Setting priorities, investing in quality are the keys for the new dentist
Traditionally, new dentists are defined as fourth year dental students up to five years post graduation. This is usually a very exciting but nerve-racking period in a dentist’s career. Exciting because everything is new and different; nerve-racking because everything is new and different from dental school.
Procedures and materials are different. The pace of practice is much faster. There is technology and equipment that you have never used or even seen before. And, the modern practice and business models make dental school seem archaic. Many dental school clinical operatories were equipped in the 1970s and 80s. And, sadly, some new dentists become associates in practices with outdated equipment and no technology. Suddenly, they start to realize, “I don’t even know what I don’t know!” Relax, a new dentist is not supposed to know everything. These years are for building on what you do know and identifying what you don’t.
The one constant throughout a dental career is that as doctors, we strive to provide clinical excellence and service to every patient, every procedure, every time. This excellence is what the new dentist can learn to master during that five year period. Now, it would take more than one article to discuss all the ways a new dentist can accomplish this goal. This article will focus on the equipment and technology required to provide that excellence, what to look for, how to use it, and what it means to you, your team, and most important, to your patients. For the new dentist, the modern dental operatory is both exciting and critical to propelling you to the cutting edge of clinical excellence and service. THAT is what you must know!
Space
Before discussing what equipment the modern operatory should have I would like to mention a few particulars with respect to dimensions and features of the actual operatory room. Everybody realizes that space is limited and, quite often, expensive. The modern dental operatory has to be large enough for the equipment essentials, it also has to include ample cabinet and material storage space as well as ample counter space. There is a consensus that most dental operatories never seem to have enough of either. Also, the operatory must be large enough to accommodate portable dental technology.
Which leads to the next feature that each operatory should have; dual entrances. This will allow for not only easy transfer of portable technology but also provide unrestricted entrance and exit for both dental provider and assistant. In addition, economy of effort and expense can be realized if two operatories, side by side, can share one sink and radiographic acquisition unit. The sink can be strategically placed at the common entrance of both operatories, and the x-ray acquisition unit placed in a barrier or wall cabinet that separates the operatories. I have utilized this arrangement in my own private practice and it works beautifully.
Finally, if there are two or more operatories parallel to each other, I recommend entrances and exits at the base or far end of the operatories. This provides accessible transfer of portable technologies such as lasers, office whitening units, and in office CAD/CAM acquisition units in an efficient manner.
The essential major equipment of every operatory, be it restorative or hygiene, are the cabinetry, delivery and suction units, patient chairs, operator stools, overhead patient treatment lights, and radiographic units. Naturally, cabinets and radiographic units can be shared between two operatories. Patient chairs, delivery units, and patient treatment lights are a matter of personal preference. Patient chair decisions should be made using the criteria of operator accessibility and performance as well as patient comfort. The same is true of delivery units. Be it overhead, over the patient, side or rear delivery, these units must be efficient, proficient and ergonomically beneficial to the dental provider.
The accompanying cabinetry should be able to store and accommodate all necessary supplies, equipment and technology required to perform diagnosis, information gathering and clinical treatment. Overhead patient lighting is also personal preference between a stationary light fixture and a track light system. It must be noted that a track light requires certain ceiling structure specifications as well as a higher price tag, so it may not be a viable option. Operatory stool selection will be based on provider performance and comfort. Finally, radiographic acquisition units will depend on whether you plan to use conventional x-ray film or digital radiography, which I strongly recommend. However, they should be space effective, easy to program and use, and strategically placed between a common wall or cabinet of two parallel operatories if possible. Another option exists in the Nomad portable x-ray acquisition unit from Aribex.
Every procedure, every operatory
There is specific equipment and technology required for restorative operatories, hygiene operatories, and some required for both. Every dental procedure in your practice should be able to be performed in every operatory in your office. This maximizes the productivity of each operatory and is the reason portability of equipment and technology is so valuable a consideration when deciding on what to purchase.
Every modern Dental operatory should have computer software and hardware (monitors), digital radiography, intraoral cameras, and video patient education systems in order to enhance diagnosis and patient education. This digital technology offers the ability to create the digital (virtual) patient record in an efficient manner while providing the ultimate in risk management; documentation in both words and pictures!
Computer software and hardware are a personal choice. And, there are options as to how many monitors are needed in each operatory. Certainly only one monitor is required in a hygiene operatory, and many restorative operatories function fine with just one as well. However, some restorative operatories have two screens, one for the doctor and one for the assistant. These monitors are quite thin and very space conscious. They can be placed on counter tops, mounted on walls or patient chair units, or in the cabinetry on the delivery and suction unit.
Once computers are in the operatories the advanced imaging software program will enable seamless transition to digital radiography, digital intraoral camera images and a networked video patient education system. Digital radiography will be a choice between direct (sensors) and indirect (phosphor plates) systems. Each system has its own appeal to dental providers. Intraoral cameras will also be a personal choice based on image quality, ease of use, depth of field, image capturing device, and portability. In other words, you may want an IOC in every operatory but it is not mandatory. Some IOCs are so light and portable that two or three IOCs can be sufficient for a five- to 10-operatory practice. Patient education will have one central server but will be networked to all monitors. So there really is no space issue.
