Keep It Running: Best Practices for Equipment Repair and Maintenance in the Dental Practice

Robert Elsenpeter;

In many ways, equipment maintenance and repair are like tending to one’s personal health. Keeping up with healthy habits is the best way to avoid physical malady, and keeping a problem from getting worse is ideally addressed at the first sign of trouble. That goes for seeing a dentist, another doctor, or even fixing a mechanical problem. Regrettably, not every dental practice is as responsible with their equipment as they are with patients’ health.

Modern dental equipment tends to be robust and reliable, but that doesn’t mean it should be neglected or abused. Spending a few minutes to ensure equipment’s proper maintenance keeps those devices functioning optimally, reduces the need for expensive repairs, and keeps the practice treating patients.

“Keeping up on regular equipment maintenance is one of the most important steps a practice can take to ensure their equipment functions properly and at optimal efficiency,” Jason Lincoln, supervisor at Henry Schein Technical Advisors, says. “Not only does maintenance keep equipment running smoothly, but during maintenance, potential issues that cause equipment failure can be detected and resolved before equipment failure occurs.”

Miele’s PG 8581 washer-disinfector cleans and reprocesses instruments. It is vital to keep up with regular maintenance to ensure powerful, important equipment–like the PG 8581–is efficient and effective.

Preventive maintenance covers the gamut and can be as simple as basic, no-frills housekeeping steps. “As is true for all types of equipment, maintenance is very important in prolonging the life span of the machine and reduce downtime or recurring issues,” Rodney Yeung, regional marketing manager of lab, medical, and dental at Miele Professional North America, adds. “Maintaining your machinery starts with the proper usage and operation of the washer-disinfector. Some basic housekeeping maintenance and routine checks include cleaning sump filters [and] door seals and starting a rinse program to wash away any spilled cleaning agents during refills.”

It’s important not to lose sight of the fact that dental equipment isn’t just any piece of machinery; these machines are critical health care devices. As such, preventive maintenance keeps those critical systems reliably ticking along.

“I have always seen health care as a combination of a patient, provider, and instrument,” Jinesh Patel, cofounder and CEO of UptimeHealth, says. “Hardly any procedures or care is administered today without the use of a medical device of some sort. With that frame, it becomes easier to understand the importance of proper maintenance and upkeep for dental equipment. Maintenance of equipment does a few things. It ensures you are doing everything possible to guarantee your patients are being seen with high-quality, accurately performing equipment [that] will provide accurate readings and results. It keeps you and your clinics in compliance with equipment management standards. It can help you identify potentially problematic devices and remove them from service before they become an operational burden for your staff. Finally, it can increase the life span of equipment while reducing the overall cost of ownership.”

Dental practice equipment comes in all shapes and sizes, and just because something is small doesn’t mean that it’s not an engineered piece of complex machinery. “Proper daily maintenance for any handpiece is vital to the long-term or short-term sustainability for any handpiece, whether it be an air-driven high-speed, low-speed, or electric contraangle/attachment,” Christian Godoy, president and CEO of Lares Research, says. “Air-driven and electric handpieces are extremely intricate mechanical devices that rotate at speeds ranging from 100,000 revolutions per minute [RPM] to 500,000 RPM. To give you a frame of reference for comparison, imagine a turbine or engine rotating at half a million RPM [where] the diameter of this turbine cartridge [is] fueled by the highest quality ball bearings [that] can fit inside your pinky nail. This technology is more innovative than a jet propulsion engine or even a Formula 1 race car, and those machines cost millions of dollars. Therefore, lubrication and cleaning are crucial after every patient, and Centers for Disease Control [and Prevention] guidelines also require sterilization after each patient to eliminate the possibility of cross-contamination.”

It might be tempting to buy the least expensive piece of equipment to save money. However, with that temptation comes an adage: “The cheap comes out expensive.” Expanding on that phrase, the money spent repairing a cheaper device ends up costing more in the long run than buying the more expensive item to begin with. Spending the extra money to buy a quality piece of equipment saves money in the long run because there’s less downtime and potential failure. Additionally, if you are spending the extra money, it’s even more desirable to properly maintain that equipment.

