DENTAL EQUIPMENT COURSE THREE TIPS This is where we start to get into the fun stuff You will want to save as much money as possible when you first open your practice but certain things you need to spend more on and consider ergonomics, easy of use, operating expenses and maintenance A common mistake is buying things cheap or ON SALE you have to ask yourself, why is this dental chair $2000 cheaper then all the others? It could be because the company knows they are going out of business and once the chair breaks down thats it the company is no longer around to validate the warranty and you need a new chair (this has actually happened!)
SEATING Seating ergonomics is so important for everyone involved with your dental practice Adjustable seating is a must so that you can move the chair up or down and back rest forward if needed One size DOES NOT fit all so make sure to sit and adjust many different chairs to find one that works for you Keep in mind need to be able to get close to your patient without straining the neck, some chairs are thicker or wider so this depends on your body type as well The patients chair is just as important you dont want the chair too wide or narrow, you will need arm rests for them, and movable arm rests (in case you have a wheelchair patient who needs to transfer into the chair a moveable arm rest to move it out of the way
is key) If the patient chair is too firm it wont be comfortable for them either DENTAL UNIT This can be over the patient, off to the side or at 12 o'clock position on the counter. If you have both left and right handed staff it may be using to have an overhead unit so it can move around or a side unit to move around as well You should visit a supply showroom and see how all units move and which may be best for your practice. Keep in mind that some over head units may be attached to the dental chair and can only move so far either way If a new chair ever needs to be purchased you may not be able to transfer the over head unit and may need a whole new chair/unit attachment which adds to the cost The most cost effective is probably a movable unit to either left or right or
having the unit at 12 oclock behind the patients head on the counter PATIENT LIGHTS Ceiling mounted, track, wall-mounted, cabinet mounted, orbit (left/right), chair mounted, and unit mounted Extra ceiling support and framing is required if you choose a ceiling mounted light The track light is also mounted to the ceiling and also need extra ceiling support It depends on the dental unit and where it is, see more in the following slides: LIGHTS The ceiling-mounted patient light is permanently attached to the ceiling on either the left- or right-hand side of the patient chair and requires extra ceiling support or framing above the finished ceiling. The ceiling-mounted light is not recommended if you are using the orbit (left/
right) dental unit. The track light is also mounted to the ceiling and has a patient light mounted to a trolley that can be rolled toward the toe or head of the patient chair. This style of light can be used for left- or right-handed dentistry. Track lights also require extra ceiling support or framing above the finished ceiling. The wall-mounted patient light attaches to a side wall, and the side depends on if you practice left- or right-handed dentistry. The wall must be sturdy enough to mount this style of light. This style of light is not recommended if you are using the orbit (left/right) dental unit. Cabinet-mounted patient lights are mounted into a center island cabinet (center island cabinets are used in open concept style dental offices) and can be used with orbit (left/right) dental units. Orbit (left/right) patient lights are attached to the patient chair and can be rotated from side to side around the toe end of the patient chair. This style of patient light is recommended when a practice has left- and right-handed dentists and hygienists. Chair-mounted patient lights are attached to either the left or right side of the patient chair. The same left/right conversion procedure applies
here as outlined in the over-the-patient dental unit. The unit-mounted patient light attaches to the over-the-patient dental unit that is attached to either the left or right side of the patient chair. The same left/right conversion procedure applies here as outlined in the over-the-patient dental unit. It is recommended that you visit a dental equipment supply showroom or a tradeshow to see examples of these items. STERILIZERS There are three types: Dry heat Chemical Steam Dry heat means the sterilizer uses only heat and no chemicals or water. Chemical sterilizers use heat and chemicals for the sterilization process. Steam sterilizers use heat and distilled water for the sterilization process. There are two types of steam sterilizers: recirculating and non-recirculating, offered as either manual or
