Clinic Design Guide

by Dental Surgeon Herluf Skovsgaard

Copyright: Flex Dental A/S & Dental Surgeon Herluf Skovsgaard
Table of content
Introduction
1. Critical evaluation of the traditional operatory 1
2. New demands for the central operatory 2
2.1 In general 2
2.2 Unit 2
2.3 Hand instrument table 2
2.4 Worktop for the DSA 3
2.5 Worktop for the dentist 4
2.6 Placement of hand instruments, materials and small items 5
2.7 Organisation of materials 6
2.8 Organisation of instruments 7
2.9 Instrument and material organisation in the FlexForm modules 8
2.10 Supra modules for materials, instruments and small items 9
2.11 How to organise the mixing module 10
2.12 What can advantageously be placed outside the central operatory 10
2.13 PC with screen(s), keyboard and intra oral camera etc. 11
3. Three concepts for operatory design 12
3.1 FlexForm Duo 13
3.2 FlexForm Duo/Solo 13
3.3 FlexForm Solo 13
4. Central operatories with FlexForm 14
4.1 Central operatory 1, Duo/Solo (2025/985) 14
4.2 Central operatory 2, Duo/Solo (1825/985) 15
4.3 Central operatory 3, Duo/Solo (1020/755) 16
4.4 Central operatory 4, Duo (2010/800) 17
4.5 Central operatory 5, Duo (1810/985) 18
4.6 Central operatory 6, Duo (1810/800) 19
4.7 Central operatory 7, Solo workplace 20
4.8 Examples of operatory design 22
4.9 Space requirements for operatory placement 29
4.10 Improvements to existing operatories 30
5. Operatory lighting 33
6. Positioning of XRay apparatus 34
7. Point suction 35
8. Conclusion 35
Introduction
Rational systematised working procedures are required for the dentist and DSA while treating
patients.
In the Ergonomics Report* we presented rational working methods which result in maximum
undisturbed concentration when treating patients.
In this Clinic Desig Guide we particularly consider the demands such objectives make upon
actual surgery layout and planning - that is, how to plan the surgery and organise materials and
instruments so that the surgery resources and activities are maximised.
1. Critical evaluation of the traditional operatory
Often this looks like the one shown below:
This has the following weaknesses:
1) There is not enough room for the dentist in the 12 oclock position because the distance
from the back of the headrest and the front edge of the work top is too small (sometimes
as little as 45 cm.) This is a serious problem as the ability to work from 12 oclock is very
significant ergonomically. The worktable/headrest distance should be 60-70 cm.
2) When seated next to the patient the DSA cannot reach the worktop - she has to stretch
across, or move away from, the patient to attempt to function.
3) It is difficult to place an instrument table by the patients temple - on this illustration it is
not present at all.
4) Often there will be insufficient room for a PC, screen and keyboard in the treatment area.
* This subject is discussed in the Ergonomic Report which can be ordered from Flex.
Fig.1: Traditional workplace
1
2. New demands for the central operatory
2.1 In general
The central work place is one in which everything can be accessed by both the dentist and the
DSA without leaving the patient.
The central operatory contains
* Unit
* Hand instrument table
* Work area for the dentist
* Work area for the DSA
* Modules for materials, instruments and small items
* PC, screen, keyboard and intra oral camera.
The following detailed analysis forms the basis for the design of the FlexForm elements.
2.2 Unit
In the report on ergonomics I argued that a major requirement for teamwork is that the dentist as
well as the DSA are able to access unit instruments and suction. The conclusion is that the ideal
placement of the instrument table is above the patients chest, between the dentist and the DSA.
2.3 Hand instrument table
The tray placed over the patients chest would be so high that both the dentist and DSA have to
strain their shoulders to reach the instruments. This is not a good solution!
The best solution is to place the hand instrument tray between the dentist and DSA, just to the left
side of the patients head. Both the DSA and dentist can easily reach the instruments and the di-
stance between them and the mouth is minimised.
