Keep it running

March 21, 2012

You’ve got a practice and staff you’re proud of and patients coming through the door. You have all the tools you need to deliver great care. but are you in total control?

You’ve got a practice and staff you’re proud of and patients coming through the door. You have all the tools you need to deliver great care. but are you in total control?

What if your computer network crashes? Will you be able to get up and running quickly or will it spell a disaster for your practice? Will valuable data be lost? What if your highspeed handpieces don’t seem to last very long at all, or what if you seem to have too many out on repair and not enough to handle all your cases? Do you know just how important your utility room is? Sure you know that you need vacuum and air pressure to perform dentistry, but do you know just what your practice should be doing to ensure the water and air pressure that’s critical to your success is performing just right?

Read on as we talk to some of the experts in the areas of handpiece repair and maintenance, computer networking and utility room maintenance. Following some very simple steps and setting up a maintenance protocol can help keep your practice up and running strong, and also can extend the life of key equipment, ultimately saving you money.

“Service technicians stress that dentists should make sure to schedule a yearly preventive maintenance call. The best way to ensure your equipment will be in top working order year after year is to have a professional evaluate and take care of any small items before they become office debilitating,” said Marya Lessard, National Technical Service Manager for Patterson Dental, whose company provides a Preventive Maintenance Guide to its customers with detailed steps.

Handpieces

Henry Schein’s ProRepair service includes one of the largest handpiece repair centers around. Ron Appel, VP and GM Repair Business Group, and Kent Eggleston, Director of ProRepair, each offer up advice on how to properly use and maintain handpieces, as well as how best to repair them when necessary.

“A significant amount of the product that we see in for service, specifically on the handpiece side, the primary reason that they come in for service is poor maintenance,” Appel said. “Where the product is just not being maintained to manufacturers’ specification, therefore bearings burn out, the unit doesn’t have the torque or speed. In some cases it even heats up to temperatures that can create significant safety issues for the patient and for the user.”

Henry Schein’s handpiece repair business, which repairs more than 400 handpieces a day, sees many repairs come in due to lack of maintenance.

“That’s not the only reason, but if you were to speak to our technicians you would find that improper maintenance, improper lubrication, over-sterilization, sometimes sterilization without the right protocol, can burn out bearings and create major issues with the dental handpiece,” Appel said.

All handpiece repairs go back with literature. This usually includes documentation on how to properly maintain the handpiece, some from the original equipment manufacturer, and some from the technician who may include information on the repair summary sheet sent back to the customer.

“I can tell you any time one of our service technicians speaks to a customer about problems with a handpiece we typically bring up the maintenance side. We find that not only are some of our users not maintaining the handpiece properly but they are not using it to the manufacturer’s guidelines,” Appel said.

The typical highspeed drill requires a certain amount of air pressure to be pumped through it to run correctly (about 30-40 psi). Some doctors will increase the air pressure to try to get more speed and torque out of the handpiece. Eggleston warns against this.

“It will improve the cutting performance for some models. But I think the conventional wisdom among doctors is if I turn up my air pressure my handpiece is going to perform better,” he said. “It’s not always the case. But the thing that is always the case is that it will shorten the handpiece life. And handpiece repair over the life of the handpiece is a significant cost. Many times it will exceed the initial purchase price of the handpiece.”

Henry Schein sponsors handpiece and small equipment maintenance classes at trade shows that stress the importance of practices having a proper protocol for the staff member responsible for the sterilization center.

“What makes handpieces a little different is that there’s a maintenance protocol associated with sterilizing handpieces that goes beyond just bagging the handpiece and putting it in the sterilizer,” Eggleston said.

“We teach that the most important thing is to follow some sort of established protocol. There’s the protocol that handpiece manufacturers recommend but there’s also protocol built around other maintenance and maintenance products. Our message is not what maintenance products you use but that you’re following an established protocol that includes some combination of cleaning the handpiece to remove debris, then lubricating the handpiece as part of the whole sterilization reprocessing of the handpiece. It also should include periodic cleaning of the chucking system to maintain proper bur retention during procedures.”

Much of this is just awareness. A practice may not have dedicated staff working the sterilization center and they may lack expertise in terms of how processing a handpiece is different than a hand scaler or a bur or something else that needs to be sterilized.

“The difference between following an established protocol and not following a protocol makes all the difference in the world,” Eggleston said. “Take a little bit of care in terms of following an established procedure, and your practice is going to benefit not only from reduced down time but you’re going to save yourself a lot of money on repairs over the life of the product.”