automatic models. The recirculating steam sterilizer reuses the distilled water each time a cycle is run. This type of sterilizer requires a frequent maintenance schedule. The non-recirculating steam sterilizer uses the distilled water for only one cycle. At the end of the cycle, the water is purged from the sterilizer into a container or a drain. This type of sterilizer has a higher distilled water usage but requires less maintenance. CONTINUED Another version of the steam sterilizer is the dry-to-dry model. It is offered in the recirculating and non- recirculating versions as well. With this model, the instruments and/or handpieces are dried after the ultrasonic/disinfecting process, and then placed into the sterilizer. The items inside the sterilizer go through an entire sterilization process, including a drying cycle, before the sterilizer door opens. This type of steam sterilizer is more costly compared with other sterilizers and the sterilization process is longer due to the drying cycle. However, the contents are dry when the door opens at the end of the cycle. After you have determined which type of sterilizer you want, you need to determine an appropriate size and
whether you need more than one sterilizer. For example, if you use instrument cassettes, you will need a larger sterilizer. If you use sterilization pouches for instruments and/or handpieces, they should be laid in a single layer on the tray. If you use a cassette-style sterilizer, the pouches should be laid in a single layer on the bottom of the cassette. If pouches are multilayered, the middle layers will not completely sterilize, and if you have a dry-to-dry sterilizer, the middle layers will not dry. Also, multiple layers can shift and slide off to the side and touch the sterilizer chamber wall. This will result in burnt pouches and possible cycle failure. It is recommended that you have a larger sterilizer for larger loads and a smaller sterilizer for quick turnaround items (that is, handpieces, specialty instruments, etc). This also gives you a backup if one unit breaks down. X-RAYS INTRA-ORAL X-RAY UNITS
Film or digital x-ray imaging. When using film the exposure time is increased, resulting in a longer radiation exposure. In contrast, digital x-ray requires a lower exposure time, resulting in a much lower radiation exposure. When setting up a new office or clinic, costs and cost savings are always an issue. But remember this could be a great headline to set your office apart from others in the area WE ONLY USE DIGITAL, LOW RADIATION X-RAY UNITS Intra-oral x-rays can be set up in an x-ray room, one x-ray per operatory, in a pass-thru cabinet, or mounted on a center island. Consequently, the most expensive setup will be one x-ray unit in each operatory, and the use of an x-ray room will be the least expensive to set up. There are, however, other things to consider. Depending on the size of the practice, an x-ray room could cause a slowdown in productivity due to waiting for the room to become available. The passthru or center island option utilizes one x-ray unit mounted between two operatories, which will reduce costs. While this option will help reduce equipment costs. Remember too that machines can break downkeep this in mind.
THE PANORAMIC MACHINE Panoramic x-ray units produced today are capable of either film or digital x-ray imaging. When using film exposure time is increased, resulting in a longer radiation exposure. In contrast, digital x-ray requires a lower exposure time, resulting in a much lower radiation exposure. If you purchase a film-based panoramic x-ray with intentions of upgrading the unit to digital in the near future, be sure to inquire whether a conversion will be possible for that unit. Also, it may be more costeffective to purchase a digital panoramic unit instead of purchasing a film-based unit then doing a digital conversion at a later date. The panoramic x-ray is the one mechanical piece of equipment that has the ability to pay for itself and continue to generate a significant income for the practice. Two key things to consider here are your current and future needs; then purchase the unit that best fits both. To keep costs down, do not purchase a unit that can be upgraded for things you will not use. For example, if you plan to take only panoramic x-rays, try to purchase a unit that will do only panoramic xrays. This unit will have a lower purchase price because it will not have the extra internal components necessary for the addition of a cephalometric. If you think in the near future you want to have the ability to take cephalometric x-rays also, then purchase a unit that has the
ability to add the cephalometric option. This type of unit will have the necessary internal components for a cephalometric upgrade but will also have a higher purchase price. X-RAY FILM PROCESSING X-ray film developing can be accomplished manually with the use of dip tanks, or automatically with the use of an automatic film processor. The dip tank method requires manually handling films through the entire developing, fixing, and rinsing process before exiting the darkroom. The automated film processor allows you to feed the films into the film processor, and once they are completely inside the machine, you can exit the darkroom. If a darkroom does not exist, the film processor can sit on a stand, cabinet, or countertop where space allows and will require purchasing an optional daylight loader. This is a small compartment that attaches to the film entry end of the processor for the handling of films without exposing the film to light. Automated film processors are offered in an intra-oral
