FINE MOTOR SKIILLS / MANUAL DEXTERITY / AND DENTISTRY
Fine Motor Skills vs Gross Motor Skills
GROSS motor skills require the use of large muscle groups to perform tasks like walking, balancing, and crawling. The skill required is not extensive and much of the development of these skills occurs during early childhood.
FINE motor skills are the ability to make fine movements using the small muscles in our hands and wrists. They require the use of smaller muscle groups to perform smaller movements with the wrists, hands, fingers, feet and toes. These tasks are precise in nature, like playing the piano, writing carefully, taking things apart and putting them back together, or sewing by hand. Generally, there is a retention loss of fine motor skills over a period of non-use.
It’s Largely Genetic
Current studies demonstrate that individual differences in motor skills has a genetic influence, with heritability being 68%.
A study on Heritability of Motor Control and Motor Learning, specifically regarding the contribution of genetics and environment differences in motor control *1 (nih.gov website) notes: “The present findings suggest that heredity accounts for a major part of existing differences in motor control and motor learning”
We all remember that kid in grade school who could color in the lines better than anyone else in class…or the kid who could draw things other students found impossible. That kid had great fine motor skills – and likely still has better fine motor skills than most people whether he or she has been using them, or not!
Obviously, having outstanding hand skills is something you want your dentist (and, your brain surgeon!) to have! Most people just assume all the skills used in dentistry are learned in dental school. Techniques and procedures are learned, but the fine motor skills (the ability to have outstanding outcomes, repeatedly) are either present or not, long before dental school admission.
Is Dexterity Testing Part of Applying To Dental School?
“The selection of the dental students at most Universities is mainly based on the GPA they acquired from high school and college. The dental school admission is based on their knowledge about science, mathematics and languages. An interview is conducted before the final selection process. However, no test on aptitude or manual skills is used as criteria.”
The *3 ADA website under Dental School Admissions Requirements does not even mention a Fine Motor Skills test/Dexterity test:
Dental Admissions Test (DAT)
*Take the DAT at least a year prior to seeking admission to dental school. This computerized test measures general academic ability, comprehension of scientific information and perceptual ability. Completion of at least one year of college level courses in biology and general and organic chemistry is recommended before taking the DAT.
Many years ago, a manual dexterity test was administered. Dental school candidates had to carve a tooth out of a bar of soap. This was a giant step in the right direction for evaluating fine motor skills prior to or in conjunction with the admissions process. It is not known how that test influenced admissions but a return to those types of tests would certainly help the admissions committees select those applicants with the right skills over those without. Unfortunately, these tests will never return to the admissions process.
Excellent Fine Motor Skills Are EXACTLY What We All Expect When We Go to the Dentist!
In the modern digital age, are dental students less able to handle the challenges demanded in manual dexterity? Does the time spent manipulating a flat two-dimensional screen come at the expense of developing the hand-eye skills set essential for a clinical dentist?
According to Clinical Professor, Dr. Anthony Silvestri Jr, of Tufts University School of Dental Medicine:
“I think we see as many outstanding, gifted, and technically skilled students as ever.” “However, as class sizes have grown larger and larger over the years, the number of less outstanding, less gifted, and less technically skilled students may have grown as well. It may well just be a numbers thing.”
Continues Dr. Silvestri, “The number of technically gifted students in any applicant pool is finite. The number of less gifted applicants is not. The range of technical skills of incoming students, between the most competent and the least competent, therefore, may be stretching out in a disproportionate way.” *4 Dentistry Today Article: Do Today’s Dental Students Lack-Or Need-Dexterity?
Here’s What Other Clinical Professors Have to Say:
*5 Advisory Board: “Why Aren’t Today’s Surgeons As Good With Their Hands?” June 3, 2019
Dr. Maria Siemionow, a transplant surgeon at the University of Illinois College of Medicine, who currently trains residents to perform surgeries under a microscope, says she’s increasingly seeing surgical students who “don’t have a good feeling about their hands. And these students are easy to spot”. She explains, “They are already in their residencies and yet, they don’t have a good feeling about their hands, and you observe them getting frustrated, they are impatient, there is blood all over.”
