D
entistry is a demanding profession requiring especially for LH dentists or in a way that they can be
concentration, precision, and skills.1 Suc- used by both RH and LH dentists with minor modi-
cessful dental treatment depends on such fications.3,4 Likewise, some of the dental instrument
factors as the anatomy and location of teeth, selection manufacturers have started designing dental instru-
of a well-adapted instrument, proper angulations of ments especially for LH dentists. The effect of being
the instrument, and the proper position of the patient left-handed on professional practice is a concern not
and the dentist as well as manual skills.2 In dentistry, only in dentistry, but also in other fields of medicine
as in many other professions, equipment and instru- requiring hand skills like surgery.10,12,17-21
ments are manufactured to be used by right-handed Dentists, and particularly general dentists, are
(RH) users.3-8 In the general population, the average at high risk for development of musculoskeletal dis-
percentage of left-handed (LH) people ranges from 8 orders due to the high visual demands that result in
to 15 percent.9 About 11 percent of U.S. citizens are the adoption of a fixed posture.22 To work on a chair
LH (20 percent of men and 8 percent of women).10 designed for RH students was found uncomfortable
The percentage has been found to be slightly less than by 85.7 percent of the LH students in a study of forty-
10 percent in dentists11 and around 9.3 percent in sur- two dental students (twenty-one RH and twenty-one
geons.12 Henderson et al.11 reported the prevalence of LH).2 In a study by Tezel et al.1 about musculoskel-
self-reported sinistrality as 8.6 percent among dental etal disorders in LH and RH Turkish dental students
students and 17.2 percent among orthodontists com- (ninety-seven RH and twenty-four LH), they found
pared to 7.4 percent among the general population.11,13 that LH students experienced more musculoskeletal
In an older survey of dental students, Brown3 found symptoms than RH students. LH students especially
that one in twelve (8 percent) were LH. suffered from more neck and shoulder pain when
Manual dexterity is defined as the ability to compared with RH students.
integrate precision and speed with finely coordinated Most if not all of the dental techniques and
movement of the arm, hand, and fingers.14 Brayer procedures taught in dental schools are taught to
et al. defined skill as proficiency that results from fit RH students.3-7 Carter and Triplett23 described a
training and practice.15 In dental schools, dental technique for the successful administration of the
procedures, techniques, chairs, and stations are inferior alveolar nerve injection by an LH dentist.
designed mainly for the RH students.1,2,5,6,16 Some There may be other techniques or procedures in
dental equipment manufacturers design dental chairs dentistry that also need to be modified to allow LH
N % p-value
Age 21 8 7.3%
(left-handed n=110) 22 13 11.8%
23 19 17.3%
24 21 19.1%
25 17 15.5%
26 9 8.2%
27 3 2.7%
Did not indicate 20 18.2%
Gender Male (n=924) 63 6.8% 0.724
(total n=1660) Female (n=736) 47 6.4%
Institution King Saud University (n=452) 26 5.8% 0.236
(total n=1660) Riyadh Colleges of Dentistry and Pharmacy (n=613) 51 8.3%
King Abdulaziz University (n=469) 25 5.3%
University of Dammam (n=126) 8 6.3%
Educational level Undergraduate 81 73.6%
(left-handed n=110) Third year 25 22.7%
Fourth year 29 26.4%
Fifth year 27 24.5%
Intern 29 26.4%
available about the prevalence of left-handedness in required dental techniques. Some of them asked if
the general population of Saudi Arabia that could be there is an LH instructor to teach the LH students.
used as a reference figure. Maybe it would be useful for dental schools to encour-
Slightly more than one-third of the LH respon- age qualified LH or mixed-handed specialist dentists
dents indicated that it is difficult to be LH in general. to provide special attention to LH students.