This tray should be capable of moving sideways as well as backwards and forwards.
Figure 2: Both dentist and DSA can
reach unit and hand instruments
Figure 3: Optimum placing of hand
instrument table
2
Adjusting the height of the tray is not desirable as raising the tray only makes it more difficult to
pick up the instruments. The tray has to be large enough to hold two instrument cassettes.
In the Ergonomics Report you can see how an instrument table of this kind is used either for
4-handed dentistry, or for when the dentist is working alone.
2.4 Worktop for the DSA
The DSA needs a worktop which can be used when standing and for when sitting.
The worktop height when standing should be 83-91 cms. depending on the height of the DSA.
Figure 4: Worktop height for a standing
DSA
Figure 5: Worktop height for seated DSA
A worktop for seated work can be compared to a desk when, of course, there is leg room. The
height of the dentists working surface is decided by his/her height. It is desirable for the DSA to
sit at the same height as the dentist by using the stool height adjustment.
Figure 6: The DSAs worktop - measurements and placement
3
ca. 90 cm
ca. 75 cm
TEMPORARY
CROWNS
TEMPORARY
CROWNS
Figure 7: The dentists worktop - measurements and placement
The left side of the worktable has to be placed 30 cm. from the middle of the patient chair so that
the dentist has the space to work in the 12 oclock position.
The distance from the back of the headrest to the front of the worktop has to be 20 cm. It is very
important to place the worktop in this relation to the headrest to ensure that the DSA can reach
her worktop just by rotating on her stool.
The worktop has to be at least 100-125 cm long to accommodate instruments and materials for
any type of treatment. For example, when undertaking crown and bridgework a work area of
100x40 cm. is fully utilised as shown in the illustration (see Figure 6).
2.5 Worktop for the dentist
The dentist requires about 70 cm. free space behind the headrest to have sufficient room to work
at 12 oclock.
The dentists worktop consists of the left side of the DSAs worktop plus a worktop at 12 oclock.
This is for the placement of models, articulator, papers, records, radiographs and a viewer, and/
or PC and keyboard.
Note that this arrangement does not necessitate a larger surgery than that of the traditional
working system.
4
In the traditional workplace as in figure 8a the distance between the back of the headrest and
the wall is 95cms.
This dimension is exactly the same as that described here as in figure 8b.
The difference is that the dentist has far more space in the 12 oclock position and that the DSA
can use her worktop simply by rotating her stool.
2.6 Placement of hand instruments, materials and small items
The DSAs reach in the horizontal plane can be seen in Figure 9.
Figure 8 a
Figure 9: The useable space is limited by the
DSAs horizontal reach...
Figure 10: ...and her vertical reach
5
Figure 8 b
In the vertical plane, the DSA can reach the upper 3 or 4 drawers under the work top as well as
everything to a height of 65 cm above the worktop without difficulty, as in figure 10.
2.7 Organisation of materials
Much time can be saved by storing materials in this central
workplace in cassettes. This avoids having to fetch different
materials from various places.
Here are some examples for cassette materials:
1a: Handpieces in half cassette (figure 11)
1b: Cotton rolls in half cassettes (figure 11)
2: Various aids for fillings
Matrix bands
Matrix holders
Strips and curved strips
Transparent and wooden wedges and polishing strips
3: Composites for incisors (figure 13)
The 8-10 most frequently used composite colours,
etching gel, adhesives.
4: Compomer
5: Molarcomposites
6: Pins
Pin systems for dentine
Pin systems for root canals
Cements
7: Endodontics
Paper points. Gutta Percha points.
Extra files
Rubber ring dispenser
Root filling pastes etc.
8: Rubber dam, clamps, forceps etc.
Figure 12: Filling aids
Figure 11: Handpieces
& cotton rolls
To limit the numbers of times the DSA has to leave the patient I suggest that the central
workplace stores instruments and materials for
a) Examination
b) Diagnosis
c) Emergency and provisional treatment.
d) Conservation therapy
e) Instruments and materials for acute treatment
f) Perhaps endodontic treatment.
