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The Concepts of Four-handed Dentistry Including Ergonomic Instrument Transfer and Exercises for Stress Reduction


Betty Ladley Finkbeiner, CDA-Emeritus, BS, MS

Credit Hours:

2 Hour(s)


This course describes and discusses four‑handed dentistry; its integration in the modern dental office as well as a review of an ergonomically acceptable instrument transfer for use in four-handed dentistry. In addition, a series of exercis...

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This course describes and discusses four‑handed dentistry; its integration in the modern dental office as well as a review of an ergonomically acceptable instrument transfer for use in four-handed dentistry. In addition, a series of exercises for the dental professional to use for stress reduction is included.

Over the years as new technology has been integrated into the modern dental office, no single product has increased productivity and reduced stress and strain on the dental team as much as using the concept of four‑handed dentistry. The clinical dynamics of four‑handed dentistry is an ergonomic chairside concept performed by a well-trained dental team in an organized manner. Combined with the practice of ergonomics in the workplace, the concept of true four‑handed dentistry must be revisited by the dental profession and applied to both the clinical and business areas of the office. The young dentists of the 21st century have had minimal exposure to true four‑handed dentistry during their educational experiences due to budget cuts in many of the dental schools around the country limiting their use of auxiliaries trained in this technique. The concept of four‑handed dentistry was born in the 1960s to overcome a manpower shortage. Demands were made on the dental profession to provide more services to more people due to the creation of third-party payment. As the years have passed, this single concept, when executed properly, has become even more important. Some demands may have diminished but the impact of regulatory agencies, managed care, infection control guidelines, the global pandemic due to COVID-19, and quality assurance of skills places even greater demands on the practicing dentist to implement efficient clinical practice methods to ensure a safe, comfortable environment for the entire team.

  • Intended Audience:

    Dentists, Dental Hygienists, Dental Assistants, Dental Students, Dental Hygiene Students, Dental Assisting Students, Office Managers

  • Date Course Online:

    Nov 17, 2021

  • Last Revision Date:


  • Course Expiration Date:

    Nov 16, 2024

  • Cost:


  • Method:


  • AGD Subject Code(s):


  • Technical Requirements:

    Stable internet connection and the latest version of browser and device software are recommended.

Learning Objectives

Upon the completion of this course, the dental professional should be able to:

  • Identify the basic tenets of true four‑handed dentistry.
  • Describe motion economy.
  • Identify the basic zones of activity.
  • Explain why the concepts of true four‑handed dentistry can increase productivity.
  • Identify dental team responsibilities to ensure effective four‑handed dentistry.
  • Examine equipment to increase visibility.
  • Understand how the concepts of motion economy and ergonomics can apply to both the clinical and business areas of the dental practice.
  • Describe and discuss each team member’s responsibilities during an instrument transfer.
  • Recognize and discuss specific instrument transfer techniques including the single-handed transfer, two handed transfer, hidden syringe transfer, pen grasp, modified pen grasp, palm grasp and palm thumb/thumb to nose grasp.
  • Discuss the benefits of a proper instrument transfer technique.
  • Discuss the required commitment on the part of the members of the operating team to specific work practices before and during a dental procedure.
  • Describe the role of an additional set of hands as used in six handed dentistry.
  • Explain exercises to reduce stress.


  • P&G is providing these resource materials to dental professionals. We do not own this content nor are we responsible for any material herein.
  • Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice.  Only sound evidence-based dentistry should be used in patient therapy.

Note:  Registration is required to take test.


Conflict of Interest Disclosure Statement

  • Ms. Finkbeiner reports no conflicts of interest associated with this course. She has no relevant financial relationships to disclose.

Betty Ladley Finkbeiner, is a Faculty Emeritus at Washtenaw Community College in Ann Arbor, MI where she served as Chairperson of the Dental Assisting Program for over three decades. She has served as a consultant and staff representative fo...

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Submission Information

Academy of General Dentistry (AGD) Submission For credit transfers to appear in your AGD account in real time, make sure to add your AGD membership number in the field provided on the “Share Your Test Score” page.

CE Broker For all states that use CE Broker for licensure, “proof of completions” are electronically reported the first of every month. If a course was taken in November, the “proof of completion” will be submitted the beginning of December.


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Approved PACE Program Provider


Nationally Approved PACE Program Provider for FAGD/MAGD credit.

Approval does not imply acceptance by any regulatory authority or AGD endorsement.

8/1/2021 to 7/31/2027

Provider ID# 211886


AADH Approved Program Provider

Procter & Gamble is designated as an approved Provider by the American Academy of Dental Hygiene, Inc. #AADHPGC (January 1, 2024-December 31, 2025). Approval does not imply acceptance by a state or provincial Board of Dentistry. Licensee should maintain this document in the event of an audit.