In response to the question about how difficult it is It is not surprising to find that most of the LH
for LH students to perform the required dental pro- respondents (84.5 percent) said their institution is not
cedures, the percentage increased to slightly more equipped properly to accommodate them as LH den-
than half of the group. This finding is consistent with tal students. It is probably not easy for dental schools
the results of Henderson et al.,11 who found that LH to provide these needed modifications of the dental
dentists thought that left-handedness was a general chairs and laboratory stations. However, it could be
inconvenience. The finding points to the difficulties done.3,4 The same majority in my study asked for
LH individuals face, and these difficulties increase dental chairs and stations designed especially for
when practicing dentistry. LH dentists. This is in agreement with the results of
When working with RH instructors, around Kaya and Orbak that 85.7 percent of LH students felt
two-thirds of the respondents indicated that they had a uncomfortable using dental chairs designed for RH
problem. This could be due to the difficulty of the RH providers.2 In addition, a majority of the respondents
instructors to teach an LH student some techniques (80 percent) in my study agreed that they use devices
that may require certain modifications or to adjust to designed especially for RH. It is very important
their LH station for the evaluation of their work. The for LH students to be familiar with the equipment
thoughts of RH instructors or mentors concerning designed for RH. Someone may argue that teaching
teaching LH dental students could be for the focus a student to work in a comfortable LH environment
of a future survey. In their comments, most of the LH does not prepare them for the RH units present in
students complained that there were no clear instruc- most dental practices.11 Still this finding should not
tions or materials to read either in the literature or in be used as a reason not to provide LH students with
dental textbooks that would help them to master the convenient LH chairs and stations.
Figure 2. Percentage of left-handed participants’ responses regarding the hand they used in performing dental
procedures
If an LH dentist works on an RH dental chair, found convenient at the left of the chair.3 Kaya and
some modifications were found to be convenient Orbak2 reported that “the care their patients received
such as over-the-patient delivery (which may be could be improved by providing the opportunity for
unpopular with patients) and also the spittoon was LH dentists to work from the left side of the patient.”
Adusumilli et al.17 made many suggestions based on between LH and RH dental students and concentrated
their findings with LH surgeons that could also be only on the position, location, and severity of the pain
applied to LH dentists. These include having basic without any other aspects of being LH in dentistry.
sets of LH instruments available in the teaching In my study, the questionnaire focused on being LH
hospitals for medical students to minimize the incon- in dentistry and the problems associated with being
venience associated with learning, the provision of LH in dental education and dental practice in general.
LH mentors, and other environmental modifications, My findings were also in agreement with the
a simple website, a chapter in surgical textbooks, or a results by Henderson et al.,11 who found that fixed RH
pocket manual outlining the guidelines in performing units seemed to generate minor irritation to LH den-
invasive and surgical procedures specifically for LH tists. This could be explained by the inconvenience in
medical students and surgery residents. using RH dental chairs and stations. Canakci et al.16
The convenience of dental assistants to assist reported that the average negative scaling and root
an LH dentist is an area of interest. The participants planing forces were significantly greater in LH den-
in this survey were dental students who usually tists than in RH dentists. It could be that LH dentists
work without the help of a dental assistant to do exert more efforts than RH dentists due to working
four-handed dentistry in dental school. However, the on an RH dental chair. This poor working condition
majority of them (57 percent) said being LH may af- may cause musculoskeletal symptoms. The present
fect the ability or convenience of the dental assistant study results are consistent with this consideration.1
to work. Dental assistant training programs should As stated by Tezel et al.,1 “The best ergonomic work-
include training to assist LH dentists.3 The opinions ing principles should be taught to the students, and
of dental assistants about assisting LH dentists could dental schools should provide a comfortable working
be obtained in future survey. environment. LH students should work on an LH de-
Surprisingly, one-third (31 percent) of the par- signed chair, and further study is required to identify
ticipants said that they will change the habit of their factors that will reduce the prevalence of symptoms
children in the future if they show LH preference. amongst those practicing general dentistry.”
This could be because of the difficulties facing being Most of the participants reported being able to
left-handed, which they do not want their children use both hands in performing dental procedures. This
to face. This attitude can be expected in a dominant could be an advantage for them. This result was in
RH world. It adds some responsibility for dental agreement with the findings by Henderson et al.11 that
educators to accommodate LH students without any there are many more mixed-handers than LH only
kind of differentiation than RH. Simply, it is not a among dental students. Schmauder et al.26 found that
disability that needs correction. the strength of the sub-dominant hand-arm system is
The results of this survey showed that one-third inferior in RH subjects. Contrary to this, the differ-
(33.5 percent) of the participants have musculoskel- ence in strength between the arms of an LH person
etal symptoms mainly in the neck and shoulder. This was hardly noticeable. In treatment of dental calculus,
finding is consistent with the results of Tezel et al.1 Orbak et al.13 reported that the LH students were bet-
when they compared the musculoskeletal symptoms ter than the RH students when using reverse chairs.
of RH and LH dental students. The purpose of that The finding that 51 percent of the respondents
study was to find out the musculoskeletal disorders used their left hand in sports was consistent with