Figure 13: Incisor com-
posites
6
Examination and filling cassette
The tray is supplemented with a filling cas-
sette (Figure 17).
Examination cassette
This cassette contains a mirror, a probe, a
pocket probe, two pairs of tweezers and
perhaps a scaler. (Figure 14). One pair of
tweezers is for treatment and the other to
pick up burs, discs, cotton rolls and other
small items.
As an alternative instruments can be kept
in sterilised bags (Figure 15).
Having been used, the instruments are
placed on a paper napkin or metal tray on
the hand instrument table (Figure 16).
Figure 16: Examination instruments
setup
Figure 15: Instru-
ments in sterilised
pack
Figure 17: Examination and filling setup
2.8 Organisation of Instruments
Time and space will be saved if instruments are made up into sets for treatment types e.g. a set
for examination, one for fillings etc.
It is a good idea to colour code the instruments with rings which gives the sequence in which
they are to be used.
Figure 14: Examina-
tion cassette
Figure 18: Examination and endo setup
Examination and endo cassette
The examination instruments are sup-
plemented with an endo-cassette (Figure
18).
7
Figure19: Supra modules on the worktop and mixing module below
In addition to the above, cassettes may be used for numerous other treatments. If one does not
have a central workplace with room for instrument cassettes, they could be placed in a suitable
wall cabinet.
2.9 Instrument and material organisation in the FlexForm modules
These modules are designed for easy placement of the surgery essentials.
These modules are constructed so that hand instruments, materials and small items are all
accessible. The modules contain a mixing area, with drawers and worktop for mixing, beneath
the right side of the DSAs worktop and a number of supra modules placed on the worktop.
8
Low supra module with drawers
This module has two drawers normally placed in
the lowest position (nearest the worktop).
Altogether there is space for 6 cassettes or 12
half cassettes used for storage
For example, the following cassettes can be
utilised (ref 2.7):
- Top drawer, from the left:
- cassette no 1a, 1b 2 and 4.
- Bottom drawer from the left:
- cassette 3, 4 and 5.
Figure 20: Low supra module with drawers
High supra module with flap
This module is used for a capsule mixer, powder
and liquid bottles, pellet dispenser, dappens glas-
ses, burholder etc. The bottle stand can, for
example, contain cements as well as the bur hol-
der in the front. One, two or three such holders
can be placed in a cassette.
Figure 21: High supra module with flap
Low supra model with flap
This module is used for small apparatus such as
the electro surgical unit, composite curing lamp,
sandblaster, the intra oral video camera and per-
haps a CD player.
As an example, when the video camera is in use
the handpiece may be placed with the tube
hanging down from the supra module.
Figure 22: Low supra module with flap
2.10 Supra modules for materials, instruments and small items.
The Supra modules are used for storage. There are three supra modules which can be placed
vertically or horizontally.
9
2.11 How to organise the mixing module
The items used most frequently are placed in the front of the top drawer.
Suggestions for use:
Mixing:
Small cassette with mixing slabs and spatulas
Small cassette for writing materials
Various diagrams for registration
Perhaps a small PC
1st. drawer - the materials most often used:
Suction tips, temporary filling materials, rubber cups, polishing pastes, articulating papers,
floss, colour samplers.
2nd drawer - extra hand instruments:
From the outside a series of bagged hand-instruments most frequently used, with a
maximum of three or four pieces per bag.
The instruments are tight in the bags and are removed using one of the two pairs of
tweezers.
In this way as many as 50 - 100 instruments can be stored in one drawer.
3rd drawer - anaesthetic section:
Tubes of surface anaesthetic, cotton buds
Syringes and needles in autoclaved bags
Intra-ligamental syringes and needles
Anaesthetic cartridges
4th drawer - your favourite things:
Perhaps a pulp tester, additional bagged instruments, sterile scissors, sutures.
