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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
How ambient technologies can make your dentistry better.
Technology abounds at the dental practice. From handpieces to lasers to cone beam scanners, there are amazing pieces of equipment that help practitioners take the best care of their patients. But helpful apparatus isn’t limited to the equipment used in patients’ mouths. A look around the office can reveal thoughtful and helpful design additions that can also help the clinician.
Ambient technologies are those products and pieces of equipment that improve functionality, efficiency and can help you do a better job. They can encompass anything from computers to stools to cabinetry.
For example, patient chairs-like Pelton & Crane’s Spirit 3300-are designed with ergonomics in mind, making it more comfortable for staff to reach a patient and for patients to enter or exit the chair with ease. The chairs also offer one-touch programming, allowing preset positions with a single touch of a button.
Dr. John Flucke, DDS, Dental Products Report Technology Editor, observes that computers are getting smaller and less obtrusive while being able to do more.
“I’m just blown away now,” he says. “We put a couple of new computers in my office in our check-in area. When we moved in, we had two tower computers. They were hidden away under the counter and the machines we replaced those with are about the size of two paperback books. It’s going to be the same way when we replace the computers in the clinical area. The size factor of that, the footprint, is just becoming so small that these things can go anywhere.”
Cabinetry is one area that seems fairly straightforward, but in reality, there is a lot that goes into functional dental office cabinetry. Crissy Treon, Midmark product manager, notes that her company serves dental clients with two lines of cabinetry.
“The Integra line is more of a steel structured cabinet,” Treon says. “Within that, we still do things where we do operatory casework, so we make the treatment stations, the central stations, the side cabinets that would go into your operatory, but we also make another line of modular cabinets within that line that can be integrated into sterilization areas, lab areas, even in canteens, kitchens and really anywhere throughout the dental office.”
Another line is their Artizan Expressions collection, which is more esthetically oriented wood cabinetry.
“We make treatment stations, central stations, side cabinets,” Treon says. “We also do cabinets for the sterilization area, and we also have cabinets within there that are freestanding enter also modular. We get into a little more of a specialty product, so we do things for the ortho market, the pedo market and we can do a little bit more custom work.”
Seeing a need
Many of these items might seem like standard, run-of-the-mill pieces of equipment, but in a dental office, a cabinet needs to be more than just a simple cabinet.
In 1994 Dr. Flucke practiced in an office that he leased in a strip mall. When he built his own office nine years ago, he knew that changes were in order.
“When I moved, I was looking at cabinetry in 2006-2007, and it had really evolved,” Dr. Flucke remembers. “The cabinetry piece of it had evolved to the point where it held computers and it was wired for computers. There were several different things to look at as far as, how is this going to let me practice? Where are the information pieces located? Can I get the screen where I need it? That’s the kind of thing we use everyday. That’s central to what we do.”
Dr. David Rice, DDS, is a general dentist in Amherst, New York, and founder of IgniteDDS.com. Outfitting his office turned out to be more involved than simply opening a catalogue.
“We flew out to the manufacturer for three days and, wow, both what I saw from a cabinetry and from the stool and chair perspective was really enlightening for me,” Dr. Rice says. “As a result of that, 10 years into owning all of that stuff, I have a really high appreciation for it. I would highly encourage every dental practice to spend the extra dollars, because the manufacturers have done so much homework on the ergonomics and the layout and the efficiency side that nobody can build the cabinetry or the chairs and stools [or] anything that resembles it. It just can’t be done. That’s why it’s so much less expensive to have a carpenter come in and do something that it attempts to mimic.”
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Addressing the current needs of the practice
The value-added additional features are built with the specific, current needs of practices in mind.
“That’s the beauty of buying from a dental manufacturer,” Treon says, “because we are looking at things that are very profession-specific to what dental facilities need. We’re always looking at things like technology. We look at technology integration. We integrate things like powered USB hubs, CPU cooling fans, monitor mounts-anything that helps support the integration of cameras and sensors and any type of computer hardware. We also pre-wire electrical outlets and other utility-related features that go into work cabinetry that you aren’t going to get from a local millwork company. We try to take in specific needs. We also try to accommodate, from a storage standpoint, those types of equipment that are going to be needed in the future. I always view the treatment stations as the technology hub. Because that’s where all the hardware is being stored-the monitor mounts, the USB equipment. So that cabinet, in particular, needs to be set up to accommodate and integrate that type of equipment.”
How are these products created? Do manufacturers see a need or do they anticipate needs? It comes down to extensive research.
“We spend a lot of time out in the field, going to dental offices and dental facilities,” Treon says. “We do conduct some interviews, but it really is more about observing how the staff is operating, how they’re using their equipment, how they’re interacting with their equipment, the workflow of the office. Because a lot of times it’s the unmet needs or the unseen needs that are the biggest ones. I think a lot of times we all get caught up in how we do it, and I think sometimes coming in and watching and observing how you do it gives you the greatest type of information.”
The product development phase may take several years before a product comes to market.
