Close Support or Four Handed Dentistry is the area of dentistry concerned with allowing the dentist and dental nurse to function as a team in a seated position with maximum efficiency and minimal strain.

'The clinical dynamics of close support or four handed dentistry are the components of the process of a skilled operator and assistant working together to perform clinical tasks in a safe, stress free, productive environment' [1].

Some of the recognised benefits of Close Support Dentistry include good posture, prevention of musculoskeletal disorders, increased productivity, reduction of stress and fatigue to the dental team, work simplification and shorter appointments resulting in more patients being seen and higher financial gain.

The Cork University Dental School and Hospital (CUDSH) recently introduced a pilot programme in relation to the concept of Close Support Dentistry to third year dental students, dental nursing students and staff members. This course comprised of a didactic component followed by a practical hands on session in the Clinical Skills Laboratory of the CUDSH.

The learning outcomes of the course were that on completion of this course the attendees should be able to:
. Describe the basic trends of Close Support Dentistry . Understand the concepts of motion economy
. Describe zones of activity and understand the benefits of ergonomics in the dental clinical environment
. Identify common symptoms of musculoskeletal disorders and the side effects of poor posture
. Understand the role of each dental team member to ensure effective practice of Close Support Dentistry
. Identify the common barriers to the implementation of Close Support Dentistry

Evaluation forms were disseminated to all participants at the end of the programme and a 100% (n = 54) response rate was achieved. Participants were asked a range of questions to determine their interest in this initiative (Figure 1). They were also asked how this practise could be applied to benefit clinical efficiency (Figure 2).

Overall the response from participants was very positive and indicated that Close Support Dentistry should become part of the undergraduate curriculum. This initiative also highlighted the necessity for continued integration of all members of the dental team.

As a result of this initiative, on-going integration of Close Support Dentistry within the Dental Science and the Dental Nursing undergraduate curricula has been achieved.

It is also hoped that in the future Close Support Dentistry can be introduced as an OSCE station for examining purposes for both the dental nursing and the dental science students as suggested by the Dental Council of Ireland.

The aim of Close Support Dentistry is that we all 'Work Smarter...Not Harder'.

"I really thought this was great. Gave me glimpse into the potential efficiency gained in having a well-integrated and well trained dental team" (participating student).

"I think today's course has captured what we really need to know" (participating student).

"This course clearly demonstrated the benefits to the patient, the operator and the dental nurse; increasing efficiency, reducing fatigue and decreasing the appointment time required for a procedure. Attending a Close Support Dentistry course is essential to develop cooperative skills between the dental team members" (participating staff member).

Ms Helen Farrelly RDN, Dental Nurse Tutor, Dublin University Dental School and Hospital.

Dr. Edith Allen, BDS, Dip Con Sed, MFDS, PhD, PGCert T&L, Lecturer, Cork University Dental School and Hospital.