5th drawer - at your disposal
2.12 What can advantageously be placed outside the central operatory.
Instruments and materials used for pre-planned treatment may be stored in an area central to all
the surgeries. This central storage area would also contain less used items and would be in the
central sterilisation and packaging area.
Materials for extensive treatments are placed on large trays stored on cabinet shelves. There
needs to be at least four such instrument trays.
10
2.13 PC Screen and keyboard and intra oral camera etc.
There are many uses for the PC in the dental surgery.
In the reception area it is used for patient files, accounts, bookkeeping appointment system etc.
In the surgery it can be used to describe and illustrate treatment plans, display radiographs,
intra oral pictures, CD ROMs and so on.
The PC screen and keyboard are placed according to who will view the screen and who will be
operating it. Possibly a junction box could be used so that one PC can control two screens -
and another possibility is to connect two keyboards to same PC. More space will be created on
the worktop by using small keyboards.
Problems related to hygiene in connection with keyboard use can be solved by:
1) The use of an instrument handle to operate the keyboard
2) To cover the keyboard with a plastic sheet which is changed between patients
3) Removal of operating gloves when using the computer
In this working area there are several choices for placement of the keyboards and screens.
1. PC screen is placed on the top of the supra module with the keyboard on the DSAs
worktop.
2. PC screen and keyboard are placed on the right of the DSAs worktop to the right of the
supra module.
3. The screen is placed on a holder above the dentists worktop with the keyboard under-
neath or, perhaps on top of the mixing module.
Figure 23: Trays for crown and
bridgework
Example:
Two instrument trays for crown and bridgework.
One has impression materials and the other is for
occlusal registrations and temporisation (figure 23).
A tray for denture work could be set up and also one
for surgical procedures.
11
TEMPORARY
CROWNS
TEMPORARY
CROWNS
4. The screen can be placed on the unit so that the patient is able to see it either when
seated or supine. After treatment, when the patient sits up, the screen is moved so that it
still faces them. This position would be used for more extensive informative procedures
such as discussing X Rays, intra oral pictures, demonstration and discussion of treatment
plans and for example, short preventive videos.
During treatment the screen is used by the dentist for brief patient information, for exam-
ple to show digital X Rays and certain intra oral camera images.
An intra oral video camera can be attached to the PC which enables video images to be shown.
Video photos are especially suitable for patient information and can be stored on the hard disc.
The video camera in the low supra module with flap. When in use the camera is placed on the
hand instrument table. See fig. 22 page 9.
3 Three concepts for operatory planning
These concepts may be chosen according to the dentists preferred working methods.
Duo
Is for the dentist who always works with a DSA
Duo/Solo
Is for the dentist who varies between working with, and without, a DSA
Solo
Is for the dentist who always works without a DSA
Figure 24: The PC screen on the unit is visible when the patient is seated or
supine
12
3.2 FlexForm Duo/Solo (figure 26)
Here the dentist changes between
working single-handed and four-
handed. Both the supra module and
mixing module can be rotated from
the DSAs position to one in which
they can be used by the dentist. It
takes less than 5 seconds to rotate
these modules!
Abb. 26. FlexForm Duo/Solo
3.3 FlexForm Solo (figure 27)
The dentist always works single
handed (Solo). Here the supra
module and mixing module are
permanently placed on the dentists
side.
Abb. 27: FlexForm Solo
Abb. 25. FlexForm Duo
3.1 FlexForm Duo (figure 25)
The dentist always works with a DSA.
Here the mixing and supra modules
are permanently placed on a plinth to
the side of the DSA.
13
4. Central operatories with FlexForm
On the following pages seven standard FlexForm packages will be shown.
4.1 Central operatory 1, Duo/Solo 2025/985
This workplace is arranged for Duo work (with DSA) as well as Solo work (without DSA). There is
plenty of storage space and a wide table top (202.5 cm.)
