Why it's critical to design with the future in mind

Evolution can be a real bear for a species that refuses to change. From the dodo to the saber-toothed tiger, animals who, for various reasons, failed to adapt to a changing environment or predation paid the ultimate price. The really bad part about paying the ultimate price is not extinction in itself. No the really bad part is usually the slow and painful demise that awairs. Change is not a natural part of our universe.

The second law of thermodynamics states that the total entropy of an isolated system always increases over time, or remains constant in ideal cases where the system is in a steady state or undergoing a reversible process. The law of entropy basically states that things naturally progress from order to disorder.  

Now, I know what you are thinking: “Flucke, you’ve finally totally lost it. What does order and disorder have to do with technology and/or technology in dentistry?” Well my friends, let me explain myself. Our profession is continually evolving. We can have things organized exactly the way we need and want them today, but next week a new product comes along that requires us to change the setup for a procedure or variety of procedures. Unfortunately, sometimes when that happens, things can rapidly progress from order to disorder. Behold entropy!

The starting line

This is that magical part of our careers when we have everything exactly the way we want it. Maybe it’s the first day of clinical practice or maybe it’s the first day in your very own office. No matter what the circumstances, there is a place for everything … and everything is in its place. We dentists love organization. Having everything organized into properly done setups makes procedures go faster and with less stress.

When you really think about it, we as health care professionals spend decent amounts of our time and treasure achieving organization and keeping it that way. Whether it is instrument cassettes, digital dentistry or our custom dental cabinetry, we like things organized. 

Keeping it together without falling apart

In order to fight our old enemy entropy and to help keep things in an orderly fashion, we employ a number of techniques, tricks and devices.

As mentioned above, one of the most important of these is dental cabinetry. Over the years I’ve had lots of discussions with both manufacturers and colleagues about the subject. The manufacturers are focused on quality and innovation, while the majority of the dentists I’ve spoken to are focused on cost. One of my friends even humorously asks where “dental wood” comes from, because it sure is expensive.

Here’s my opinion on the matter. Everything made specifically for dentistry costs more than a consumer version. However, there is a good reason for this. The dental specific models are dental specific. That means they can only be sold in a very limited market (dentistry). That fact means there is a limited number of sales that can be made. If Quicken were a dental program it would cost more than $10,000. However, because it can be sold to millions of users, it can be purchased for less than $100.

The costs have nothing to do with the materials the products are made of. It’s just a simple matter of economics … supply and demand. I mean, let’s face it, if IKEA could sell dental cabinetry to their customer base you can quickly imagine what the cost savings would be.

Also remember the research and development that goes into lots of dental products. If you combine those costs with the costs of governmental regulations that some of the products must go through, you can understand how those costs must be spread out over those individuals who purchase. That, it turn, simply causes the purchase price to increase.

Over the years that I’ve been experimenting and tinkering in dentistry I’ve tried several different ways to save money while maintaining or increasing efficiency. One of the ways I tried was by using non-dental specific cabinetry. I learned that was a mistake. My grandpa Flucke used to say, “Experience is what you get five minutes after you needed it in the first place.” He was a smart man, my grandpa. The companies that make dental cabinetry have a vast history of experience to draw on. They not only know how to avoid the mistakes of the past, but they are also constantly thinking about the future and how it will affect their products.

The cabinetry that I had custom built for an operatory saved me some money, but it definitely didn’t function nearly as well as the other operatories. Little nuances that I failed to include (because I lacked the experience) made that particular workspace less organized and efficient. Yes, I saved money initially, but the long-term costs in terms of efficiency were not worth the savings. When I built my new office, all the clinical cabinetry was dental cabinetry. I had learned my lesson. This was especially true because of all the technology that I use on a daily basis. Today’s cabinetry has been designed to contain and support the technology platforms we need to do dentistry in the current environment.

With all of that said, there is one recommendation I’d like to make to all the cabinetry companies out there: Give us more counter space!  When I built my new office, I had grown tired of fighting space limits as far as floor space. Because of this, I made my operatories three feet wider and three feet longer than the industry standard. This gave me plenty of room to bring in things like a cart for endo, my hard tissue laser, my iTero digital impression scanner, etc. However, the cabinetry that was delivered and installed had the standard amount of counter space since it was designed for the standard operatory space. Of course this meant that I was still going to struggle with what I’ve come to call “countertop real estate.” So, all you cabinet companies that are reading this, give us counter space options! We need them!

