Cliff's Notes

The Business of Dentistry

Dental Operatory Equipment “In The Long Run”

Dental operatory equipment is very expensive and understanding what causes breakdowns is an important part of maintenance and work flow. The task of maintaining working assets in a dental office is usually entrusted to a team member (Dental Assistant) and never thought of again until something breaks. But, what caused the down time and can it be avoided in the future? Proper maintenance will cost a few dollars but will dramatically increase the life span. It starts with quality.

Quality Lasts … I have been in the dental industry all of my life and I have seen so much come and go but quality lasts. Today I still see 30 year old Midwest Quiet Air handpieces still in operation. 25 year old Adec Mini-Troll delivery systems & Belmont 071-A X-rays are still working everyday. Why is a $5000.00 chair better than a $3500.00 chair? It’s quality and life expectancy. So, what can be done to maximize your investment? Disinfectants can be a big part of the problem.

Disinfectants … Infection control protocol requires all operatory equipment be cleaned and disinfected after each patient. The chemicals used in the sprays and wipes are made to kill things and are not kind to plastic, metal, circuitry and upholstery. Did you ever notice a yellowing effect on your equipment? Disinfectants need to dry on a surface to be effective and the vapor in the air settles on everything. After repeated use these chemicals will reduce the life expectancy of all equipment especially lower quality items. You can’t prevent it but you can maximize the time line.

Chairs & Stools … Every dental chair manufacture recommends that nothing but soap and water be used to clean patient chairs and stools immediately after use.. That’s not practical because of the time it would take to turn over a room. Sprays and wipes are used to for faster turn around, but the chemicals involved will deteriorate the equipment over time. There are several products on the market that now address the issue of upholstery and plastics yellowing such as Optimum 33TB by Sican or CaviWipes1 by Kavo Kerr. However, barriers are the best. There are barriers for everything but Cover Film should be used every where. Use cover film on the chair switches to protect liquids and vapers to settle on circuitry. Use a full chair cover (my favorite is Slip-N-Grip by Kavo Kerr) to prevent excessive ware, especially when the weather is bad. And at the end of the day clean the upholstery with soap & water or even better, Chair-Guard by Palmero Sales. Chair-Guard will protect the upholstery against disinfectants but it has to be used everyday and it does have an odder so end of the day use is recommended.

Delivery Systems … Internal and external maintenance is required if you want to protect the tubes, valves and blocks from corrosive agents. If you choose to use wipes, the same ones used on chairs and counters will work but lower quality plastics may yellow. Internally you should be using inline biofilm filters and utilizing a handpiece purge. Handpieces have drive air & exhaust lines. Excess lubricant will expel through the exhaust and build up on the inside of the tubing that will lead to replacement. An external system will reduce the vapor and also increase the life of the handpiece. All handpieces should be removed from the room before clean-up. Please feel free to contact me with any questions or concerns.

 

 

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January 17, 2019 Posted by | Uncategorized | Leave a comment

Infection Control, Not Good …

Over the last several months the local news has been covering the lack of infection control at several large health care facilities. One resulting in numerous deaths and the others just now getting investigated. Being as infection control is one of my strong points let’s do a quick review.

History … Boring to most but we learn from it. The first infection control seminar I produced featured Dr. Robert Runnels from the University of Utah. Dr. Runnels was the developer of the Chemclave, a chemical vapor sterilizer. Without a doubt it was the best form of sterilization available to dentistry but not practical. Dr. Runnels spoke about the need to continually improve your infection control protocol because bacteria and viruses continue to evolve. Today we are fighting things that didn’t exist when Dr. Runnels spoke 30 years ago..

They Didn’t Exist … Politics aside, people, animals and plants can move globally with more ease than in anytime in history. The recent outbreak of measles in New Jersey was spawned by a visit to Israel. A flu outbreak in New York City can easily start a pandemic after a jumbo jet plane ride to London or Paris. Medical science is at constant war but now we have super bugs. Up graded protocol is needed. Lets look at what most offices do and what they should. You don’t know what you don’t know.

Face Masks … Did you ever wonder why some face masks sell for $15.00/box and others for $3.95? There is a difference in the filtration and how long the mask is effective. A top quality face mask loses most of its filtration ability after 45 minutes. After 60 minutes it is just keeping out dust. The lesser quality brands are good for about 20 minutes but unfortunately most people don’t know that, it’s all about price. The CDC recommends Level 3 face masks.

Gloves … Nitrile is a CDC suggestion due to the fact that 10% of the population has some form of latex allergy, that’s one out of every 10 patients that walk into your office. Just like masks, a $2.95 box of gloves can not be compared to a $9.99 box. Where are gloves made? Economy gloves have microscopic pin holes. Microbes can enter through those pin holes plus the glove may tear easily.

Autoclave Pouches … If a pouch with a color strip turns color it does NOT indicate sterile.  Lower quality pouches will not maintain a sterile environment as long as a quality pouch. Think about it, during the dry cycle moisture escapes so if vapor can exit it can also enter. The pouch is just a barrier that will wear-out sitting in a draw.

Disinfectants … There are a lot of them to choose from. The key to surface disinfectants is how they are used. Wipes are the most popular but maybe not the best. For proper disinfecting the liquid should be allowed to dry on the surface, spray bottles and paper towels do a better job. However, wipes are faster and speed up turn-around time. Also, using wipes will not expel as much vapor in the air which is not only a health concern but can also damage dental equipment. I guess it’s a trade-off.

Summery … The average dental office cannot maintain a sterile environment like an operating room, it can only attempt to control the transfer of bacteria and viruses with procedure and protocol. Masks, gloves, and barriers should be changed every time you leave the operatory. An annual infection control review is as important as OSHA & HIPAA training. For my clients I provide a free one our lunch & learn review with CE’s. Please free to contact me at any time with any questions or concerns.

January 6, 2019 Posted by | Uncategorized | Leave a comment