Learning: Frequently asked questions

There are a multitude of opinions about operator position and, as is commonly the case when there are differing opinions, that usually means that there is no single answer. However, we can give you some background and a method of deciding how to make positioning ideal for your style of practice.

First, here's a bit of history. The quest for "ideal" operator positioning comes from the studies of industrial hygiene (factories not dentistry!) at the middle of the past century. The whole idea was to make man part of the machinery-- a tool with a dental degree.

Here's the problem:

1. Our patients vary; we have obese patients and tiny patients and patients that can't lie flat. This isn't an assembly line.
2. If you break the machine (the doctor) you can't just buy a new one! So we have to create an environment that is best for the "machine" not just for the task.

Therefore, we need to split the process into basic principles and flexible options.

Basic principles-- these are the ones that you probably learned in school:

• Back upright
• Minimal head tilt
• Thighs parallel to the floor (not really -- more on this later)
• Feet flat on the floor (which can't really happen because of the foot control)
• Patient low to the legs (there are reasons why this is probably wrong too)

These principles are easier to adhere to from the 10° to 12° position, but that doesn't mean much in reality.

This brings us to a flexible view of posture and positioning.

1. Spines get nourishment through motion. Motion is good! If you convert to a fixed focal length, for example with a microscope, you do so at great personal risk, especially if you perform long detailed procedures such as endo or crown and bridge. (There are solutions coming for this but they are still a ways off).
2. If it is true that bodies are healthiest when in motion, the goal should be to comfortably accommodate the range of postures required to provide care, so that it is not a big deal when Mrs. "I-can't-lie-back-beyond-45°" comes in for endo on an upper molar.
3. To accomplish this you need flexible equipment-- and most equipment isn't very flexible.

What are the requirements for equipment flexibility?

Flexible Equipment:

• Allows the operator to sit, stand or sit-stand in function
• Allows the assistant and to a lesser extent the operator to sit, stand or sit-stand in function
• Permits work from 7° to 1° for right handed operators (11° to 5° for left handers)
• A flexible equipment layout should not place dynamic instruments to the side or rear of the operator or assistant except in very special situations (but please don't do it -- you don't need to)
• Equipment flexibility is most easily accomplished with over-the-patient or over-the-head equipment

There are many, many factors involved in determining absolute productivity and many ways to influence productivity without adding treatment rooms... but that is another question!

We know that, in general practice, one doctor and proper support staff are, without question, best served by three operatories per doctor-- not including hygiene rooms.

Most practitioners are unwilling to do this and, as a consequence, suffer economically and via increased stress. If a practice is unable to afford the space or expense of providing this volume, it is best to stagger office hours between practitioners.

Now, here is the real answer - You can do this:

• Operatories don't have to be big.
• They don't have to be expensive.
• They do have to multifunctional.

If you are smart about your operatory design and implementation, you can have it all-- number, productivity and affordability.

Many offices desperately need additional treatment rooms, but the challenge of creating additional space is huge. Nonetheless, by using specialized layouts, it is entirely possible to create fantastic hygiene treatment rooms in extremely compact spaces. In order to compact doctor rooms, we often use what we refer to as room pairs, space saving and efficient layouts. Though not always possible, we frequently trim room dimensions considerably, by recommending Ergonomic Products' Inwall® cabinetry.

Another opportunity for increasing operatory counts occurs, when there's no real reason to make a hygiene room design 9 or 10 feet wide, since so few hygienists are 9 or 10 feet wide! Wasted dimensions will only trigger a waste in motion. And consequently a waste of time and money. Compact hygiene rooms are much easier to work in.

By the way... we can also make reasonably sized rooms super-productive!

Most operatories are both too large and too cramped! Dentists are only human - we tend to take a space, and then fill it up until there is absolutely no room left to budge. Imagine how that feels for the patient, to lie amidst a clutter of dental objects. Also, think about what it is doing to your performance! Working in a cramped and inefficiently organized environment is like trying to change your clothes in a broom closet! You can do it, sure, but it won't be fun or productive.

Normally, we recommend one primary design objective for your treatment rooms -- maximized throughput. Frequently, we create symmetrical cross function space (doctor and hygiene). We commonly will set these rooms at 8' 4" x 10' 6". Since room length is rarely the constraint, even in a crowded space, sometimes we'll even go to 11' in length. This extra length allows the room to feel less medical, as it's more inviting and certainly more spacious. Patients don't see width and less is generally better for wall use.

We can also redefine how you use your space in general. In order to increase your treatment room count, you may not want to simply shrink each room space, but instead consider... room pairs.

The doctor and assistant team work very, very differently than hygienists or even hygienists with hygiene assistants. Dedicated hygiene rooms should be narrower. How wide is a hygienist's wingspan? 4 1/2 feet? Why would you put walls and shelves for your dental equipment out where you have to stand up and walk to get it? Why create an 8 - 10' wide room for a 4 1/2' wide operator? In this situation, the place for width is at the toe end of the room where the patient sees and feels its spaciousness.

Room pairs allow two rooms in a width of as little as 14 feet. That's right, f o u r t e e n feet. That means that if you thought that you had room for four operatories, two pairs of rooms will leave you with space for a fifth operatory. And, you can accomplish all this for about the same cost as creating the four initial conventional rooms.

A thoughtful design can make almost any room highly functional. In actuality, size doesn't limit most doctors or their practices. Rather, it's a lack of adequate room numbers that can be stifling. For example, you need space for overflow, emergencies, increasing hygiene or, you need extra room in the event of equipment failure, or to allow a slightly slower staff member the time to learn and improve new skills and techniques.

We recommend that you slow down for the design process. Simplify. Condense. Organize. We want to help you create space for an adequate number of treatment rooms. You'll spend less, you'll get more, and you'll enjoy the benefits of a more productive office after having completed the process.