“If you are seeking the best handpieces with preeminent quality, there is a simple formula to abide by in manufacturing state-of-the-art handpieces,” Godoy says. “You must utilize top-rated ball bearings, design a best-in-class chucking mechanism, and balance your turbine cartridge, which is exclusively designed and engineered in each of the Lares Research handpieces. If a handpiece manufacturer is not monopolizing this recipe to design, produce, and market their handpieces, the probability of bad vibration, higher sound output, and [inevitable] early degradation is guaranteed. Many companies try to reduce their cost on certain critical components such as bearings or the chucking mechanism that grips diamonds or burs, but sacrificing quality in these components will adversely affect your cutting precision, vibration, [and] sound output and result in an early failure. Again, Lares Research does not sacrifice quality to save a buck. Our company mission is solely focused on promoting transcendent handpieces with a United States factory direct value price point. Since Lares Research is a direct-to-dentist manufacturer based in California, dental professionals save 30% to 75% on every handpiece we offer versus handpieces sold through various distributors. As you know, distributors will add their margin, which increases the end-user prices, and the [client] experience working with distributors [is] subpar in comparison [with] what we offer at Lares Research.”

On the other hand, all equipment, no matter the cost, must be properly maintained. Even less expensive devices can last a long time if they are well maintained. “I don’t think you should consider how long the equipment will last,” Lincoln says. “All equipment has the potential to last a long time. It is more a matter of the long-term costs. [Although] a more inexpensive product may have a lower up-front cost, over time, the price to the practice has the potential to be more due to parts and labor costs as well as a loss in productivity. A more expensive quality product with a higher up-front cost can end up costing the practice less in the long term [because of] fewer service issues. There is no 1 right answer to every situation. Every practice needs to look at all variables and not just the initial cost when purchasing,” Lincoln says.

“I don’t think it’s fair to directly correlate price, longevity, and quality with the data the industry has at this moment,” Patel adds. “I think there are many examples where a cheaper device is actually one of the best items you can buy and others where you are essentially getting what you pay for.”

Cost can be a complex issue, including how a device affects other pieces of equipment at the practice, Yeung observes. “Our washer-disinfector pricing is competitive in the marketplace,” he says. “Miele’s ‘Immer Besser’ [‘Forever Better’]motto means we strive to always do better in everything we do, from our corporate sustainability pledge for the planet to actual products and services. For example, our variable-speed pump can adjust water and energy consumption automatically depending on the wash block parameters and soiling, and our dosing pumps use the precise amount to save detergent. Moreover, the intensive factory testing of our products proves they can last for a minimum of 10 years and 10,000 washes. But we also focus on the longevity and safety of our [client’s] critical instruments. Unique to Miele is the use of an acidic neutralizer, which balances the pH of the wash program and provides a passivation layer to protect dental instruments against corrosion. As a Class II medical device, thermal disinfection is also achieved in the final rinse cycle at an A0 value of 3000 (93 °C/199 °F for 5 minutes), thus providing added safety for the instruments’ handlers.”

No matter what device the practice is investing in, the manufacturer will offer precise guidelines on exactly how that equipment should be maintained. “What I can say is that manufacturers provide instructions for use and maintenance guidelines in every user manual,” Patel says. “They provide these items for a reason: to ensure that their equipment has optimal performance in the field. However, often we see that [individuals] do not follow the recommendations provided, which can lead to failure events. Although the device user or owner may not agree, I don’t think it would be fair to ding the manufacturer in those instances.”

Cost, Patel observes, isn’t just limited to the initial outlay. There are many other factors that go into calculating a piece of equipment’s price. “Here is what I would review and evaluate when thinking about a purchase: total cost of ownership—not only what the device costs upon purchase but the ongoing maintenance costs or parts costs that [you] may incur throughout its useful life in [your] practice; total burden of ownership—how much time does it take to use the device in normal operations and how much time would be required by my staff to maintain [it] based on user manual guidelines; access to service and parts—if something were to fail, how easy would it be to put [it] back in use; and criticality to business function—how much of [your] business relies on this device functioning as you spend more on the things that keep your lights on. Once you weigh these questions, you will be in a much better position to make the right purchase,” Patel says.

If something does break down, what are best practices for repair? Who should the practice contact for repair services? Should they ever attempt the repair themselves? Are there services they keep on retainer? Is it best just to call somebody for a one-time repair?

The answer, of course, is that it depends. “We all wish equipment would not break down, but the best action is to contact an authorized service provider when it does,” Lincoln says. “I think this is a vital course for an office to follow. I am reminded of a Clint Eastwood movie quote: ‘A man’s got to know his limitations.’ When I had an electronic issue with my stove in my own home, I knew it was beyond my scope of knowledge, and the best course of action was to bring in an authorized service provider who knew how to repair it. They were equipped with the training and experience necessary to perform the repair correctly. The same is true for dental equipment. Utilizing a service provider with manufacturer training and experience [to service] the practice’s equipment is the best course of action to ensure equipment is repaired correctly and quickly.”

