Bringing changes to Cambodian dentistry

Introducing 4 handed dentistry to Cambodia

Fate leads people to many destinies. For me the moment I got into dental school there was no way I could exit my destiny as a dentist. Fate would make me even take a pay cut to leave for private practice and introduce me to the world of 4 handed dentistry. Tay and partners was then a young dental practice in Orchard Road, Singapore. It was ahead of the times.  It was also where I learnt how to deliver dental care in the most efficient and productive manner.

                                           Both dentist and DSA is seated down

                                        Patients cannot see the instruments

                       

                                           All four hands in action

                                   You can even use your left habd to take out teeth so no strength needed

Till today I am very surprised to find the majority of dentists all over the world who have no clue what 4 handed dentistry is all about. Dentistry is basically manual work. No matter which procedure is performed for the patient, it can be broken down into many simple and repeatable steps. The oral cavity is a very small worksite. All the materials and equipment need to be delivered to this worksite to finish what is needed to be done. The dentist being human must be able to conserve his movements throughout the day so that at the end of the day he is not stressed or tired. The patient obviously benefits from it as one need not open his mouth for too long.

The concept of 4 handed dentistry.

All dental procedures can be simplified. They also can be done with the least number of instruments and materials. More important a dental assistant can be taught how to deliver all the necessary instruments and material for the dentist to use. As such the dentist is fully focused on the work and using only finger and wrist action can deliver the highest quality of dental care.  With the additional hands of the assistant the term 4 handed dentistry was coined. It can also be extended to 6 handed dentistry if one more nurse is brought into the picture.

                                                              The ideal dental chair

One must start from the design of the clinic. The flow of patients and staff to and from the treatment area is very important. The patients should be able to reach and exit from treatment area is quickly as possible. The majority of dental chairs used by dentists all over the world is not ergonomically design for the patient. There is this equipment arm that is a barrier to the patient getting on to the chair. Personally I can never understand why dentist must be a slave to this arm, pushing it in or out every time a patient is seated or even when they want to rinse their mouth in between procedures. Imagine how much time can be save in their life just by using a different design.  

By introducing 4 handed dentistry to one’s practice , the productivity can be increased by at least 30%.  If the clinic setup is well planned, I am sure most dentist can double their productivity. If you extrapolate over the lifespan of a practicing dentist it is extremely significant.

The Cambodian challenge.

At a lunch gathering I was seated with Dr Khov Sov president of the Cambodian Dental Association who was visiting Singapore as a guest of the Singapore Dental Association. 3 other prominent Singaporean dentists were present. The conversation lead to the discussion on seated down dentistry. One of the most important rule in 4 handed dentistry is the dentist and assistant must be seated down at all times so that both of them have a clear view of the operating field. However as I found out I was the only dentist at that table that do so. My Singapore colleagues were arguing that is technically impossible to do all dental procedure seated down. Dr Khov Sov was surprised that since we were all graduates of  Singapore dental school we have different working style.

So here I am in Phnom Penh. As this was my first trip to Cambodia, I wanted to see for myself how Cambodian dentists are doing before introducing to them the art of 4 handed dentistry. I am quite sure nearly all Cambodian dentists practice 2 handed dentistry as few dental schools in the world teaches 4 handed dentistry. To change one’s style, one needs to completely change the mindset. Fortunately all the dentists I met were very young and eager to learn. As usual most questions they posed  focus on whether I do implants for my patients. There were surprised that I don’t. They were more surprise to hear that I am so productive such that I can earn a very good salary just doing very basic dentistry.

Visit to the dental school.

The dean

This brings back memories to me as the Cambodian dental school looks similar to  the facilities I was attending back in late 70’s. The dean was very kind to meet me and spoke at length of the changes to the school. The school is expanding and upgrading their facilities. It would be ideal if they can  introduce 4 handed dentistry to their students.

                                         The overhanging arm I mentioned

Taking one step at a time.

The first step was to conduct a clinic for some dentists at Dr Khov Sov’s practice. Four of his classmates turned up for the session. I put them through a slide show introducing them to the idea. It was difficult to impress them as I did not have it as a hands-on demonstration with my own dental chair setup and with a trained nurse assisting me. Well to add more fun I had asked Dr Khov to arrange for a patient with a mesio-angularly impacted wisdom tooth for me to perform a live demo. His clinic assistant came in as the right candidate. Obviously his setup was not for 4 handed dentistry. Still I managed to demonstrate to them how one can perform a surgical removal of  a wisdom tooth seated down. It also gave me an opportunity to show them the use of the subluxator for speedy extractions. They were amazed that  the whole procedure took only fifteen minutes.



my first group of students



performing the operation in a seated position



 

 A very bright future for them

It would be an uphill task to bring 4 handed dentistry to Cambodia. Their equipment does not pose any issue as their present dental chairs are modern. With the addition of the assistant’s mobile clinic they will be able to start on it. However just as any new skills, a lot of hand holding is necessary and as old habits are difficult to discard, most dentists will fall back when they are stuck with nurses who are not able to assist properly. In my own clinic all the nurses are trained to assist any dentists who join us. They are thus able to coach any newcomers.

However I can come back again to Cambodia to show them again if the need arises. The ideal place would be to conduct the program in their dental school. This would enable a group of DSA’s to become well verse in the technique and be able to promote it. This should go for all other countries. Ironically I am not able to do so in my own country.

                                          A visit to a rice paddy farm

Its great to meet new people from all over  the world.
I wish to thank the Dean , Dr Khov Sov and his friends for giving me this opportunity to share my experience with them.