only version and an intra-oral/extra-oral version. Intra-oral automatic film processors develop only intra-oral x-rays. These units are smaller, require less space inside the darkroom, and are less expensive to purchase than the intra-oral/extra-oral models. CONTINUED If you have a panoramic or panoramic/cephalometric x-ray unit, you will need the larger automatic film processor that will develop both intra-oral and extra-oral films. Automatic film processors can be purchased as a plumbed or stand-alone unit. The plumbed model is hooked up to a cold water supply line and a drain. The stand-alone model is totally self-contained. These models use pumps to circulate the chemicals and water from containers into the automatic film processor, then back into the containers. The stand-alone unit with a daylight loader offers the flexibility of placing an automatic film processor virtually anywhere within the dental practice. They are, however, more expensive than the plumbed automatic film processors. The film-based x-ray process has a significant ongoing operating expense in the form of x-ray film,
processing chemicals, and cleaning chemicals. Also to be taken into account is the staff time required for the frequent maintenance of automatic film processors. Lastly, the purchase of duplicating film and a film duplicator is necessary in order to send film(s) to another dental practice, insurance company, and so forth. Duplicating film is another item to be added to the list of ongoing operating expenses. The film duplicator will require a space in the darkroom. DIGITAL There are two forms of digital x-ray available to the practitioner: phosphor plate technology and digital sensor technology. Determining which one is best for your practice means understanding what each one has to offer. Phosphor plate technology uses a phosphorus plate that is the same size and shape of an x-ray film. Preparing to take an x-ray has the same set-up steps as that of an xray film-based process. Once the image is captured on the phosphorus plate, it is placed into a light-proof container and carried to the scanner. The plate is removed from the container and placed into the reader. The reader is connected to a computer and monitor, and you can watch the image coming up on the monitor as it is being read. Processing a phosphor plate image is quicker than film-based processing but longer than digital sensor processing. Digital x-ray software offers numerous features that allow you to manipulate images in a variety of ways as well as send images
electronically. Phosphor plates are available in intra-oral and extra-oral sizes. Phosphor plate technology eliminates the need for duplicating film, a film duplicator, processing chemicals, cleaning chemicals, and the need for staff to perform routine maintenance. Care must be taken with the phosphor plate to avoid scratching or bending it. Phosphor plates are not repairable and do have a limited lifespan. Digital x-ray uses a digital sensor with a wire coming out of the sensor that is connected to a computer to capture and show images. Once the x-ray is taken it is available for viewing within seconds. The sensor is much thicker than film or phosphor plate and can be uncomfortable in smaller mouths or the posterior region. Digital x-ray software offers numerous features that allow you to manipulate images in a variety of ways as well as send images electronically. This technology replaces the use of x-ray film, a film processor, duplicating film, a film duplicator, and darkroom. Digital x-ray has a greater start-up cost but a considerably lower ongoing cost compared to its film-based counterpart BUT remember can be uncomfortable for patients. OTHER AIR COMPRESSORS Air compressors are available as both lubricated and lube-free units, and both offer various
sizes of units that are then matched to the number of users. Dental air compressors have built-in filtering systems in order to provide clean and dry air into the oral cavity. The lubricated models are quieter and usually less expensive than the lube-free models. On the other hand, the lube-free models do not require annual oil changes, and there is no risk of compressor oil ever getting into the air lines and dental unit(s). When purchasing an air compressor, consideration must be given to where the air compressor is placed within the facility and the decibel level generated from the unit. It might be necessary to purchase an optional sound cover that will help to reduce the decibel level. VACUUM SYSTEMS Dental vacuum systems are offered in two versions known as wet-ring or dry. Both
systems are sized based on the number of users. The wet-ring version is available as a single pump or dual pumps. Because of the compact size, especially the single pump, this system will fit into very small areas. A cold water supply line must be run to the pump(s), and the water is then injected into the operating pump(s). These pumps are offered in a water recycling version that reduces water consumption to approximately one-half (or less) of the non-recycling versions. The dry vacuum systems use an electric motor to drive a pump to create suction. While they use no water to create suction, they are larger and are more difficult to fit into confined spaces. In terms of purchasing and ongoing costs, the wet-ring vacuum systems are less expensive to purchase than the dry vacuum systems. In contrast, the dry vacuum systems have no impact on water bills, especially in cities that impose a high user surcharge. USED EQUIPMENT WHAT TO LOOK FOR WHEN BUYING USED EQUIPMENT