A PC can be placed in the wide PC cabinet on the dentists side. This cabinet is only 30cms. deep
so that there is enough legroom for the dentist under the tabletop.
This PC is provided with 2 screens and 2 keyboards.
The dentists PC is placed on a shelf with the keyboard beneath.
This arrangement is suitable for brief use
The DSAs PC and keyboard is paced in the top drawer of the right hand side drawer module -
this is suitable for longer periods of use. A digitalised XRay scanner could also be placed on the
DSAs side.
14
4.2 Central operatory 2, Duo/Solo (91825/985)
This is similar to Workplace 1 but the nurses table top is 20 cm. shorter. This is the smallest
size that can be recommended.
During more complicated procedures involving many items this table top becomes completely
utilised.
The right hand cupboard is fixed and is used for various cassettes.
The DSA would use a small keyboard which can easily be moved to the side when not in use. It
could also be placed on the top of the moveable mixing module.
15
4.3 Central operatory 3, Duo/Solo (1020/755)
This work area consists of a mixing and drawer module which can be rotated and two supra
modules which are also rotatable. The table top is small and on the DSAs side should be
supplemented with more table space on other modules. On the dentists side it can be
supplemented by a 25 cm. deep worktop to allow space for models, articulators, records and so
on.
There is no room for a PC in this central work area.
16
4.4 Central operatory 4, Duo (2010/800)
This operatory contains the low mixing module with drawers, a drawer module plus a tall supra
module with a tiered bottle holder and a further supra module with 3 cassette holders. The PC
for this operatory is in a cabinet behind the mixing module.
Both the worktop and storage area are large. The lower cabinet and left supra module are for
the materials and spare instruments which used most.
The right lower cabinet is used for materials and instruments used for the more extensive plan-
ned treatments, or which are used less often.
Materials and instruments for the larger treatments, which are used less often, are placed in the
lower right cabinet.
The right supra module is used is used for cassettes containing materials which, when in use,
will be placed on the table top next to the hand instrument table.
The table top behind the dentist is 30 cm. deep to accommodate models, articulators, etc.
The Supra module and PC screen often compete for space in the system, so here the left supra
module is low enough to enable the screen to stand on it. It can then be used by dentist and
DSA, and in this example, the PC has two keyboards.
17
4.5 Central operatory 5, Duo (1810/985)
This workarea contains a wide PC cabinet and a cassette cabinet.
It has two low Supra modules with drawers and a high Supra module.
The operatory is ready for a PC. The screen is placed on the top of the left supra module. It can
be used by the dentist and DSA and has two keyboards.
18
4.6 Central operatory 6, Duo (1810/800)
This operatory contains a mixing module, a cassette cabinet, plus a low Supra module with
drawers and a tall Supra module with tiered bottle storage and also a short Supra module with
a flap.
The PC and keyboard is placed to the right of the Supra module where, for example, there
could also be a scanner for digital X Rays.
There is not enough space for a normal PC screen on the dentists 30 cm. worktop but a flat
screen could be placed there.
19
4.7 Central operatory 7, Solo operatory
The Solo operatory is for the dentist who always works without a DSA. The work area is arranged
so that there is the most possible storage space as close to the patient as possible. In the
12oclock position there is a fixed mixing module, a drawer module plus two short Supra modules
with drawers.
In the 3oclock position the work area has a fixed working module plus a shelf with room for a PC
and possibly a scanner for digital X Rays. There is also a short Supra drawer module, a tall Supra
module with tiered bottle storage and a low Supra module with flap.
The PC has two screens and two keyboards. A mouse or small keyboard is placed on the worktop
by the hand instrument table
For other PC work and administration matters, the left screen is used with a keyboard placed in
the top drawer of the left mixing module.
The screen placement enables both the dentist and patient to view it.
Dentists who work Solo often use a hand instrument table on the unit in addition to the one
placed to the left of the patients head. The right hand is working in the patients mouth and is
contaminated. Therefore the left hand is used for handling materials. These are placed to the left
and behind the patient where the dentist can reach them by rotating the operating stool.