Large practices should look into investing in a handpiece maintenance machine. This can simplify the process and in the long run deliver a nice return on investment for practices repairing a lot of handpieces.

Appel also said it’s important to make sure that when they do go out for service, the handpieces are worked on by trained technicians.

“One of the other ways to improve the longevity of these products is to make sure that when they are sent out for service that they’re sent to a qualified service repair operation,” he said. “We’ll see other companies that are not using new parts, they’re not using manufactured specified parts and a lot of them can reduce the longevity of the handpiece. Not only is maintenance important but when the customer does have to send it out for repair make sure they select a qualified repair service.”

While proper lubrication is critical to the life of turbines, Eggleston adds that there’s more to caring for the handpiece than just lubricating. “It’s definitely not enough to communicate that lubrication is the begin all, end all. It’s really a process of both lubricating and cleaning out the handpiece to remove debris or material that may have gotten sucked back up into the handpiece. A lot of people don’t realize that with most handpieces when you let up off the air pressure it creates a negative airflow that can pull debris into the head of the handpiece.”

So get that staff member in a routine of always taking good care of those very important tools.

“Get the staff in the habit of doing something that’s the same every time that accomplishes both the cleaning and lubrication aspects of maintenance,” Appel said.

Lance Payne, National Sales Manager for DENTEX, which handles repairs and sells brand new aftermarket turbines, its own original equipment manufacturer (OEM) turbines, and its own line of handpieces, points out that letting handpieces cool down after autoclaving also is important to remember, as well as making sure the staff knows which handpieces should indeed be lubricated.

“A big issue with some dental practices is they’ll have different staff members coming in to maintain their product,” he said. “With a handpiece there’s a number of things that will kill them right off the bat. One is obviously if you don’t lube per manufacturing suggestions. If you’re running dry it’s like running your car without oil basically. There are lube free turbines out there, but they’re grease packed. If you lube them at all you have to keep lubing them because it actually flushes out the grease that’s in the bearings. If you force all the grease out then you’re running dry again.”

Then there is proper cooling.

“Make sure they’re cooled down to room temperature out of the autoclave before you run them,” Payne said. “If you run them hot there’s a cage inside the bearings that expand under heat thus it creates more friction. Some offices might only have 2-3 handpieces and they’re turning them over constantly. Sometimes when they autoclave them they’ll run them under water to cool them off. They should not do that, and we’ll tell these offices they just need more handpieces. Then they’ll have time to run them through the autoclave and give them time to cool. Some of them don’t have time to do that because they’ve got patients and they’ve only got a couple handpieces.”

Your handpieces are an integral part of your practice, and when they malfunction, you need them repaired fast. There are a number of options when it comes to repair.

Hayes Handpiece Company offers rebuilds (also known as an overhaul), as well as quality aftermarket turbine replacements or OEM turbine replacements.

“In the majority of cases, rebuilding your turbine will make the most economic sense,” said Joe Hayes, CEO of Hayes Handpiece Company. “Why throw away a good chuck if you can reuse it? A rebuild-or overhaul-of your highspeed handpiece reuses your chuck (the part of a turbine that holds the bur). This allows you to get more out of your original handpiece investment.”

Normally, a quality chuck can be rebuilt several times over its life.

“We test every chuck to ensure it holds burs properly (so they don’t fall out or wobble), and the chuck actuation works correctly,” Hayes said. “This provides maximum safety, and eliminates the frustration of a handpiece functioning poorly. And it improves turbine life.”

As part of the overhaul process, Hayes also checks the concentricity of every chuck, to ensure it holds the bur very straight. They adhere to manufacturer’s specs for concentricity, which requires an investment in expensive measurement devices capable of ten thousandths-of-an-inch accuracy.

“Few repair companies make this kind of investment in technology, but the payoff for customers is that it eliminates vibration, which can shorten the life of the turbine,” Hayes said. “If a chuck doesn’t pass our tests, we don’t rebuild it. That means you get a quality repair that lasts longer.”

Hayes Handpiece Company does more than just handpiece repair. For more details on their other services, visit dentalproductsreport.com.

There are even companies like Handpiece Experts that specialize in delivering parts to technicians who repair dental handpieces. The company’s website includes information for both dentists looking for repairs and dealers looking for parts. Owner Betty Garabedian said dentists considering a purchase should look into warranty repairs and time for return of the handpiece; what is the price to replace the turbine of the handpiece after warranty runs out; repair turnaround; and if dentists can try the handpiece out.

