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' .
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
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
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
"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.