"four handed dentistry and instrument transfer"
Four Handed Dentistry and Instrument Transfer Principles for four-handed dentistry: Intro: Primary issues that face the dentist on a daily basis. How to reduce fatigue and stress. How to increase production while delivering the highest quality dentistry possible. Paramount importance to reduce unnecessary movements and actions. Necessary to maintain a high level of concentration due to the difficulty of working in the oral cavity, where there is restricted visibility, limited access, and confined workspace. Easy for the dentist to tire working with an assistant is called four-handed dentistry. Increases productivity through increased efficiency. Four basic ideas: 1. Performed in a seated position to reduce fatique 2. The assistant has an understanding of the procedures 3. Effective patient and practice management is the goal 4. All procedures are simplified where possible. Positions of operator, assistant, and patient: allow for fewer and greater range of motion. You and the patient are positioned to the operators convience. Equipment is handled in the same priority. Operators position- while seated, his thighs are parallel to the floor. Stool should support weight evenly. Keep elbows close to his body to reduce fatigue. Shoulders should be parallel to the floor and back should be straight. The distance between the operators eyes and the patients oral cavity should be about 14-17”. Dental assistants postion- your position should affor you good visability of and easiy access to the oral cavity as well as to instruments and equipment being used. With right handed operator you should be seated at the 3 o’clock position. To increase your visibility, your stool is usually higher then the operatory stool. Seated as close to the patient as possible with your body weight supported by the body support arm. Your legs points towards the patients head, keep thighs parallel to the seat, because your stool is elevated has a foot rest to maintain comfort and good circulation. The procedure being performed will dictate variations to postioning at times you may find it more comfortable standing. Patients postion- must be positioned so that the oral cavity is centered over the dentists lap at the height of the dentists elbows. Usually placed in the supine position- may be some patients who are uncomfortable in this postion due to health reasons, you may elect to eleveate the back of the chair to their comfort level . The patients legs shouldn’t be eleveated higher than his head for any long periods of time. Operating zones for the dental team: four primary zones that represent the treatment area around the patients oral cavity. Imagine a clock with the center being the patients oral cavity. With thte patients in the supine postion this circle includes the position of the dentist and the assistant. The positions of the clock represent the position of equipment and team members related to the patient. The positions are designated as follows: operators zone: 7-12 o’clock- the dentist is positioned to gain access to all parts of the patients oral cavity. This area includes the path of the patient entering and exiting the dental chair. Static zone: 12-2 o’clock- a speciality zone, an area of no traffic. Some dentists use a rear delivery system which brings hand-pieces and air-water syringe into the circle from this area. May be called the speciality zone, nitrous may be here too. Assistant zone- 2-4 o’clock- area linking the operating field to the assistants work surface. Transfer zone- 4-7 o’clock- area where instruments and materials are exchanged between operator and the assistant. Exchange occurs here for safty reasons. DO NOT pass anything over the patients face- over the napkin instead. Requires the dentist to make the least amount of arm and hand movements. Handpiece delivery system: is the dental unit that holds and controls the dental handpieces, air water syringes and a portable work surface. Basically three systems that enter the operating zones from different areas. Over the patient delivery- mounted on a pole alongside the dental chair. Swings into the treatment area by way of the patients feet and into the transfer zone. Main advantages- all handpieces are very close to the oral cavity. Requires the least amount of movement for the operator to reach the instruments, the assistant as well as the operator, can access any handpieces or syringe form the delivery unit. Disadvantages- tubbing may drag across a patients chest, it cant be hidden from the patients line of sight. Side delivery: mounted under a cabinet to the side of the dental chair. Its pulled out to the patient after everyone has been seated. Enters treatment area through the operators zone. Advantages: handpieces are accessed out of the patients view. Tubing from the handpiece cant drag across the patients body. Disadvantages- assistant cant reach the handpieces during treatment. This delivery requires more movement by the operator, possibly snap clothing because they must exit near the delivery unit. Rear delivery system- handpieces are mounted to a cabinet or wall directly behind the patient. Enter the treatment area thru the static zone. Advantages: completely out of sight of the patient, both prior to and during treatment. Allows both the operator and the assistant to access handpieces and controls. Disadvantages: requires the most body movement. Limited to sit down dentistry. Instrument transfer: one of your main functions as a dental assistant is to deliver materials and instruments to the dentist as they are needed. Your job is to eliminate any unnecessary movements by the dentist. Intro- transfer should involve little movement of the operators eyes and fingers. Transfer occurs in the transfer zone, near the patients chin. Must anticipate the dentists needs with a little practice youll beable to anticipate the sequence of events. As you remove the used instrument, immediately place the next instrument in the operators hand. If the operator is right handed you use your right hand for the oral vacuum. Your left hand is free to perform any one of these tasks- retraction to improve visibility and access, exchange and retrieval of instruments as needed, operation of the air water syringe to maintain a clear operating field. Wiping the working end of instruments as theyre withdrawn from the mouth, operating the curing light when the dentist requires two hands to maintain the integrity of a matrix band, minor adjustments to the dental light to improve visibility. Watch procedures very closely. In different procedures it will be more helpful for you to assist with retraction instead of holding the next instrument ready. Mentally alert, paying attention to the operators needs as the procedures progress. Fundamentals of Instrument transfer- instruments to be passed are held with the thumb, index finger and middle finger, must be held either above or below the location where the operator will want to grasp it. Instruments are retrieved with the pinky, the ring finger can also be used if needed. Should be passed in the position of use, the instrument should be facing the correct location in respect to the dental arch being treated (downward for mandibular, upward for maxillary) Instrument shouldn’t become entangled during the exchange should occur in a smooth continuous motion. Transfer shouldn’t require the dentists vision to shift from the operative field. Certain instruments require an entire hand or palm grasp to exchange. Always be careful to keep the instrument clear of the patient. Sequence: 1. Approach- when he removes the instrument from the tooth, the action signals you for the next instrument. Extend your pinky finger and grasp the instrument by the shaft at the opposite end that the operator was using. 2. Retrieval- close your pinky finger and cradle the instrument between the pinky and the ring finger. Now lift the instrument safely away from the patient. Position the new instrument so that the operator may grasp it with the least amount of movement. 3. Delivery- the transaction is complete when the operator grasps the new instrument and continues with the procedure. If the retrieved instrument will be needed again next, immediately reposition it on the delivery system. If you drop any instruments leave them there. Do not pick up in front of the patient. Never say oops.