AGE OF THE EQUIPMENT When considering the purchase of used dental equipment it is to your benefit to research its age. If it is newer equipment, there may be the balance of a factory warranty still in effect. If its older equipment, some parts or the entire unit may be obsolete. Do not hesitate to ask the seller if he or she can produce documentation showing the purchase date. If the seller is unable to provide proof of the purchase date, the next step is to get the items model and serial number, manufacturer name, and where applicable, model name. With this information, a dental equipment supplier should be able to give you at least a general idea of the manufacturing period. If you have at least a manufacturer name, model name (if applicable), and model number, the internet is another helpful tool. With this information you should be able to learn the general manufacturing period. In some cases,
having the serial number(s) during your internet research could also provide you with the year and month of manufacture. CONDITION There are a number of things you can do to determine the condition of dental equipment. The most obvious is looking at the equipments appearance. Look for missing or broken parts. If its upholstered, is it discolored or torn? Dips in seat backs and seat cushions could indicate breakdown of the foam padding. If the surfaces are painted, look for discoloration, chipping, and flaking. If the surfaces are laminate, look for discoloration and chipping. Other red flags are sounds like squeaking, grinding, snapping, rattling, leaks, or a loud electric motor hum. In some cases a squeak might be nothing more than a part needing to be cleaned and lubricated. A grinding or snapping sound might indicate a fatigued part or parts that could lead to costly repairs. Some equipment has been very well maintained but just needs some updating. An
example of this is patient chairs, doctors seating, and assistants seating that has outdated or worn upholstery. CONTINUED Before you make a purchase, you should check with a dental equipment supplier on the availability and price of replacement upholstery packages. Another area in which to exercise caution is with dental equipment that is, or has been, stored in a non-temperature-controlled storage in a freezing weather climate. If dental units and wet-ring vacuum pumps do not have the water purged with air before going into storage, the freezing temperatures will rupture water lines and crack vacuum pump housings. Needless to say, these are costly repairs, and in some cases the cost of parts and labor far exceeds the value of the unit. If you purchase used dental equipment and intend to do some refurbishing, be aware of your total investment in the project. Remember, you are most likely refurbishing what is known to need attention. All other parts could still be original equipment. After an initial purchase and refurbishing you could end up putting as much as one-half (or more) of what new would have cost, and yet the used item is not completely
refurbished and has no warranty. Something else to consider is the image your practice presents to your patients and prospective job applicants. Lets say you have one operatory youre going to equip with used dental equipment. You end up purchasing doctors seating, assistants seating, and a patient chair from three different sellers and also end up with three different upholstery colors. BEWARE Obsolete dental equipment is knowingly and unknowingly offered for sale. A product is deemed obsolete when a manufacturer decides to stop producing it or if a manufacturer ceases to exist. Once the manufacturers parts inventory is depleted, that source for parts is now gone. The next option would be checking for after-market parts companies that offer new replacement parts for a number of different equipment brands. However, not all parts are manufactured in the after market due to high manufacturing costs, low demand, or exclusivity to the original manufacturer. If you should happen to purchase obsolete dental equipment and new parts are not
available, you can always shop the internet for replacement parts. Remember, the part you are looking for is probably going to be used and as old as the part you are replacing. Other red flags are poorly performed repairs, air leaks, and fluid leaks. CONTINUED Look for electrical wires that have been taped. This could be covering bare or broken wires, and if this is part of a wiring harness it could be a costly part(s) and labor repair. If you are looking to purchase a dental unit and the dental unit and junction box are still hooked up and in use, listen for air leaks and look for water leaks. When looking at a wet-ring vacuum pump, if at all possible try to hear it run because a loud squealing sound and/or water leaking indicate needed repairs. If you are looking to purchase a used sterilizer, run one cycle from a cold start (first run of the day), and as soon as that cycle has finished, immediately run another cycle. On both cycles, note if the sterilizer reaches sterilization temperature or if it took a lengthy amount of time reaching sterilization temperature. Also check for leaks around the door or cassette and drips under the unit. If any or all occurs, the unit requires repairs. Older hydraulic patient chairs are susceptible to hydraulic fluid leaks
