Design Throughout the Dental Office
Your reception area and the entrance to your office will affect the overall “feel” that patients have about your office and about you. Subconsciously, patients are making value judgments about the office based on hundreds of little items they notice. It cannot be stated strongly enough that your office makes a statement about you and an impression on the patient. Generally, the reception area should be “inviting” with an open design. These days dentists are handling the “checking in” of their patients in a variety of ways. For example, some dental offices have “greeters” who provide concierge types of services, such as offering beverages, or “treatment coordinators” who may offer office tours on the first visit and handle all transactions for the patient for the entire time they are with that practice.
Dentists often make the mistake of having a business area that is too small. Increasing clinical complexity, special business needs, prepaid dental programs, and insurance copayments are just some of the reasons why the space for the business office has become more important. A general guideline is that one person needs a two feet wide space to walk comfortably between objects such as a filling cabinet and a desk; allow at least five feet for two people to work around each other without interference. In addition, each employee in the business area should have two to three feet of working space, plus room for equipment such as computer, telephone, etc. It is important your staff have enough room to do their job comfortably. A good rule is to use 100 square feet for one full-time person in the business office. For each additional person, use 75 square feet.
Trends in the design of the treatment rooms include integrating high tech dental equipment and moving from a clinical environment to a more warm, inviting space. Designs are becoming more sophisticated in all materials; upholstery, cabinetry, flooring, wallcoverings and flooring and window treatments are becoming more decorative than ever. The basic question dentists and designers start with is how many dental treatment rooms are needed. It has been estimated that a well run, busy professional office, with one dentist and one dental hygienist, will utilize at least four treatment rooms. This is broken down as follows: two for the dentist, one for the dental hygienist and one for emergency or overflow patients. Offices with a higher number of shorter appointments, such as a pediatric dentistry or orthodontic office, will likely need additional treatment rooms. Practitioners who are building a clientele will likely need only two functional treatment rooms, until patient demand indicates a need for additional space. For maximum efficiency, all treatment rooms should be the same in size, equipment and layout. This will allow the dentist to perform any regular service in any treatment room. It will also prevent bunching of the appointment schedule around certain “preferred” treatment rooms or a delay in seating patients while a room is occupied or being prepared. It is also important to place the treatment rooms close to one another to reduce the time necessary to move between rooms and to enhance productivity. Great care in planning the treatment room layout should be taken if more than four treatment rooms are designed to ensure a smooth traffic pattern.
Types of Treatment Rooms
There are three basic room designs for dental treatment rooms. These include:
• “H” configuration
• “U” configuration
• “Y” configuration.
Many designers prefer the “H” configuration. In this design, four doors exist for each treatment room, two from behind the patient and two at the foot of the chair. Dentist, patients and staff can easily enter and exit with this type of arrangement. Drawbacks to this design include the necessity for two separate hallways and the inability to place the chair in a position that allows the patient much of a view while waiting. Costs are often increased in this design due to extra hallway requirement. The “U” concept is an adaptation of the “H” configuration that eliminates the doorways at the foot of the chair. Patients and dentist come in through one entry and staff enters through another, both behind the chair. Advantages include the ability to place the chair facing a window while the head of the chair is left in a non traffic area, allowing for carts, tubing, and other mechanical requirements to be placed there. Both the “H” and “U” concepts are popular and allow ease of motion to and from the dental chair, which is an important aspect in any treatment room design. A “Y” design plans for one doorway into the treatment room, from either the side or the foot of the chair. All traffic enters through this doorway and then moves to the appropriate areas of the treatment room. The design is popular but often results in slightly more distance for both the dentist and staff when moving from the treatment room to another.
A curved corner triangular feature volume, clad with natural wool felt strips of different thicknesses and widths, dictates the flow of the 1,800 square foot office. Lined in bright yellow to encourage energy, admissions and checkout are handled separately from inside at opposite ends. Read more
Treatment Room Design Elements
Regardless of the treatment room design, a basic principle of good design places the assistant and as much of the support equipment as possible along the long axis of the dental chair and within reach of the dentist or the assistant. Dental assistants will need to sit slightly higher than the dentist to allow for adequate vision. Furthermore, since the average reach radius of an assistant is approximately 26″, all work surfaces, materials, and instruments should be within this distance when performing treatment to prevent unnecessary motions, which can be stressful and time consuming. All types of delivery systems, such as behind the patient, one or two carts, or over-the-patient, can function well in a properly designed treatment room and the final choice is usually up to personal preference of the dentist.