But it doesn’t necessarily mean you have to choose one option or the other. Some middle ground does exist. “[Although] you may think I am contradicting myself by saying a practice should attempt repairs themselves, there is something called the Technical Advisor Team that is offered by Henry Schein,” Lincoln adds. “The Technical Advisor Team [composed] of a group of highly skilled remote service technicians. This team can not only assist with basic equipment maintenance questions, but they can also remotely walk the practice through diagnosing equipment issues over the phone. And when phone support is not enough, the technical advisers can use remote assistance software that allows them to assist via video through a cell phone camera. This enables the practice to perform some basic troubleshooting steps and eliminates the need for a technician onsite in many cases, limiting downtime and revenue loss.

“I think we should leave retainers and the associated fees for the lawyers,” Lincoln continues. “Having a partnership with a service provider such as Henry Schein is all you need. There is no need to have a retainer when a service provider can quickly dispatch a service technician when you need a service. I do not see a difference between regularly contacting an authorized service provider and a one-time repair. The focus should be on using the right person for the job. Just calling somebody for a one-time repair may result in it not being a one-time call. Use an authorized and qualified service technician that can help ensure it is just a one-time call,” Lincoln says.

“Every handpiece manufacturer will inform the [clients] that utilizing the genuine replacement parts for repairs is the best option to guarantee the longevity of the handpiece as well as the cutting performance,” Godoy adds. “I would only suggest having your handpieces repaired by the manufacturer’s authorized repair facilities that utilize the critical components customized for that handpiece. I do not recommend chairside replacements to any [clients] because they do not have the resources at hand to properly repair and test the product before use on a patient. At Lares Research, we test each handpiece numerous times during production and repairs to ensure all functionality has been identified and repaired. In terms of service charges and a retainer, Lares Research was the first and still is one of the only companies that offers a 5-year warranty handpiece, because we stick by our quality. In short, this will save dental professionals time and money with any repairs: no quotes, no hidden fees. And you can save hundreds if not thousands in service fees each of the 5 years.”

Another key component is ensuring that every team member knows what to do in the event of malfunction. Having a standard operating procedure ensures the equipment is properly repaired. “I believe that everyone should have an internal process and system in place so that in the event a repair is needed, all team members know what to do,” Patel says. “Before we even talk about what to do if something breaks down, it’s good to know what should already be in place prior to the event.

“First, everyone should have an accurate equipment inventory list,” he continues. “You need to know what you own so you can create a plan for each device. Ensure that your list has as much information as possible: the manufacturer, the model, the serial number, the location of the unit, etc. Second, the list should also know who the preferred service vendor is by device. This way everyone knows who to call when something happens. This could be 1 company for all, but sometimes you have different technician groups for different items. Third, you should assign a device manager to each device. This will ensure everyone knows who the point person is for any issues related to the unit and will oversee follow-up.”

Once these are in place, Patel explains, the rest is a logical continuation. “For example, when you have a scenario where something breaks, you can go to the inventory sheet that should be accessible to anyone who could identify a problem/report an issue; send the information to the device manager about what is wrong with the unit along with the device information; let the manager reach out via phone to the service vendor and have them follow up with the technician with an email, cc’ing the person who reported the issue; [and] as the service is scheduled and completed, respond to the email chain with confirmations and steps along the way. Writing an email and cc’ing the person who reported the issues will allow more than 1 person to track what is happening. If the device manager is sick or on vacation, they will not be taking all knowledge with them. We see communication breakdowns all the time when [individuals] resort to phone calls and text messages that can only be viewed by 1 person,” Patel says.

Having a dedicated team member in charge of the practice’s equipment reduces redundancies and streamlines maintenance and repair. “The great thing about having a device manager as a point person is that they are the best person to remember [whether] there is a repeat issue on a device,” Patel says. “A device could fail multiple times but for different [individuals] on different shifts. A device manager could catch this and remember that it should be a warranty repair, or they can remember how the technician told them to fix the issue if it was simple. If it’s simple and does not require a wrench turn, then they may just do it themselves.”

