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a. Team Work. A standard technique to passing instruments is the four-handed dentistry technique that requires the dental officer and the dental specialist to work as a team. There are definite steps in passing instruments that must be planned and

practiced in advance:

b. The First Step. The first step is the approach. The dental specialist brings the new instrument into the zone of operation with his right hand. He then takes the next instrument to be used in his left hand in a modified pen grasp and holds the nonworking end of the instrument between the thumb and first two fingers. Then, he holds the instrument parallel to the one the dental officer is using. See figure 4-10.

Figure 4-10. The approach.

c. The Second Step. The second step is the signal. When the dental officer has finished using the instrument that he is holding, he lifts the instrument from the tooth in a fingers-only movement. This is a signal to the dental specialist that the dental officer has finished using the instrument and is ready for the next instrument. See figure 4-11. The signal may also be verbal, usually when an instrument is desired that is not in sequence on the prearranged tray.

Figure 4-11. The signal.

d. The Third Step. The third step is retrieval. The dental specialist extends his third and fourth fingers to grasp the instrument that the dental officer has just finished using. After the dental specialist has securely grasped the used instrument, the dental officer can release the instrument from his grip. See figure 4-12.

Figure 4-12. The retrieval.

e. The Fourth Step. The fourth step is the delivery. The dental officer receives a new instrument in the correct position so he can use it without adjustments. The dental specialist then takes the used instrument from the dental officer's hand. By turning his hand downward, the dental specialist lowers the retrieved instrument that allows him to place the new instrument in the dental officer's fingers in the position in which he will use it. See figure 4-13. Some instruments are double-edged and sharp.

Figure 4-13. The delivery.

f. The Fifth Step. The fifth step (the last step) is the withdrawal. The dental specialist holds the used instrument in the third and fourth fingers opposed by the thumb. He then takes the first two fingers and opposes the thumb on the instrument and releases it from the third and fourth fingers. Now he holds the instrument between the thumb and the first two fingers. Then, the dental specialist is ready to replace the used instrument on the preset tray. See figure 4-14. For this action, the tray must be positioned properly alongside the patient's face and over the dental specialist's lap. In returning an instrument to the operating tray, lay it down gently and return it to its former place in the arrangement. If you should drop an instrument, leave it and take a fresh one from the instrument cabinet.

Figure 4-14. The withdrawal. Continue with Exercises

EXERCISES, LESSON 4

INSTRUCTIONS. Answer the following exercises by marking the lettered response that best answers the question, by completing the incomplete statement, or by writing the answer in the space provided.

After you have completed all the exercises, turn to "Solutions to Exercises" at the end of the lesson and check your answers.

1. Situation: A dental officer and a dental specialist are working together and are following a procedural outline planned and practiced in advance. Identify the term or terms used for what is happening.

a. Prearranged procedures. b. Four-handed method. c. Dental assistance.

2. In the rubber dam application of the four-handed method, the ________ places the rubber dam over the teeth and the ____________ unrolls the dental floss. a. Dental specialist; dental officer.

b. Dental officer; dental specialist.

3. In the four-handed rubbed dam application, who ties the dental floss on the dental officer's side after the floss is inserted into the interproximal spaces?

a. The dental officer. b. The dental specialist.

4. In the four-handed rubbed dam application, who places the saliva ejector under the rubber dam?

a. The dental officer. b. The dental specialist.

5. Why does a dental chair have a thin and narrow back?

a. To allow __________ ______________ to be placed nearby. b. To allow room for the dental officer and dental specialist to ___________ _______________.

6. List the characteristics of operating stools. They must: a. Have a broad base for _______________________. b. Be completely ___________________.

c. Have good ________________ and/or _________________ support.

7. Describe the characteristics of operating light. a. Lighting should be _____________________. b. It should be easily _____________________.

c. It should have _________________________ on both sides.

8. The operating position of the dental specialist is in the: a. 2 to 4 o'clock position.

b. 7 to 12 o'clock position. c. 4 to 7 o'clock position.

9. Identify standards for operating positions.

a. The patient's chair height must be positioned so that the zone of operations is ________________ _______________.

10. Why is the main reason that high velocity suction is used in four-handed dentistry? a. To eliminate the need for a cuspidor.

b. To pick up fluids without touching the surface of the tissue. c. To allow the dental specialist to reach all areas of the mouth. d. To move massive amounts of fluid quickly.

e. To maintain a clean, clear field of vision.

11. What kind of grasp is recommended when using the suction tip? a. The pen grasp.

b. The thumb-to-nose grasp.

12. Which of the following must be positioned first? a. The suction tip.

b. The handpiece.

13. The suction tip is placed parallel to the: a. Occlusal surface.

b. Buccal and lingual surface. c. Mesial and distal surface.

14. The edge of the suction tip is placed even with the: a. Occlusal surface.

b. Buccal surface. c. Distal surface.

15. What is the second step in instrument transfer? a. The withdrawal. b. The delivery. c. The retrieval. d. The signal. e. The approach.

16. In the first step of instrument transfer, the dental specialist holds the instrument parallel to the one the dental officer is using. The instrument is held with the: a. Right hand.

b. Left hand.

17. In the third step of instrument transfer, the dental specialist grasps the instrument that the dental officer has just finished using with the:

a. Modified pen grasp.

b. Thumb and first two fingers. c. Third and fourth fingers.

18. In the fourth step of instrument transfer, the dental specialist places the new instrument in the dental officer's fingers in the position in which it will be used. To accomplish this, the dental specialist turns his hand:

a. Downward.

19. In the fifth step of instrument transfer, the preset tray of instruments must be positioned properly alongside the patient's:

a. Lap.

b. Chest.

c. Face.

20. In which step of instrument transfer does the text specify that care must be taken by the dental specialist not to cut himself, the dental officer, or the patient?

a. First step. b. Second step. c. Third step. d. Fourth step. e. Fifth step.

SOLUTIONS TO EXERCISES, LESSON 4