over time. Hydraulic hoses can split, and hydraulic cylinder seals can fail, which allows hydraulic oil to leak onto the chair base and/or floor. If parts are available, parts and labor costs range from moderate to expensive. Air compressors also require a close inspection. They can have obsolete parts, rusty tanks, faulty electrical components, and slow recovery times. Lubricated compressors can have oil consumption issues that will allow oil to saturate filters and drying systems. This can also cause contamination of air lines and damage parts inside dental units, as well as emit oily-smelling air from the handpieces and the air side of the syringe. FAIR MARKET VALUE On used equipment it depends on the age first and foremost Also look at condition, part availability, color, popularity, and cost of purchasing a new one Individuals wanting to sell and companies that refurbish used dental equipment often post on auction sites. In either case you cant actually see the item(s) in person, so ask for photos from various angles and dont hesitate to ask questions. Keep in mind that in addition to the winning bid amount, you will most likely incur shipping and insurance expenses. Always cover yourself by asking for a written return and full refund guarantee in the event the item
has missing parts or does not work upon receipt. This is especially important when purchasing any equipment with circuit boards and used x-ray equipment. Replacement circuit boards, if still available, are quite expensive. The filament in used x-ray tube heads is very fragile, and rough handling can ruin the tube head. If the tube head can be repaired or replaced, the repairs are extremely costly and in most cases will far exceed the value of the x-ray unit. One other resource for guidance on used dental equipment is a dental equipment supplier. They might be able to provide you with approximate time frames of production, tips on what to look out for, information on reliability issues, and parts availability. MAINTENANCE GETTING THE MOST BANG FOR YOUR BUCK Dental equipment requires a significant financial investment, so you will want to perform the necessary maintenance in order to maximize its life. As with anything mechanical, periodic maintenance is necessary,
and its simply a matter of getting a routine schedule set up and sticking to it. Because of the demands that will be placed on your time, you should assign equipment maintenance tasks to staff members. Additionally, ask that your staff note and inform you if they hear air leaks or see water leaks, or if normal operating sounds change (that is, handpieces, air compressor, vacuum pump, etc.). Oftentimes air compressors and vacuum pumps are placed in small closets or share a space with the furnace and water heater. Most of the time these rooms are not temperature controlled, so heat and humidity can be very high, especially in the summer. This causes the air compressor filtering system to become saturated with moisture, which will necessitate more frequent maintenance and increased maintenance costs. It is recommended to have a heating/air conditioning duct run to this space, with the duct open in the summer for the cold air. The duct should be closed for winter in order to keep additional heat out. Air leaks can be another source that will cause unnecessary stress and an early demise of your air compressor. Air leaks are most commonly found in the junction box where the dental unit connects to the plumbing and in the delivery unit. Air leaks are also possible where air operated accessories are connected and within the accessory itself. CONTINUED
Air leaks will cause your air compressor to run more frequently, causing unnecessary wear and tear. If you own a lubricated air compressor, the oil level should be checked monthly. There is a sight glass on the side of each compressor head with a FULL indicator line next to the sight glass. To obtain the most accurate reading of the oil level you should check it in the morning before the compressor is started. Checking the oil level when the compressor is cold will ensure all of the oil has drained down. Over-filling the air compressor with oil can cause damage. Each month when the oil is checked you should also check for moisture in the tank. This is accomplished by slowly opening the valve at the bottom of the tank a few turns. Water (and sometimes air) may leak out. If water is coming out, let it drain completely then close the valve tight. Failure to tighten the valve will result in an air leak. THE LIGHT AND HANDPIECES The lens shield and the reflector should be cleaned with only water and a soft cloth. Glass cleaners or all-purpose cleaners will ruin the coating on the reflector, and paper towels will
scratch the lens shield and reflector. You should never attempt to clean a patient light reflector that was just in use. The glass will be extremely hot and will crack if touched with a damp towel. Replacement reflector prices vary, but even the least expensive reflector will cost several hundred dollars. Handpieces should never be placed in the ultrasonic cleaner or be doused with spray disinfectant, as this also causes expensive repairs. Handpieces should be wiped down with a two-by-two dampened (not soaked) with alcohol prior to sterilization. Handpieces with fiberoptics should have the exposed fiberoptic lens wiped with alcohol prior to sterilization. Any debris not removed prior to sterilization will be baked, possibly permanently, onto the handpiece and/or fiberoptics. There are some duties that need to be performed but that are not part of the manufacturers recommended maintenance schedules. The next section will cover setting up maintenance calendars for various manufacturers equipment. DAY-TO-DAY DUTIES Some of the following duties are day-to-day duties and should be included on those calendars.