Peering into the great beyond

We’re looking at a future of devices. During our original “Integration Phase 1.0” we got lucky with USB being developed and having the ability to power some of our devices like intraoral cameras and X-ray sensors. That decreased the need for power outlets. However, I doubt we get that lucky the second time around when we enter “Integration Phase 2.0”

Because of that, we are going to need electrical outlets and plenty of them. My recommendation is to try and figure out how many outlets you feel you will need in the future and then double it. If you truly want to be sure you’ve planned adequately, triple it. I’ve never walked into an office before and thought “well there are way too many electrical outlets in here.” Plus, with dental cabinetry, you can hide some of the outlets (if you desire) inside the cabinets.

I would also plan for the largest conduit possible. Conduit is simply plastic pipe that caries the technology cords, wires and cables through walls, floors, etc. Two-inch diameter is the largest you can use in standard wall thickness and I highly recommend it. Moving your cabling through a large diameter is orders of magnitude easier than skinny conduit.

Never assume you have enough room for supplies. As your inventory of technology devices grows, so does your inventory of supplies to keep them running. I’m not sure how many percent by which I increased my storage in the new office, but it is several hundred. We haven’t outgrown the storage yet, but we are using a lot of it.

Remember to build in space for devices you don’t own. In the early 2000s it was fairly common to hear a doctor say, “I’d love to have a pano, but I don’t have any room in the office for it.” When you factor in what space costs, I feel it behooves a practice to have a bit of unused space they can grow into. Unfortunately, it seems the logic is frequently to use a smaller space and wedge as much into it as possible. Of course, the problem that develops with that philosophy is when a new piece of technology is added. Suddenly there is stress as the office tries to figure out how to accommodate something new. If it just cannot be done, the office now begins to fall behind the curve. Not having enough space is a very difficult problem to solve easily and affordably. It’s just so much better to have the space there ahead of time.

Do your homework

It’s hard to predict everything that can affect your practice and its plans, but there is an old adage that will never be proven wrong. That adage is “failing to plan is planning to fail” or as Grandpa Flucke used to say, “there’s never time to do it right but there’s always time to do it over.” Smart man, my grandpa-he’s two for two in this article.

To avoid these scenarios, it’s best to try and do as much research as you can to learn what new things are developing. For instance, you might not be interested in printing restorations at this point, but doing good research can give you enough information to allow you to plan for the potential of it being in your office. You can begin to understand the potential requirements from power to size and then have space pre-designed to use that.

You may not want fancy dual-monitor setups in the treatment areas now, but planning for the buildout in infrastructure can aid your IT team in design. It will also make it much easier to upgrade to dual monitors in the future if you’ve done proper planning in the present.   

Take the wheel

Someone has got to drive the bus and it better be you. The only way you are going to get the plan and environment that you want is to become personally involved in guiding your practice and team.

You’ve got to go all in with the process and the decisions. There are lots of experts out there who can offer lots of recommendations. From architectural to construction/remodel to IT, there are professionals who can create incredible environments. However, only you can create your environment.

Heck, even if you are only going to move one wall or equip one treatment area that has been vacant until now, I’d still be all in and going over the area and process with the proverbial fine toothed comb to make sure I got exactly what I want and need.

Wrapping up

Our profession is going to continue to improve and evolve over time. Some changes will be vast and some will be subtle. However, we always need to plan for change. When I built my building I was lucky enough to get 1.25 acres of land. A couple of weeks ago I was staring out one of the windows wondering how long it would be before I have to start thinking about expanding.

The days of hanging out a shingle and practicing without change for the next 30 or 40 years are behind us. Thirty years ago, there was absolutely no need to have anyone in dentistry who tried to figure out the future of the profession. Now I spend two-to-three hours a week researching and trying to figure out where the profession is headed on this crazy journey.

Now, you don’t have to spend tons of time or invest a whole lot of effort into trying to see the future. That’s my job. If you want info from someone who lives and breathes industry changes, that’s what I’m here for. However, I do think it will make your practice better if you put your ear to the ground occasionally and listen for the pounding hoofbeats of change.