University of Palestine
College of Dentistry
FOUR HANDED DENTISTRY&
DR. MUSTAFA I. ELGHOUL
Master of Orthodontic
What is Four-Handed Dentistry?
Is an operatory technique that was
conceptualized by many researchers during the
early 1960's and formalized through clinical studies
at the University of Alabama, School of Dentistry,
Applying time and motion study techniques
used by industrial engineers to increase
efficiency and productivity in repetitive task
environments, the university studied dental
procedures of hundreds of practicing dentists
and dental students to define the criteria for
The goal of four-handed dentistry is
to allow the dentist and assistant to function as
a team in a seated position with maximal efficiency
and minimal strain
as it has been developed, not only increases
productivity, but also reduces stress and fatigue on the
provider and assistant.
Four-handed dentistry can be used in all of the specialty
areas, and in operative dentistry.
The two most frequent issues facing practicing dentists
(1) the need to minimize stress and fatigue and
(2) the need to maintain or even increase productivity
without sacrificing the quality of care. As the practice of
dentistry has become more complex with intervention at
almost every level by third parties and government
agencies, the intrusion on the dentist's chairside time has
become critical. The use of this concept of four-handed
dentistry will enable the practitioner to spend their time at
chairside more efficiently.
Concepts important to teamwork
Done in seated position
Work area used
Availability of second assistant
has many choices as to what they will do with
1- One can see more patients,
2- spend more time with each patient,
3- spend the time in other activities.
therefore, we should see it as the effective use of
the principles of time and motion allowing the
practitioner more schedule flexibility
The Benefits Include:
-- There is an increase in the efficiency of the
dentist through the use of a full time trained chair
--- There is a decrease in the muscular stresses
involved with the practice of dentistry through
conservation of muscular activity,
-- adherence to the principles of balanced posture.
-- The dentist is able to concentrate their skill and
judgment on the tasks directly associated with patient
The concept of four-handed dentistry described by Dr. G.E.Robinson
and others will be reviewed. Research shows that production can be
increased by 100% and simultaneously stress and fatigue will be
reduced by 50% -70%.
principles of four-handed dentistry
The following will describe
1- the principles of four-handed dentistry,
2- areas of activity,
3- work simplification and motion economy.
4- the proper selection and arrangement of operatory equipment
according to the criteria as established by the research completed at
the University of Alabama
This system of four-handed dentistry is based on the
1. POSITIONS: The dentist (or hygienist), assistant
and patient are seated and positioned properly.
2. ASSISTANT UTILIZATION: The operator uses the
skills of competent, full-time chair side assistant.
3. TREATMENT ORGANIZATIONS: Every aspect of
the patient's treatment is organized and repetitive tasks
simplified to take maximum advantage of the chair
side time available.
4. EQUIPMENT ARRANGEMENT: The equipment
used is selected carefully and positioned properly to
enable the operating team to use the principles of work
simplification and motion economy