Chapter 5
Dental Equipment
Tips on Buying New Equipment
This section addresses tips on purchasing what is considered large, and the more expensive, pieces of equipment for the dental practice. These items consist of patient chairs, doctor’s and assistant’s seating, dental units, patient lights, sterilizers, intra-oral x-rays, panoramic x-rays, x-ray film processors, digital x-rays, air compressors, and vacuum systems.
When it’s time to purchase new dental equipment, there are some obvious factors to consider, such as what fits your needs and/or budget. There are some often overlooked or less obvious factors such as ergonomics, ease of use, operating expenses, and equipment maintenance to consider as well.
In some cases a piece of equipment you currently use may have a specific function or feature you feel you must have when purchasing a replacement. Be sure to discuss this need with a dental equipment supplier in order to avoid any disappointment with your purchase.
Seating
One area of dental equipment that has received much-needed manufacturer attention is seating ergonomics for the doctor, assistant, and patient. There is a history of neck and back discomfort associated with practicing dentistry over an entire career, and manufacturers have worked diligently to revamp seating to help eliminate this problem.
It is advisable to select doctor’s seating that has an adjustable seat and back. When the seat is properly adjusted you will keep circulation flowing in your legs. An adjustable seat back, when properly adjusted, will keep your back and neck from being hunched over. When purchasing doctor’s seating, keep in mind that one size does not fit all, so be sure to try out seating at a dental equipment supplier showroom or trade show.
The same is true for assistant’s seating regarding neck and back pain over an entire career of dental assisting. Assistant’s seating consists of a seat and upper body support. If your practice usually performs lengthy procedures, the purchase of assistant’s seating with an optional backrest is recommended to help eliminate back and neck fatigue.
Ergonomics has also had an effect in the development of the patient chair for the benefit of the doctor and patient. When you try out patient chairs, you should place the chair into your working position (with someone in the chair if possible) and see if you can get close enough to the patient without straining your neck and back. Also, check the accessibility of the patient chair controls while you are in the working position. Patient comfort is also important when considering the purchase of a patient chair. If the patient chair is too short or too narrow; has poor arm, lumbar, or shoulder support; or if the upholstery is too firm, the patient will become restless and tense. That in turn slows you down and affects your productivity. It is recommended you try out patient chairs at a dental equipment supplier showroom or tradeshow before making the purchase.
Dental Units
The dental unit is available as over-the-patient, orbit (also called left/right) unit, side delivery (wall or cabinet mount), and 12 o’clock (cart, wall, or cabinet mount). If you are undecided as to which to purchase, here are some things to consider that will help narrow down the choices. For example, if your practice has both left- and right-handed doctors and hygienists, you might want to consider the orbit (left/right) dental unit, cart with the left/right feature, 12 o’clock wall-mounted unit, or 12 o’clock cabinet with the left/right dental unit option. These units easily convert to left- or right-handed dentistry by simply rotating the unit from side to side.
Over-the-patient units, by contrast, are attached to either the left- or right-hand side of the patient chair. In order to convert the unit to the opposite side of the patient chair, the unit must be removed from the chair. The steel arm, known as the chair adapter, attached to the patient chair must be removed and re-configured, or in some cases a new chair adapter must be purchased. The chair adapter and dental unit are then reinstalled onto the opposite side of the patient chair. Keep in mind that there are labor and possible parts costs associated with this conversion.
If you practice four-handed dentistry, you can choose from the cart, 12 o’clock wall-mounted unit, or 12 o’clock cabinet with dental unit. It is recommended that you visit a dental equipment supply showroom or a dental tradeshow to see examples of these items.
Patient Lights
Another area with multiple choices is the patient light. These are available as ceiling-mounted, track (ceiling-mounted), wall-mounted, cabinet-mounted, orbit (also called left/right), chair-mounted, and unit-mounted. 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 righthanded 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 of dental sterilizers: dry heat, chemical, and 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.
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.
Intra-oral X-ray Units
Intra-oral x-ray units produced today are capable of either 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. 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 pass-thru 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, keep in mind that if that x-ray unit breaks down, two operatories will be unavailable for taking x-rays.
Panoramic X-ray Units
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 cost-effective 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 x-rays. 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 Processors
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. 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/>
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