She said practices can reduce their repair costs by finding a qualified technician who uses parts that cost less.

Don't forget these important utility room tips

Sure dentists want their handpieces to run smoothly and for the practice’s computer network to stay on top of things. But they’d better not forget about that utility room setup hidden out of site of the patients and the staff.

That air pressure and vacuum pressure is the lifeline to a functioning dental practice. Luckily, the steps required to keep those lines flowing cleanly and smoothly don’t require a lot of time, just regular care.

“Whenever you lose vacuum or you lose air, you’re not going to practice dentistry, which is going to cost you a lot of money,” said DentalEZ Group’s Ryon Waddington, Senior Utility Room Product Manager. “We are seeing some challenges, not with our equipment, but with some of these practices not maintaining their vacuum lines or their utility room. The utility room is sort of out of sight out of mind. They don’t pay any mind to it until it goes down.”

Most of the maintenance required by a practice for utility room efficiency is easy and quick, but cannot be overlooked. The air intake filters for compressors need to be changed out once a year. Some of today’s equipment, including DentalEZ’s RAMVAC Badger dry vacuum, have features in place that actually provide maintenance reminders to the doctor every 1,000 hours.

But Waddington can’t stress enough just how important the daily cleaning of the vacuum lines is, even if the practice does not have line cleaner on a particular day.

“It’s most critical for the doctor to make sure that he performs a daily line cleaning of his vacuum lines,” he said. “If the doctor doesn’t, there’s a chance you have build-up in the lines and it will have an effect on your vacuum performance. You’re not going to have the vacuum strength that you may need.”

So take heed to the manufacturer’s advice as far as maintaining the utility room equipment and making sure the vacuum lines are being taken care of daily, even if it’s just with hot water. “If the dentist doesn’t have any line cleaner available, a quart of hot water at each HVE will do wonders,” he said.

It’s also important to make sure the water recyclers are maintained when using a wet ring pump. Another thing to keep in mind is that a lot of the time manufacturers won’t warranty their equipment if it’s not maintained properly.

Steps to keep that utility room operating well:

  • Once the vacuum unit is shut off at the end of business each day there always will be some residual left in the vacuum trunk line. If not properly maintained debris will build and the vacuum performance will suffer. Starting with the chair furthest from the vacuum unit, use a quart of warm/hot water followed by 5-7 oz. of “Non-Foaming / Non Chlorinated” line cleaner at the HVE. Line cleaners that are not non-foaming will overwhelm the vacuum unit’s separation tank thus causing the vacuum to shut off and potentially damaging the vacuum unit itself. All line cleaners will state “Non-Foaming” right on the label.

  • All water ring pumps have a trap up-stream of the vacuum unit. This is so large debris doesn’t get to the pump’s impeller where it can damage the unit. Most water ring traps are transparent, and you can tell how much of the dental byproduct is captured. This should be cleaned daily along with the chairside traps.

  • Water recyclers are extremely advantageous because they use half the water compared to pumps without recyclers. They too require maintenance, and if neglected can have dire circumstances. Water recyclers should be cleaned at least once a month, twice a month for busier practices. If not properly maintained there will again be a build up of debris and if enough build up is present, will reduce the amount of water reaching the pump and cause the pump to work harder, running the risk of causing a failure. As the pump starts to heat up from lack of flow, prophy paste will actually start to cure and harden like cement. So it’s very important for the doctor to follow the maintenance steps laid out by the manufacturer.

Computer networks/backup

The best practice management software and the fanciest computers and equipment around won’t do your practice much good if your system crashes or your network is not properly integrated. That’s where companies like Liptak Dental Services can save you time and money. 

“The latest dental technology, such as digital x-rays and sophisticated practice management software, has amazing potential to improve the business of dental,” said Paul Hinman, Vice President of Technology for Liptak Dental Services. “But the reality is that most offices are struggling to keep pace with it all. There is definitely a lack of training available and a steep learning curve with a lot of the latest dental technology.”

Liptak offers in-office installation, support and project management, as well as convenient on-call telephone support for small challenges. All Liptak personnel are senior-level IT professionals who have been trained in dental technology.

So don’t ever put yourself in a position where you don’t have the opportunity to do what you do best-practice dentistry. Make sure you have proper maintenance guidelines for your practice, proper back-up plans for critical services, and that you know how to get the best, fastest repairs when you need them most.