Chapter 5 Control and use of materials in practice
The manufacturer is required to provide the material to the end user in an ideal condition for use. It is the responsibility of the dental team to maintain the product in this condition up to and including the time of use. In order to achieve this, a method of stock control and ordering is essential. Materials should be ordered in good time to prevent untoward absences of any material during critical procedures. Furthermore, manufacturers’ instructions should be followed when using the material. Suitable methods of achieving these objectives have been set out below.
Stock Control Management
Economics and stock balance
Any hospital department, clinic or dental practice must hold a sufficient volume and range of dental materials which can be called on as the needs of the clinic dictate. As explained earlier, the process of getting a product to market is very costly and this significantly influences the retail price. Expensive dental products lying in stock cupboards as well as clinic drawers and cupboards represent significant capital commitment. The larger the practice or clinic, so more stock must be held. When establishing a business, the stock is a major capital investment and thereafter appears in annual accounts as current assets on the clinic’s balance sheet. This is an important financial consideration as unless stock control is closely and carefully carried out, a large amount of capital will needlessly sit as stock, which may affect the profitability of the business and reduce available cash flow. This is clearly undesirable and with attention to a few factors, the volume of stock held can be minimized without impacting on the smooth running of the clinical operation. A minimum volume of stock should be held in the clinic as most operatories do not have sufficient space to store large amounts of materials. Ideally, the stock room should be situated centrally so that all clinics can easily access it. The primary objective is to have a good balance: sufficient yet not excess stock in the clinic, so obviating the need to go to the stock room for materials during a procedure. An ideal stock room carries sufficient volumes of stock so as not to run out, but not an excessive amount which will deteriorate with time, pass the usage date or ultimately, not be used and discarded.
A good working relationship and communication between the various dentists in a clinic can significantly reduce the volume of stock held. Many of the generic groups of materials are produced by more than one manufacturer as they compete for market share. There is little point in a clinic carrying more than one product of the same generic type of material from different manufacturers. For example, there is nothing to be gained by stocking two (or even more!) types of resin-modified glass ionomer lining cement. If the practice decides to use either Vitrebond Plus (3M ESPE) or Fuji Lining LC (GC) (Figure 5.1) then there is no duplication of similar materials. This rationalization between clinicians will decrease stock quantities hugely with no detriment to clinical care.
Same material, multiple indications
Some dental materials may be used appropriately for more than one indication and in different applications. This again permits the reduction in material range required by a clinic, as the dentist may use the same material for different indications. For example, the clear bite registration material (e.g. Memosil, Heraeus) can also be used as an occlusal matrix for posterior composites, obviating the need to carry other bite registration products (Figure 5.2). Similarly, a material such as a flowable resin composite may be used in many applications (see Chapter 7).
Importance of the use-by date
With a smaller stock, a rapid turnover of materials will result in less wastage as the use-by date (following which the manufacturer will not guarantee the product will perform satisfactorily) will not be reached. Prior to use in the clinic, the use-by date of each dental material should be checked (Figure 5.3). If this date has been passed then the material should be discarded. Some of the ingredients might have degraded and the material may not perform as intended. For example, a catalyst not functioning properly will result in the material not setting fully, which in turn will impact on the material’s physical properties and therefore its clinical performance. When removing materials from the stock cupboard, the material with the closest use-by date should be selected to decrease the risk of the stored stock exceeding its shelf-life. The shelf-life of the material may play a part in influencing the dentist’s selection of one material in preference to another. A longer shelf-life reduces the risk of the use-by date being exceeded and the material having to be discarded.
It is apparent from the above that stock control must be well organized and carefully managed to achieve the delicate balance required. Many clinics now use a computerized stock database, and this has its advantages;
• At stock take (in many establishments an annual exercise or possibly even more frequently such as quarterly) the process can be carried out quickly by accessing the data by interrogating the computer program.
It is much more effective and efficient to carry out a regular ordering program rather than randomly ordering items from a dealer as the clinic runs out of a product. A report can be produced which can be either printed off or emailed to the dental wholesaler to order new stock, saving substantial staff time, another significant cost. For this to work effectively an ordering protocol must be devised and explained to all members of the dental team. They must all clearly understand the process. Generally the responsibility for placing orders should reside with one appointed member of staff. Most systems work by the ‘one out, one in’ principle, that is, when one unit of stock is removed from the stock cupboard, this is recorded and the information passed to the staff member responsible for ordering to replace it so as to maintain the stock balance.