the patients mouth
2. To insure a clear operating field
There are 2 types of the evacuator tip:
P is used for posterior areas
A is used for anterior areas
3.
4.
the assistant keeps the air-water syringe in the left hand and
utilizes it for
- periodic rinsing of the operative field:
- keeping the mirror surface clean when it is in use
The dentist only needs to turn the mirror away from the
patients mouth. This serves a nonverbal signal to the
assistant
One method is to place a stripe of colorcoding tape on the edge of the tray and
stripes of the same colored tape on all the
instruments included on this tray
Some practical suggestions governing the
use of pre-prepared trays are as follows:
1.
All instruments transfers occur at or just below the level of patients mouth.
2.
3.
4.
5.
Instrument transfers are never made over the patients face where a slipped instrument could result in serious injury to the patient. When transferred, instruments should have their working ends pointing in the direction of use.
All transfers are carried out with the assistants left hand. The right hand must be free for evacuation, retraction, or use of the air-water syringe.
The assistant lifts desired instrument from tray by grasping it with the thumb and first 2 fingers: II+III and shank at the opposite end of that used by the dentist
The instrument is then held parallel to the instrument currently being held by the dentist, with the working end pointing in the direction of anticipated use.
6.
7.
8.
.
Instrumenty przenoszone s rwnolegle do zestawu w kierunku rki lekarza.
W idealnym ukadzie asysta wyprzedza dziaania lekarza i dokonuje wyboru nastpnego instrumentu.
SYRINGE TRANSFER
1. To distract the patients attention from the
syringe by appropriate casual conversation
2. While the dentist is applying topical
anesthetic with his or her right hand, the
fingers of the left hand serve as a screen to
the patients vision
3. The assistant holds the syringe by the barrel
to the left of the patients head and below the
patients line of vision.
Light
For mandibular teeth light must be placed slightly behind
patients head
For maxillar teeth light must be placed above patients
head
Summary
The main objective of 4 handed dentistry is to
provide a maximally efficient and effective work
environment.
Eliminate, combine, rearrange and simplify are the
central components of work simplification.
To analyze chairside activity there are I, II, III, IV, V
classes of motions
Functional operating position provides access and
visibility to the work are
Proper patient positioning will enhance this
access.
Summary
Mastery of oral evacuation technique
prevents accumulation of debris and fluid.
Proper retraction and use of three-way
syringe will enhance visibility and access
Correct instrument handling and transfer
must be well-coordinated between dentist
and assistant.