Introduction to the dental clinic
Surgery layout and equipment
Nicole Stormon
Learning Objectives
Describe the dental surgery layout for facilitation of safe dental practices.
Apply the dental surgery area layout to universal principles of infection control in dentistry.
Identify common dental surgery equipment and their use in dentistry.
Appreciate the variation in equipment available in dental practices.
Principles
Effective layout of equipment in a dental surgery is crucial for facilitating infection control procedures and time management of procedure appointments. Dental surgeries must have floors that are waterproof and easily cleaned, such as laminate flooring. The room must be well ventilated and separate from waiting rooms, reception areas, lunchrooms and other rooms such as on-site laboratories in the practice.
All members of the dental team must have understanding of the use and maintenance for the dental surgery equipment. Dental surgery equipment can be divided into the dental chair and the surrounding workstation.
Dental chair
The dental chair is the main location where dental procedures occur. The chair reclines which facilitates the seated practitioner to comfortably view the patient’s oral cavity.
|
Equipment |
Description |
|
The reclining chair where the patient sits for treatment. |
|
|
The operatory light to direct light onto the operating field. |
|
| Dental Assistant chair |
A chair on wheels with a bar located above the seat at waist height used to rest arms on. |
|
A chair or stool on wheels, with or without back lumbar support. |
|
|
A moveable unit with a control panel for the operation of the dental chair and storage of operatory instruments. |
|
|
The unit that has the equipment for saliva evacuation. |
The location of other major equipment in this area is determined by if the operator uses their right or left hand as the dominant hand for the procedures. Some dental chairs are designed to be interchangeable for both right and left handed operators.
|
Equipment |
Location Right-handed operator |
Location Left-handed operator |
|
Patient chair |
In the middle of the dental surgery, with easy access for the dental team and patient to move around. |
|
|
Overhead light |
Directly above the patient chair, typically attached to the ceiling. |
|
|
Dental Assistant chair |
To the right of the patient chair, towards the head of the patient. |
To the right of the patient chair, towards the head of the patient. |
|
Operator chair |
Directly behind the patient chair around to the right of the patient. |
Directly behind the patient chair around to the left of the patient. |
|
Bracket table |
To the right of the patient chair, near the operator. |
To the left of the patient chair, near the operator. |
|
Suction unit |
To the left of the patient chair, near the dental assistant. |
To the left of the patient chair, near the dental assistant. |
Workstation
The workstation or working areas are the bench and surrounding equipment around the dental chair. The working areas are clearly differentiated into clean and contaminated zones. Only the required materials and equipment are placed in the working area and clutter needs to be minimised.
Clean areas must not be contaminated by potentially infectious materials. The design of the dental surgery facilitates the dental team to be able to keep these areas free of dust and other contaminants. The clean zone includes a bench which will contain patient records and computers for record keeping purposes. The inside of the cupboard and draws are to be kept clean. This is where sterilised equipment and materials will be stored.
How you do get materials out of the draw during a procedure?
The inside of the draws are strictly a clean zone. You must not use contaminated hands, whether gloved or not, to get materials or equipment out of these draws. You will be required to completely de-glove, perform hand hygiene and then retrieve your required materials with clean hands.
The contaminated working (or “dirty”) zone however will potentially have infectious agents during patient procedures. This zone is decontaminated thoroughly, between patient appointments. All the required equipment and material for a procedure, are placed in the contaminated working zone. This area will usually have a hand washing sink, a general waste bin as well as a sharps disposable bin.
Can I record clinical notes in the contaminated working area during a procedure?
You can record clinical notes in the contaminated working zone, however it is difficult if not impossible to decontaminate a writing implement. If you record notes in a contaminated working zone, you would then need to de-glove, perform hand hygiene and transfer your written notes onto the computer or into patient notes. This can also be achieved with the help of a colleague with clean hands who can transcribe your notes. Any contaminated notes and writing implements are then disposed of from the contaminated working area. The optimal way to record clinical notes is to have a dental team member with clean hands, record them at the time you are dictating them.