20
21
4.8 Examples of operatory design.
On the following pages we illustrate some examples of surgery design using
the central workplaces.
The scale is 1:50, which means that 2cms. on the drawing represents one metre.
Note:
Wall mounted cabinets are not shown in the plans.
Dispensing cabinets (VB-310)
These are placed above the sinks. They have space for paper towels, tumblers, soap,
handcream dispensers and so on. (Figure 28a)
Wall cabinet (VB 301)
In many of the examples these will be placed on walls above the table tops. (figure 28b). Wall
cupboards can have shelves, or runners for 16 cassettes.
Figure 28a: Dispensing cabinet above sink Figure 28b: Wall cupboard above
worktop
22
The centre point C is marked on all the plans. It lies
in the middle of the back of the headrest with the pa-
tient chair adjusted for supine working at a height of
80cms.
Each example shows the distance from C to the
walls of the surgery to the north, south, east and
west.
In many cases the plans can be used as illustrated.
When the available space is not ideal small
compromises can be found which do not disturb the
concept. There is more about this in chapter 4.9
Figure 29: Centre point C
23
24
(Central operatory 1)
( 4) Central operatory
( 5) Central operatory
( 2) Central operatory
25
(Central operatory 2)
( 5) Central operatory
( 7) Central operatory
( 3) Central operatory
26
Notes regarding examples 9 11:
The rooms in examples 9-10 are rather narrow and
in example 11 furthermore very short. As such, these
examples illustrate how one can compromise in the
design of the operatory, but still obtain a fully
functional operatory.
Example 9: There is sufficient room for the patient
chair to be placed on the DSAs side of the unit.
There is also sufficient space for the DSA to put her
operators stool aside when cleanup and preparation
of the operatory is required.
The patient chair is placed in a sloping position in
order to provide more space for the dentist when
speaking to a sitting patient.
There is room for the sinks in the south-end of the
room.
Example 10: In this example the room is narrow and
short on both the dentist and the DSA side of the
unit. The patient chair cannot be sloped as this
would create a lack of room on the DSAs side of the
unit.
Example 11: The room is very short. There is only
space for a 25 cm. wide tabletop behind the patient
chair.
(Central operatory 5) (Central operatory 3)
(Central operatory 3)
27
Notes for examples 12-19:
Examples 1-11 used the central operatories in the standard version.
Examples 12-19 use central operatories with tailor-made dimensions.
The modules, Supra modules etc., are the same as in the standard versions
390
28
20
430
250 250 250
250
Classical outline for minimizing the DSAs walkpattern
Central operatory 5 DUO
Central operatory 7
Central operatory 5 DUO
Open multi-operatory
Central operatory 7
Central operatory 3 DUO-SOLO
Ultra-compact open multi-operatory
STERILIZATION
RECEPTION
STERILIZATION
Distance from C to the east wall
This distance has to be at least 160 cm. The di-
stance from C to the nearest corner of the DSAs
worktop has to be 30 cm. and this worktop has to
be at least 130 cms. wide.
If this distance is less the worktop will be too small
for the major treatments.
If cabinets are placed along the east wall the di-
stance from C to that wall has to be increased by
50 cm., making 210 cm. altogether.
In small surgeries the distance from C to the east
wall can be reduced to 130 cms. if the dentist rarely
works 4 handed or if the nurse works standing up
as there would not be enough room for the DSAs
chair to be moved into during clean up.
4.9 Space requirements for operatory placement
This chapter is used when the size and shape of the surgery makes it impossible to use the
basic plans shown in the previous chapters.
The distance from C to the north wall
The space between centrepoint C (see chapter 4.8)
and the wall north of the patient chair (at 12 oclock)
should be at least 60 cm. and preferably 70cms. If
there is less distance it will not be possible to work
in the 12 oclock position.
In the 12 oclock the dentist needs there to be
worktop of at least 25cms. behind him. Ideally this
would be 50 cm. to allow room for PC screen.