Dentist’s Private Office
The private office is becoming increasingly important in design with the belief that it is important for the dentist to have “private” areas to go to during the day for mental breaks. Dentists used to work in small offices, but this is changing. They are being designed larger. Large windows always offer a peaceful, psychological break. Remember to design for a positive, relaxing atmosphere. Consider a private closet and bathroom to accompany the office. Keep in mind the accessibility requirements when designing the private office.
Staff Break Room
Dentists are becoming more accommodating to staff, again to offer private areas for mental breaks. Patients cannot judge your clinical care, but they definitely make “mental notes” about the attitude of your staff. If your staff is happy, and their needs are being met, it will show to your patients. A trend in office design is that some business owners are becoming creative with the design of the break room; building it to be flexible for conversion into conference, meeting, and employee education areas. Custom designed cabinetry can hide kitchen appliances and audiovisual equipment. Another trend is themed conference and break rooms. For example, break rooms can be designed to feel like a bistro café; or a conference room may have an “ocean” theme.
Regardless on which wall the x-ray machines are placed, make sure that the equipment and chair are positioned to allow ease of access to both left and right sides of the mouth. It is important to check with dental suppliers to determine the inner wall support necessary for intraoral radiographic machine mounting. During full extension of the arms of the machine, the weight of the tube head can put significant torque onto the mounting plate and wall supports. Many offices plan for a panographic radiographic machine even if they do not currently have one. The designer or architect needs to know about anticipated expansion plans in order to allow for appropriate wiring. Architects will begin to consider a central x-ray area if the office has approximately six or more treatment rooms. Separate special function areas like an x-ray room, are usually not recommended for the average solo practice as they are not cost effective. However, panographic equipment located near the reception area could be accommodated in a space as small as 5′ x 5′. If a central radiographic area is indicated, it is important to place enough distance between the machines for both ease of operation and for compliance with radiation safety requirements. Check these requirements carefully with the manufacturer and/or local building authorities. Be sure to also check state or city radiation laws to determine if special construction is required. If there are no specific requirements, it may still be advisable to use 5/8 inch sheetrock in the walls rather than 1/2 inch thick material.
Sterilization and Tray Preparation Area
The overall office layout will require the designer to plan for the efficient management of a sterilization area. The size of this area is dictated by
the function that is to take place there. For example, with a tray system, the sterilization area will need to accommodate both a soiled side and a clean side with a progression from one to the other. Logical placement of scrub sink, ultrasonic cleaners and sterilization equipment indicates that the items for sterilization should progress through these steps and end up in a storage area for sterilized items. In busy offices, an area with 12 to 16 feet of counter space for sterilization procedures will probably be necessary. Counter space in the sterilization area can be designed as totally linear, L-shaped, as a U-shaped, or as two parallel linear surfaces. Out of concern for infection control, many experts now recommend that dentists work from trays prepared outside the treatment room. Using prepared trays has the advantage of eliminating a potential cross-contamination point where a dentist or staff member involved in a procedure may be tempted to reach into a drawer for items. One suggestion is to store minimal equipment or supplies inside the treatment room in drawers. In general, it is more efficient and less likely to violate infection control procedures to work from sterile procedure trays that are completely assembled in advance away from the treatment room. These trays have no missing items and when needed they may be quickly brought into a treatment room for use.
Make sure you have plenty of storage space in your office. Devote at least 100 to 120 square feet for inoffice storage. Central storage areas can be used to reduce the inventory necessary in the treatment rooms and to decrease the chances of cross contamination as was indicated earlier. It is usually easier to have one storage area, if possible, for both small and bulk items: It should be accessible and easy to manage for all staff.
The office will, depending upon whether a basement exists or is planned, need an area to house the mechanical utilities. Items such as dental compressors, evacuation systems, gas tanks, and water should be housed in a well enclosed area to prevent transfer of sound. In addition, if a basement is not available or planned, sufficient crawl space is desirable to facilitate plumbing installation and repairs. Check on state and local regulations and manufacturer’s recommendations for any requirements concerning separation of mechanical pumps from chemical storage.