The digital record
What these technologies provide is the creation of the digital (virtual) patient record. This virtual record will contain all patient information including personal, charting, case notes, all documentation, radiographs, intraoral digital images on any and all computer screens. The virtual record cannot be lost, misplaced or misfiled and is backed up every day on cassettes or CDs or to an offsite location. All patient information can be accessed immediately, anywhere in the office, and all information can be electronically transferred to referring doctors, satellite offices and dental-benefit payers in the most efficient manner possible. Think about how this affects proficiency, productivity and patient service. The virtual record, with digital radiography, digital intraoral images, and video patient education, not only enables, but empowers your dental team to educate every patient to not only what exists but what the possibilities can be.
Remember, patients understand what they see, not what you tell them. They will take responsibility for their dentitions and take ownership in their treatment because they have a better visual understanding. Excellence of service does not get any better than that. Finally, the ability to document in pictures as well as words will provide every dental care provider the ultimate in risk management.
Ensuring clinical excellence
Every treatment operatory in the office should have a high-quality curing light to ensure complete and efficient curing of dental materials. It may be possible for hygiene operatories to share one or more curing lights due to their light weight and portability. Ultrasonic periodontal scalers are also a must in every hygiene room. These scalers are the most efficient and patient-friendly treatment options for patients requiring supra- and subgingival calculus removal. However, they also should have portability as they may occasionally be required in a restorative operatory. In addition, caries detection and cancer screening technology should be included in most operatories. These technologies are very lightweight and portable, so one or two may be enough for the practice. But you cannot underestimate the important service they provide for our patients. They could be life saving!
Finally, each hygiene operatory should be equipped with high- and low-speed handpieces. Very often during a hygiene appointment, a restoration may require an addition of material, a reduction, or just a smoothing of a rough spot or edge. The most efficient and patient-friendly way to accomplish this service is right at the hygiene chair. Remember, it is all about excellence of service!
In keeping with excellence, in office teeth whitening technology can be placed in just about any operatory, because these units also are very portable and easily transferred from room to room. This technology has provided patients with excellent, one visit results and oftentimes, dramatically improved their lives.
Treatment operatories should have high- and low-speed electric handpieces, which will enhance your ability tp provide clinical excellence. Electric handpieces prepare smoother preparations, with little to no vibration or torque to both the provider and the patient. Electric handpieces contribute to better preparations and better margins. Another technology for restorative purposes is shade-matching devices. This technology assists in obtaining accurate shade information for the ceramic restorations we provide to our patients. If the shade is not correct, how can we provide clinical excellence and service?
It has become abundantly clear that today’s dental lasers play a major role in how we treat our patients. Hard and soft tissue lasers are utilized for restorative, endodontic, surgical, and periodontal procedures, which enhances our ability to provide clinical excellence and excellence of service. Lasers achieve more precise removal and contouring of tissue with a smaller zone of coagulation and necrosis while maintaining hemostasis, which accomplishes in not only a better clinical result, but faster post-op healing and less post-op patient discomfort.
Now, not every practice will require a hard tissue laser but a soft tissue laser is a must for every restorative practice because it has so many applications. There are soft tissue lasers, hard tissue lasers, and lasers that do both. The good news is that in a three to six operatory practice, which is what the majority of practices in the country are, one laser will usually suffice. More good news is that soft tissue lasers are so compact and light weight you can hold them in your hand, making them very portable. Just about every dental laser can be transferred from room to room, especially with the multiple entrances to operatories I discussed previously.
Finally, in-office CAD/CAM technology is not the future of dentistry. It is today’s dentistry! This technology is not new. It has over 20 years’ experience in the United States with great results. In-office CAD/CAM technology provides a good-fitting, durable, esthetic ceramic inlay, crown, onlay or veneer in just one patient appointment. What is required by the provider is good dentistry, which is what we have been talking about. The dentist prepares an excellent preparation, takes an excellent optical impression, and the CAD/CAM unit will fabricate a superior restoration in just one visit. What you will provide to your patients is the ultimate in clinical excellence and service. It does not get any better that that! Again, the good news is that, while the milling unit can be located anywhere in your office, the acquisition unit is easily transported from operatory to operatory.
Where to start
As the new dentist can determine, the modern dental operatory contains equipment and technology he or she most likely have never used, seen, or even thought about. So, how do you go about learning how to have a cutting edge, modern operatory? The first place to start is to attend a local, state or national dental meeting or convention and participate in a course on technology and equipping the modern 21st century practice. Learn what is available, how it works, and what it means to you, your team, and your patients. Oftentimes these lectures take place where the equipment and technology vendors display their products. Speak to them, let them demonstrate it. Also, inquire as to where you can see the equipment and technology in a real life private practice setting. Speak with these doctors and ask them question about it. How do they like it? How has it helped them? If they could change or do anything different, what would they do, and why? Then you will be able to visualize what you want for your operatories in your practice. This vision will become reality and enable you to provide the clinical excellence and excellence of service you strive for and your patients deserve.