This means that the distance from C to the wall
north of the patient chair has to be a minimum of 95
cm. or 120 cm. with the 5 cm. worktop.
If the distance from C to the north wall can only be
70 cm. it will be necessary to omit the worktop
behind the dentist.
Figure 30: Distance from centre to north
Figure 31: Distance from centre point to
east
c
c
29
Distance from C to west wall
This distance has to be at least 120 cm. If a 50 cm. deep
worktop or cabinet is required the distance from C to the
edge of the cabinet has to be 110 cm. that is, a
combined distance from wall to C of 160 cm.
In small surgeries the distance from C to the wall can be
reduced to 90cms. without cabinets and 140 cm. with
cabinets. The chair is very close to the wall/cabinets and
the dentists free space will be very small. This situa-
tion can be slightly improved by rotating the chair and
unit towards east about 15 (from the footrest end).
See example 9 on page 26.
The distance from C to the south wall
This distance has to be at least 260 cm. This enables
the DSA to walk around the footrest of the chair even
when the patient is supine. In small surgeries this di-
stance can be reduced to 210 cm. However in this case
the DSA cannot walk around the footrest with a supine
patient.
4.10 Improvements to existing operatories.
Four handed dentistry necessitates a hand instruments
tray from which a DSA can pass instruments to the den-
tist.
Moveable tray
If one cannot invest in a complete FlexForm workstation
the simplest alternative is to use a table on castors with
an wider worktop. As can be seen in figure 34 the west
worktop can be elongated 30 cm. giving the dentist
room for records etc. while also leaving the DSA
legroom under the worktop.
The top is elongated 15 cm. south so that the hand in-
struments can be placed correctly close to the patients
head - the rest of the worktop is further away. This
means there is more room for the DSA. It is
advantageous for the table to have raised edges, except
above the drawers.
Figure 32: Distance from west to the
centrepoint
Figure 33: Distance from south to the
centre point
Figure 34: Table on castors with wider
worktop
c
30
Redesigning a traditional workstation
If one has a relatively new but traditional work area as described in chapter 1 the surgery design
can be modified using ergonomics principles.
This modification can take place to various degrees.
The patient chair can be moved so that there is a minimum of 55 cm. preferably 60cm. free
space behind the headrest when the patient is horizontal at a normal height. Then it is possible
to work in the 12 oclock position. An instrument table is mounted between the DSA and the den-
tist - an instrument table mounted on the unit will not enable the DSA to pass instruments to the
dentist.
The instrument table is placed as shown on figure 35b at a distance of about 10 cm. to the left
side of the patients head.
Fi gure 35a: Tradi ti onal workstati on for
alteration
Figure 35b: Traditional workstation where the
chair has been moved and an instrument table
positioned
FlexTray
The Flex Tray hand instrument table is used
for the above redesign. It consists of a dou-
ble-jointed arm to which the table is attached
and is placed as shown in the illustrations 36
and 37.
The arm is attached to the inside of the
cabinet frame from which a drawer has been
removed. This drawer space needs to be a
minimum of 41.5 cm. wide, 5.8 cm. tall, 40
cm deep and should be 65-70 cm. above the
floor.
The table itself should be placed 70-80 cm.
above the floor according to the dentists
height.
Note that the cabinet may require
strengthening at the fixation point of the arm.
Figure 36: FlexTray and instrument table
31
Figure 37: Drawer removed from cabinet and
mounting point for the FlexTray
Figure 39: Cabinets with FlexTray mounting and
SupraModule
Figure 38: Different arm placements
Use of SupraModule
In a traditional surgery layout more
space will be available for storage of
materials is a SupraModule is placed
on the worktop as in Fig. 39.
Improvements to the DSAs working
area
The DSAs mixing area is too far away
when she is sitting next to the patient.
This distance can be reduced by
inserting an acrylic mixing slab in a
drawer to the right of the hand instru-
ment table. The slab should be level
with the drawer top and about 75 cm.
above the floor.