Some medical school instructors say that “good feeling” in the hands is usually acquired in childhood and can be very hard to develop as an adult.
“We look at their grades and their test scores…but the reality of being a good surgeon has nothing to do with that,” says Michael Lawton, current President and Chief Executive of Barrow Neurological Institute. “What matters is how they handle the instruments and what kind of touch they have with tissues, as well as how they react and adapt when under stress in the [O.R.]” *6 ( New York Times, 5/30/19).
Are We Raising a Generation With Less of This Skill?
I came across an article where *7 Professor Roger Kneebone, a Professor of Surgery in London, highlighted the decline in the manual dexterity of his surgical students over the years. He attributes this decline to years spent using a computer or tablet; merely swiping or tapping a two dimensional screen instead of sewing, kneading dough, knitting, building things, tying specific knots or writing with a pen or drawing – all skills which require specific hand-eye coordination and practice! These types of skills might once have been gained at school or at home, whether in cutting textiles, measuring ingredients, repairing something that’s broken, drawing, painting, sewing, learning woodwork or playing an instrument. Because younger generations have had so little experience in craft skills, they struggle with practical things.
He believes students have spent so much time in front of screens and so little time using their hands that they have lost (or, rather, never developed) the dexterity for stitching or sewing up patients. In other words, many young people MAY have above average fine motor skills but, because of the lack of use (development) of those skills, the ability to perform tasks at small scale (fine motor skills) is never realized. Is the younger generation losing the tactile skills that our parents and grandparents spent years honing?
These hand skills are no longer passed down from generation to generation, like they once were. It is not only dexterity that these skills teach us, but patience, that hard work pays off, and that practice is how we learn. So, these skills that are not being learned and practiced throughout youth anymore, become much harder to master as an adult.
“We have students who have very high exam grades but lack tactile general knowledge,” says Professor Kneebone.
Though rarely discussed, “ethics” is another factor in outcomes. How so? If dentists desire to make more money, many practitioners resort to increasing the speed of procedures. How does that effect quality? Even a robotic production line has a maximum threshold for productivity. When speed is increased in any procedure or task, errors increase directly. Now, combine poor fine motor skills with higher speed and guess the outcome. Exactly, more errors and lower quality are the obvious result.
Fields You Can’t Get INTO Without Exhibiting Excellent Hand Skills Article From: *8 “Requirements For A Military Sniper”
- Sharp Shooters/Snipers:
In order to attend sniper school, prospective snipers must meet a number of criteria and then be nominated to attend the course by their commanding officer. Before they begin school, snipers must meet many physical requirements. Snipers must have 20/20 vision or vision that is correctable to 20/20 and have normal color vision (not color blind). In the Army, snipers must score 70 percent or better on each area of the Army Physical Fitness Test. In the Marines, snipers must get a first-class score on the Marine Corps Physical Fitness Test, receiving 80 percent or better on all tests. And, they must hit the bullseye more often than their counterparts with similar physical abilities.
- Fighter Pilots In addition to the strict health history requirements and vision tests, in order to make the grade they are tested heavily on their spatial orientation and awareness, as well as their hand-eye coordination.
OTHER JOBS/HOBBIES REQUIRING EXCELLENT HANDSKILLS
Building Computer Circuit Boards
Playing a Musical Instrument
Wood Carving & More
What About the Aging Dentist? Does He Still “Have” It?!
* The Journal of Canadian Dental Association *9 https://jcda.ca/article/a25/
*“With age, many people slowly lose memory, but are the fine motor movements that a dentist has mastered over a lifetime also lost? The aging expert experiences the same deterioration as an aging “nonexpert in tasks that are unrelated to the expertise, but tasks that an expert has selectively maintained through decades of practice are retained through aging.”
Studies suggest that while memory and balance may fade with age, aging dentists appear to retain fine motor skill well into their Golden Years. The point where handwriting declines should signal the turning point in fine motor skills where dentists and surgeons should retire from clinical practice.