If you have a chemical or steam sterilizer, at the start of the business day, you should check the fluid level in the reservoir. If the level is low, fill the reservoir to the FULL mark. If you use water bottle systems to supply water to delivery units and air/water syringes, fill the bottles with distilled water at the start of each business day. This will help to avoid running out of water during a procedure. If you have a plumbed-in nitrous system, turn the system on and check the gauges on the nitrous and oxygen tanks for pressurization and tank levels. Turn the air compressor on and check in the operatory, at the dental unit, for air to the handpieces and air/water syringe. Turn the vacuum system on and check in the operatory for suction to the assistants utilities. At days end, a vacuum line cleaner should be run through all saliva ejectors and high-volume evacuators (HVEs), which will disinfect the vacuum lines. Change or clean the solids collector in the operatory at days end. There is a simple test you can perform semi-annually that can tell you if there are air leaks that may be causing your air compressor to work harder than necessary. To perform this test requires a minimum of one hour and a time when dental units and air-operated accessories are not in use, so a lunch hour is ideal. After the last patient is seen just before lunch, run some handpieces and air syringes until the air compressor starts. Place the syringes and handpieces back on the dental unit and leave the dental units, any air-operated accessories, and the air
compressor on. For the next hour listen to see if the air compressor starts up, and if so, note how many times it starts within that hour. If the air compressor starts at all during this hour there are definitely air leaks that must be serviced in order to maximize the life of the compressor. MANUFACTURER MAINTENANCE SCHEDULE With the purchase of any new equipment, you will receive a manual that covers use and care instructions. Oftentimes some pieces of equipment with specific maintenance requirements will have a separate maintenance document that can be posted near that unit as a reminder to perform maintenance. It cant be stressed enough to always follow the manufacturers recommended maintenance procedures. Documented maintenance is critical in the event of a repair during the warranty period. By following the manufacturers maintenance schedule, you will maximize the life of the equipment. Because each piece of equipment might be on a different maintenance schedule, you should set up a maintenance calendar to keep track of the various schedules. Air compressors have an annual maintenance (under normal operating conditions). Annual maintenance for a lubricated air compressor is an oil change and filter(s) and drying system maintenance. Annual maintenance for a lube-free air compressor is filter(s) and drying system maintenance. Wet-ring vacuum pumps should
have the solids collector cleaned (or replaced if using a disposable solids collector) each week at weeks end. The sterilizer door gasket should be checked daily for proper fit and for any cuts or tears. The gasket and chamber opening surface should be checked for debris. A worn, cut, or dirty door gasket and/or chamber opening surface will cause the sterilizer cycle to fail before the instruments and/or handpieces are sterilized. If you have a recirculating sterilizer (the distilled water is used over and over), you will need to perform a thorough maintenance procedure after several cycles. The use and care guide will provide you with the specific number of cycles you can run before this maintenance must be performed. Failure to comply will result in an extremely dirty-looking chamber and water reservoir and in premature failure of some of the internal components and costly repairs. UPHOLSTERY Today are offered in vinyl or ultraleather. While both materials are very durable, vinyl has a stiffer feel to the touch while ultraleather has much softer feel. A patient chair with ultraleather upholstery is very appealing and relaxing to the patient. There are some things you will want to do to get as much life as possible from your upholstered items.
Before seating the patient in the patient chair, try to notice if any sharp objects are in their back pockets. There are numerous horror stories about sharp objects in back pockets that puncture a hole in the patient chair upholstery. Ink pens are a double threat because they can puncture or cause ink stains. Also be watchful for leather apparel that has been freshly dyed, as this has been known to stain upholstery as well. As for cleaning of the doctors and assistants seating upholstery and patient chair upholstery, avoid disinfectants with high alcohol content. Repeated use will discolor and crack upholstery and will significantly reduce the useful life of the material. Many dental offices now use a plastic barrier on the patient chair, which eliminates using harmful chemicals. The barrier is discarded after each patient, and a new barrier is placed on the patient chair before the next patient. On a final note, most seating upholstery and patient chair upholstery has a 1-year warranty against manufacturing defects.