“Our projects are always looking into the future, from three to five years,” Treon says. “So I guess you can say, yes, we always look to [solve] the customers’ needs and problems, and it has to tie back to that, otherwise there’s no sense in doing it. But at the same time, we do have to anticipate for the future, realizing there are going to be new technologies, there are going to be new things in the market that we have to accommodate. Cabinetry, basically, surrounds your staff, so it has to be able to accommodate all those things that are needed from the storage to technology to infection control, and it’s proper ergonomics, too. So there are a lot of things that we look at when it comes to cabinetry.”
“Dentsply Sirona is currently adopting a more private approach to cabinetry and operatory design, allowing for a ‘centralized distribution model’ for procedural consumables into dental operatories,” explains Stephane Leduc, product marketing manager, treatment centers, cabinetry & instruments at Dentsply Sirona. “For example, we provide a central, minimal design platform for our cabinets so that each practitioner can add-on, configure and update however and whenever they want via that central location. We feel that these minimally-designed operatory components promote and provide not only a less cluttered environment, but a serene and peaceful atmosphere so the dentist can further concentrate on his work and patient, as opposed to concentrating on his equipment. With most procedural functions being integrated into the treatment centers, there is minimal need for peripheral equipment storage, optimizing the whole office workflow. Moreover, this blank sort of canvas stimulates individual creativity and tailored preferences; the look and feel of each operatory can be easily updated without having to completely reconfigure.”
While products manufactured specifically for dental practices can seem costly, Treon says practices get what they pay for.
“I don’t want to speak for my fellow competitors in the market, but we probably always tell you that the local cabinet maker, or sometimes a contractor, becomes our biggest competitor if you don’t realize the value a what dental manufacturer cabinetry can bring to the game,” she says.
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More than convenience
Many of these products may seem simply nice to have, but the added features are more than just bells and whistles.
“From a health and wellness standpoint, it’s not just a dental stool,” Dr. Rice says. “The best stools that I sit on, as a dentist, allow me to have proper posture. And if you look statistically, and this is really frightening, 70 percent of people who are still in dental school already have a back and/or neck issue, and that’s before they ever even walk out of school. So you can imagine the limitations in the dentists’ career cycle that ties directly to what we sit on every single day. Something so simple as that stool either helps me practice 25 or 30 years, or contributes to my demise. It’s a major issue.
“On the cabinetry side, I learned the way my operatory lays out contributes to how efficiently I work with my assistant, how we work with one another, to the technology that’s built into the cabinetry that makes life so simple,” he continues. “Because everything plug and plays into that cabinetry-all the lasers, all the CAD/CAM, all the dental softwares, all of those things require something as simple as power, and those cabinets are designed to not only power that technology, but also to do it so it’s neat and clean and tidy. And they’ve thought about how it runs for the next 20 years.”
Dr. Flucke communicated his work style and work needs to the architect designing his office. With those considerations in mind, they were able to design the space that he needed to accommodate the equipment and the furniture that he required.
“I actually started with, ‘Here’s where I work, here’s the clinical piece of it and I know that I need more room in me treatment areas,’ so we intentionally made them bigger,” Dr. Flucke says. “Once we got a rough layout, then I went cabinet shopping, and I bought everything new. I spent a lot of time looking at cabinet designs and where the hardware was placed and all that.”
And that kind of future-proofing can extend to built-in instrumentation or treatment centers/units as well. “Our units are technology-driven-specifically by software that allows practitioners to integrate new features indefinitely,” Leduc explains. “Even if hardware updates have to be purchased, it’s never a complete exchange. For example, if it’s a new offering for an endodontic product previously purchased, you simply acquire the new attachment and the software update will do everything else that is needed to be done. It’s merely an add-on.”
Upgrades and renovations
Once a purchase is made, whether or not something is upgraded in the future depends on the doctor, his or her needs and the equipment’s service history.
“It’s a dynamic environment, so I purchase things hoping to get as long a lifetime out of them as I can, but I do buy them knowing that you’re going to have to swap them out at some point in time,” Dr. Flucke says. “In my case it’ll probably be because something better has come along, but it just as well could be that it starts to look dated.”
The size and how a piece of equipment is used in the practice also matter when it comes time to upgrade or replace.
“In principle it is swappable, so long as you have begun with the end in mind,” Dr. Rice observes. “For example, is it a rear delivery system, so the cabinetry behind me has all the functional capability, there’s nothing in front of the patient and it’s neat and clean? Or is it an over-the-patient delivery system? So whatever you pick, you can switch gears and move from one to the other, but if you layout your treatment room in a certain way, you almost buy into that philosophy of delivery for the long haul.
“On the flipside, I kind of look at it how people look at their home,” he continues. “Most people make an initial investment when they walk in the door-they paint the walls, they put in new carpet or they replace and put hardwood down. But it’s easy, 10 years later, 15 years later, to look at your house through the same lens that you did on day one, so it tends to be more difficult to come back in and redo the kitchen in 10 years than it was to just do it on the front end. I encourage people to always have a first set of eyes in your practice, because every single person who walks in as a patient, or a new team member, or if I’m a dentist trying to transition my practice, all those people are looking at your practice very differently than we do. Renovating, staying current, and having a plan and a budget to say, ‘Every 10 years, I might need to invest in XYZ to improve my space,’ becomes really important.”