Finding that Dentist
In closing, though it is not readily evident, all dentists’ skill sets, like all other trades and professions, range from high to low (bell curve). It is very difficult for a consumer to find a practitioner with skill sets at the top of the range. If a consumer is willing to spend the time to find a dentist with the best fine motor skills and ethics, consider the following:
- Call five other dental specialists near your zip code and ask them to recommend the dentist who has the very best outcomes. If one name does not come up repeatedly, call several more specialty offices. Ask them for recommendations not based on the referral/reward system but, instead, the dentist in the area that has the best reputation for quality regardless of price or whether that office works with them, or not.
- Call five dental labs and ask the same question.
- Seek specialty care, whenever possible. Prosthodontists are the only dental specialists with three years of additional training. Many prosthodontists will not perform General Dental procedures (fillings and simple crowns) but many do.
- Call several Prosthodontists from neighboring cities/counties and ask them who they would recommend in your zip code. These offices may encourage you to make the commute to see them. If the drive is not too long, consider driving there for the chance for better outcomes.
- Vet the dentist you choose. Ask to see before and after cases of their work. Insist that they show you their Many offices purchase other doctors completed/documented cases and show them as their own.
- Look for Board Certification in all specialties. This helps give you the best chance for great outcomes. See our section on, https://www.dentalimplantcenter.com/check-credentials/
Missitzi J; Gentner R; Misitzi A; Geladas N; Politis, P; Klissouras, V; Classen, J (2013, Dec 1),
Heritability of motor control and motor learning, NIH.GOV website
Published online 2013 Dec 17. doi: 10.1002/phy2.188
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970744/
2: JCDP The Journal of Contemporary Dental Practice:
Al-Johany, S; AlShaaf, M; Bin-Shuwaish, M; Alshahrani, F; Alazmah Sami Aldhuwayhi, A; AlMaflehi, N,
(2011, Sept- Oct);12(5):327-332,
Correlation between Handwriting, Drawing Skills and Dental Skills of Junior Dental Students,
Journal of Contemporary Dental Practice, (Original research).
- ADA website:
Career Resources: Dental School Admission Prerequisites, American Dental Association
- Dentistry Today Article; Today’s Dental News:
Davis, M (2018, Dec 3), Do Today’s Dental Students Lack-Or Need-Dexterity?,
- Advisory Board Article:
(2019, June 3), Why Aren’t Today’s Surgeons As Good With Their Hands?, Advisory Board
- NYTimes article:
Murphy, K (2019, May 30). Your Surgeon’s Childhood Hobbies May Affect Your Health, New York Times
A version of this article appears in print on 6/4/19, Section D, Page 4 of the New York edition with the headline: Basic Training for a Surgeon’s Hands.
- Re: Roger Kneebone: several sites: INFO PAGE ON HIM https://www.imperial.ac.uk/people/r.kneebone
Young, S (2018, Oct 30), Surgery Students Losing Dexterity To Sew Due To Smartphone Usage,
Coughlan, S (2018, October 30), Surgery patients ‘losing dexterity to stitch patients’, BBC.com
Retrieved from: https://www.bbc.com/news/education-46019429
Weaver, M (2018, October 30), Medical students “raised on screens lack skills for surgery”. The Guardian.
Boland, B (2019, Feb 5), Technology is damaging hands-not just heads; Manual dexterity is deteriorating-and smart phones are to blame, Spectator.US
Retrieved from: https://spectator.us/technology-hands-heads/
Wolfe, M (2017, September 26) Requirements for a military sniper.
- CANADIAN DENTAL ASSOCIATION:
K.T Duong, J, DMD; Gardner, K, DMD, Med, FCP; Rucker, L, AB, BScD, DDS, (2020, July 8)
Development and retention of fine psychomotor skills: Implications for the aging dentist, Canadian Dental Association, J Can Dent Assoc 2010;76:a25
Retrieved from: https://jcda.ca/article/a25/