Workflow
The dental clinic is a busy environment and understanding how to navigate the workplace effectively can reduce stress for the team and the patient.
Dental surgeries follow a one way flow. Clean materials and instruments enter into the contaminated working zone for use. These instruments strictly do not re-enter the clean zone and will only exit the working zone to then move to the sterilisation room for the decontamination process.
Dental surgeries are often optimised to ensure maximum efficiency. An example of workflow efficacy would be placing frequently used materials in a drawer that is closest to the dental assistant and operator during treatment. The dental assistant can then access this quickly beside them, rather than standing up, moving to another part of the room to open a drawer to access this material several times during a procedure.
Country context
Australia
The design of healthcare facilities in Australia are guided by the Australasian Health Facility Guidelines (AHFG). This is a comprehensive guideline compiling infection control principles and regulations with facility and design principles an Australian Standards.
This guideline specifies the requirements for building elements, physical environment and surfaces and finishes.
For example, under surfaces and finishes flooring is required to be easy to clean and repair and must not be carpeted. The Australian Standards outlined in the AHFG include:
- Standards Australia, 2014, AS/NZS 4187:2014 Reprocessing of Reusable Medical Devices in Health Service Organizations; and
- Standards Australia, 2004, AS/NZS 4674:2004 Construction and fit out of Food Premises.
Practical application to the dental environment
There are hundreds of different brands of dental chairs available. It is important to review the manufacturer’s instructions on how to operate the dental chair in the local practice setting, and where possible organising a demonstration of the chair by the manufacturer’s local representative .
There are similarities between the dental chairs for their operation such as:
- Handpiece control panel: Generally dental chairs bracket tables will have a control panel to adjust the handpiece speed and water volume.
- Chair recline control panel: The bracket table will have directional buttons for control of the chair position and may have pre-set positions programmed by the operator.
The operator light, dental handpieces, triplex syringe and suction unit will typically be operated in a similar way, regardless of the chair brand.
Operator light:
- The overhead operator light will have handles to move the light into position.
- Some lights have a physical switch or motion sensor to turn the light on and off.
- Some lights can be dimmed and the colour changed.
Suction:
- The suction will generally have a lever to turn the suction on and off.
- The suction in some cases may turn on automatically when lifted out of the suction holder.
Triplex syringe:
- The triplex has two buttons: water and air. When depressed the buttons will release air, water or both air and water.
Handpieces:
- The handpieces on the bracket table will usually only operate when lifted out of the bracket table. This allows for safety measures if accidentally operated.
- A foot pedal is used to activate the handpiece. The foot pedal usually has a water control switch as well.
Key Takeaways
- A dental practice will have a separate room for the purpose of cleaning, reprocessing and decontaminating instruments.
- A ‘one way flow’ must be utilised to minimise infection control risks and exposure.
- Correct personal protective equipment must be worn at all times.
The authors acknowledge the contributions of Vivian Dao, Jaewoo Jang and Shamitran Prabakaran for their contribution to the drafting of initial concepts in this chapter; and Tachae Douglas-Miller and Veronica Kindaro for their assistance in filming the dental surgery tour.
The reclining chair where the patient sits for treatment.
The operatory light to direct light onto the operating field.
A chair on wheels with a bar located above the seat at waist height used to rest arms on.
A chair or stool on wheels, with or without back lumbar support.
A moveable unit with a control panel for the operation of the dental chair and storage of operatory instruments.
The unit that has the equipment for saliva evacuation.
Clinical areas which are not contaminated by potentially infectious materials.
Clinical areas which potentially have infectious agents and are treated as if they do have contaminants.
Clean materials and instruments enter into the contaminated working zone for use. These instruments strictly do not re-enter the clean zone and will only exit the working zone to then move to the sterilisation room for the decontamination process.