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Form vs. function
There is a balance to be struck between an item’s utility and how esthetically pleasing it is. Ideally, the product would serve both needs, but it’s important not to lose sight of why that product is being used in the first place.
“In my mind, it’s always function first, because if you don’t create cabinetry that supports proper ergonomics, proper flow, all the beautiful cabinetry in the world is not going to do you any good,” Treon observes. “So it’s always function first, but one of the things that we found out is that, actually, especially if you look at our Artizan Expressions line, why we have moved forward with more esthetics in our line is because that has become very important to the dental market, and they do put a lot of weight as to how the cabinetry looks.
“You have to think, ‘They are big pieces of furniture in your facility, and they do hold a big design element,’” she continues. “So how we balance it is that we go out, we talk to our customers, we spend a lot of time in the market. For example, when we came out with our Artizan Expressions line about three years ago, back that up two-and-a-half-years prior when we were talking to customers, we took research cabinets out in the field, we compared them to our competitors, we got customer feedback on what they wanted from looks, but also, another factor about cabinetry is that it also has to be very price competitive. Because they want something that looks good, but it also has to prove its value for what they’re getting.”
It always goes back to what the customer wants and what the customer needs.
“I selfishly want it all,” Dr. Rice laughs. “I would prefer to work with a manufacturer who can deliver it all; and as a customer, I have to have the foresight in this process, not only what looks nice today, but what will look nice in 10 years? What’s going to come in and out of style as far as the look goes?”
Dr. Rice was able to get a professional’s help when selecting his office’s cabinetry-one of his good friends is an interior designer for Ethan Allen.
“He was part of our team when we designed our practice,” Dr. Rice says. “When we went to the manufacturer and came back and said, functionally, this is the stuff we need, the first thing he said was, ‘Show me every possible finish.’ And then he said, ‘Choose this color with this pattern, and choose this countertop to go with it, and it’ll not only function well but it’ll look great and you’ll fit the culture and style of what we are trying to achieve.
“Because our patients don’t understand the function,” he continues. “We understand how they feel when they walk into our practice. I’ve seen too many dental practices that have a really rocking reception area, and then as soon as you get into the clinical areas, it feels like a sterile hospital environment, and that scares the heck out of a patient, so pulling all of those worlds together is really important.”
How to choose
Selecting your technology can seem daunting-there are any number of variables, including function and personal tastes. However, there are some good rules of thumb to keep in mind.
“Do your homework,” Treon advises. “The questions I always go back to when I talk to customers is, ‘What is it that they’re really trying to achieve with their cabinetry? What are the most important things?’”
She adds, “Some questions I’ll ask them are, ‘What kinds of features do I want for my cabinetry?’, ‘What do I like or dislike about my current cabinetry?’, ‘In what ways will they be incorporating equipment and technology now and in the future?’, ‘How important is the decor of their office?, ‘Are esthetics important to them, or are they more concerned about the function of equipment?’, ‘Are supplies easy to reach?’, ‘Are countertops cluttered in their current space?’, ‘Will they have CPUs?’, ‘Will they have monitors?’, ‘How are they going to use it?’, ‘How are they going to support their current workflow?’”
Leduc says the most important thing is to explain your specific needs upfront. “The best way is to have [dentists] tell us their individual needs,” he says. “Simply talk to us. We work together with each dentist to provide the ideal system for them. Not only do we want our customers to use our equipment and solutions at their full potential, we also strive to make dentists as efficient and effective as they can be. Only then can we truly advance the industry and the practice of dentistry.”
Dr. Flucke also offers a reminder that it is important not to lose sight of your mission.
“The one little mantra that I try to have with bringing things in, if they are clinical pieces, is I say, ‘It has to give me at least as good result as I’m getting now,’” he says. “At best it improves my dentistry; at worst it keeps it the same. If it then allows me to do it faster, quicker, less painfully, gives the patient less time in the office as a patient, then that’s kind of the tipping point for me.”
Adding or changing ambient technologies is not something a doctor should do without his team’s input.
“I would highly encourage all dentists to recruit their teams,” Dr. Rice says. “Go to their team and say, ‘I’m the leader of this team and I have to make a decision; however, before we’re going to make this investment let’s get everybody’s thoughts on it.’ My hygiene team knows far better what they need than I might know, because minute-by-minute they’re working in their own space. When we built our practice, for example, we went to every single team member and said, ‘Hey, in your perfect world, functionally, what does your space look like? What would help you do your job best?’ So I’m a big fan of engaging the team and letting them know that decisions need to be made. The wish list may not be what the wish list was when it got put on paper, but their input is important, both from a function standpoint as well as from an empowerment standpoint.”
Ambient technologies aren’t just insignificant features. While they may seem small and insignificant, they help doctors and staff do a better job for their patients