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Figure 38 shows different fixing positions according to the layout of the cabinets in relation to
the patients head.
5. Operatory lighting
The intensity of the surgery lighting must not be significantly less than that in the operating area
in order to prevent eye stain when looking at strongly lit teeth. Normally a light value of 1000 -
1500 lux around the mouth is suitable, providing the floor is light in colour and therefore
reflective.
Satisfactory lighting is achieved with six fluorescent tubes with reflective fittings hung in a U
shape. The patient faces the space between the lights as in figure 42.
The reflectors should be hung 210 cm. above the floor. If this leaves space between the lights
and the ceiling, two additional tubes should be utilised to illuminate it.
High frequency tube fittings, which do not cause blinking, should be used and each should emit
35 watts.
Redesign of table top for seated work
The DSAs workstation will be
considerably improved by the provision of
a specifically designed worktop as in
figure 40. The ideal length has to be about
100 cm. by 75 cm. high. The distance to
the patients headrest will be 20 cm.
The DSA will have room for her legs under
the left of the table.
SupraModule
Fixed SupraModules will be placed on the
worktop.
Position of FlexTray
The ideal position for the FlexTray is for it
to be mounted on the corner of the
worktop. A column of drawers is removed
as shown in figure 40 and a new top
placed at the correct working height for
seated dentistry of 75 cm.
Figure 41: FlexForm tray for tabletop mounting
Figure 40: Tabletop for seated work
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High reflective fittings throw very little
sidelight and so the walls are insufficiently
illuminated and can be lit by shaded halo-
gen downlights. One armature is placed
every 150 cm.
Figure 42: Placement of operatory room
lighting
6. Positioning of X-Ray apparatus
This may be placed in a central XRay room or in each treatment room. It is great advantage,
particularly for endodontic procedures, to have the unit in the treatment room.
It is necessary to be aware of your local regulations regarding radiation protection of walls and
doors.
The XRay unit can be placed on the unit. However better function is achieved and a tidier posi-
tion obtained by placing it on the wall behind the patient.
The carrying the tube should be double jointed with an 80 cm. horizontal swing arm. When the
unit is positioned as described it is possible to take an incisor radiograph on a seated patient with
an elongated tube.
Normally radiographs are taken with the patient supine. It is easier to see and to place the film
and apparatus than when the patient is sitting.
Figure 43: Placement of wall mounted XRay machine Figure 44: The XRay machine shown at 12
oclock
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7. Point suction
Several composite materials which exude harmful vapours are used during treatment, for
example, acrylic primers and adhesive plastics. Usually the DSA prepares and mixes them on
the worktop to the right of the instrument table.
In order to remove the odours an air suction point is provided on the worktop - point suction.
In most cases the suction system is placed in the ceiling. The point suction is connected to the
existing suction system via a tube along the wall behind the work area - this is a flexible
horizontal tube running under the SupraModule to the suction pipe along the wall. The drawing
shows the funnel placement by the mixing area.
A point suction can also be provided for the dentist.
Figure 45b: Point suction seen from the front Figure 45a: Point suction seen from above
8. Conclusion
When designing dental surgeries I seek a rational result in which the dentist and DSA maximise
their concentration on the tasks to be carried out for the patient. In this report I have shown that
it is essential to place the various elements of the central work area in a particular way relative
to each other. Everything which is to be used during treatment is to be placed within reach of
the dentist and DSA.
Only in such rationally designed treatment areas are the dentist and DSA able to sit, see and
work well all the time. In other words work in accordance to the principles which I have
described in The Ergonomics Report. The design will condition the ability of the dentist and
DSA to work rationally without harm to their physical and mental health.
The optimum result is obtained when the central workplace is designed using FlexForm
elements respecting the conditions described in this report.
However if one has a relatively new, but traditional workstation, improvements are possible
merely be altering certain elements and their placement in relation to each other.
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