Introduction

Four-handed dentistry is ergonomically the most favorable way to provide dental services since it minimizes undesirable movements of the operating team and expedites the progress of most dental procedures.¹ (Figure 1)  To maximize effectiveness, a geographically favorable arrangement of the work environment must exist.  The most favorable arrangement requires the selection of equipment be based on the assistant's work area adjacent to the dental chair, since most of the movement of instruments and materials occurs in that area during a treatment procedure.  (Figure 2)  Over the years some manufacturers have attempted to meet this criterion and failed.  Some of the original research done at the University of Alabama School of Dentistry during the evolution of the concept of fourhanded dentistry during the 1960's is still among the most reliable in meeting these criteria.²

Ideal fourhanded dentistry simply cannot be performed successfully if the dental team must use excessive movement to reach for instrumentation, become entangled in an array of hoses and power cords, or are unable to comfortably access the operative field.  Exhibits at dental conventions display a myriad of equipment styles that can cause a purchaser of new equipment to become confused as to the most favorable equipment to purchase.  If inappropriate equipment is purchased, it will likely result in undue stress when used over a period of time.

An often-overlooked factor when choosing a dental unit for ergonomic practice is that the dental assistant should be the primary focus;  this will relieve the dentist of unnecessary movement during dental procedures.  Accessibility to handpieces and other dynamic instrumentation should be primary to the assistant and secondary to the dentist.2  If the dentist must reach to retrieve a handpiece or air-water syringe, time is lost;  excessive motion and physical strain can result.3  Likewise the position on the unit of the handpieces should be determined by frequency of use.  For instance, the high-speed handpiece should be closer to the doctor than the slow speed handpiece, and the high velocity evacuator and air/water syringe should be closer to the assistant than the saliva ejector.  (Figure 3)  To minimize movements, all instruments should be within a 20-inch radius of the assistant for efficient instrument transfers to the dentist to occur.1

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Citation Number: Vol. 2, No 4, Page 045