As far as repair best practices are concerned, Patel says there is no one-size-fits-all scenario. “As for keeping [individuals] on retainer vs doing one-off repairs, this is a case-by-case basis,” Patel says. “I would seriously consider a service agreement if it’s usually hard to find someone to come out in a timely manner and the agreement ensures you have a good response time, it’s a machine that is critical to the business and downtime for the unit would hurt operation and office performance, or there are a lot of units that need regular maintenance and someone can come in and tackle them all at once reliably. There are systems [such as] UptimeHealth that can automate this whole process for dental offices.”

Of course, at the first sign of trouble, the practice doesn’t need to call repair service. There are basic troubleshooting steps that should be observed first. “Basic troubleshooting can often be resolved by the operator by reviewing the frequently asked questions in the operating manual,” Yeung says. “For Miele products specifically, we rely on certified and approved technicians to service and repair our washer-disinfectors. If a technician or service call is required, [clients] can contact our service support.”

In the event of trouble, it might be tempting to reach out to a qualified repair technician. However, “qualified” doesn’t always mean “authorized.” Authorized repair services exist for a reason; some equipment is so new and specialized that its maintenance and repair is best handled by someone [whom] the manufacturer has approved to do so. But is it always necessary to use an authorized service?

“I would say yes and no, but more yes than no,” Patel says. “Having someone who is trained and authorized will usually mean they have familiarity with the product and its common failures. This will translate to quicker assessments and faster repairs. Also, a trained and qualified technician will have access to parts and service keys that others may not. This is usually the biggest bottleneck that even the best technicians can run into if they are not trained by the manufacturer. They may be competent and know exactly how to fix the device but cannot procure the part to do so. Lastly, an authorized provider will not void any manufacturer warranties that may still be active on the unit.”

There are instances where Patel thinks it’s OK to skip an authorized repair service. “I would only consider going away from an authorized person in the following instances: The device is old and well beyond warranty, the repair by a trained person will cost more than the device is worth, [or] the repair is simple in nature and can be completed by a simple component swap. As a disclaimer, I am not recommending you go with an unauthorized repair group, but these are only the times I would consider it,” Patel says.

When in doubt, however, Lincoln recommends using an authorized repair service as a starting point. “[Although] the issue a practice is experiencing may not be resolved by a technician from a company such as Henry Schein, in all honesty, it is still the best place to start,” Lincoln says. “An authorized service provider has the knowledge to determine [whether] the equipment has been negatively [affected] by an external source and [whether] the equipment can continue to be operated safely. They can also guide the practice on what steps they should take next and who they should contact for a repair if the issues lie elsewhere.”

Where does an extended warranty fit into all this? Will practices save money with an extended warranty, or is it better to pay for any repairs that may arise outside the initial warranty?

“Extended warranties can be a touchy subject, and everyone has an opinion,” Lincoln says. “I think there are situations where an extended warranty makes sense and situations where it does not. For example, for a 3D panoramic x-ray with a high initial cost and components that, if they fail, have a high replacement cost, an extended warranty might be a good option to reduce out-of-pocket expenses. Whereas for a smaller piece of equipment, such as a tabletop sterilizer with significantly lower initial cost and relatively low repair cost, an extended warranty may not make sense, depending on the needs of the practice.”

“This is a big one,” Patel adds. “Without getting in trouble, I would think about it the same way we considered keeping someone on retainer vs doing one-time repairs. I would put more emphasis on understanding how vital this device is to my business and how much a failure would cost if it was not under warranty. Cost can [be] the true cost of repair plus the cost of missed revenue from a downed device. Parts can get quite expensive, and asking these questions to the equipment distributor can help shed light on the best answer for the owner.

“I will note that the first thing you should do before considering a warranty is putting a system in place for tracking what is under warranty,” Patel continues. “I cannot tell you how many times we see the lack of a system become the biggest issue. So many [individuals] end up paying for warranties upon purchase and forget [about them]. They end up calling on technicians to do work that should already be covered. The better your equipment management process, the easier it is to make decisions like this.”

Ultimately, extended warranties can give you peace of mind that the equipment will remain serviceable. “Miele offers extended warranties in the form of yearly service contracts, which include preventive maintenance and coverage up to 10 years,” Yeung says. “This helps provide peace of mind that the unit is covered while also ensuring it receives the proper maintenance.”

Dentists tell their patients to brush and floss regularly. Although that advice is good for patients’ overall oral hygiene, dentists should follow the same sorts of preventive maintenance steps to keep their equipment in tip-top condition.