Small Town

April 1, 2006
I just returned from a lecture in Grand Forks, N.D. Although not a bustling metropolis, more than 100 people attended my lecture...

I just returned from a lecture in Grand Forks, N.D. Although not a bustling metropolis, more than 100 people attended my lecture to learn about the latest in technology. What peaked my curiosity was the number of dentists from small towns with whom I spoke. One dentist, who worked in a town with a population of less than 2,500, said his patients often travel more than 100 miles for an appointment. Why would he need all of this whiz-bang equipment? Surely, for his practice, there was no need for elaborate marketing or spa services. It became clear in talking to several of these practitioners that, although their offices could survive with traditional equipment, there were reasons for upgrading. First, several have small offices in equally small towns. So it is difficult to find trained, experienced staff members. I had to think about this - networked computers with treatment stations in operatories that have digital radiography in a two-treatment room office? A resounding yes.

Envision an office with two staff members - one at the front desk (with assisting capabilities) and a chairside assistant. If one of these individuals calls in sick, the work day could be a total disaster unless the office has a digital backbone. If the practice-management system is installed in the treatment room, the doctor can retrieve the chart. This means no one had to pull records for the day. Treatment can be entered quickly, and an appointment made while the patient is still in the chair. This is total efficiency, and the practice doesn’t lose a step. If there is a sensor-based, digital X-ray system, there is no need to leave the room or spend time developing film or poring through the chart looking for the last film taken, pulling it out and placing it on the viewbox, and then filing it. Notice, I said sensor. Phosphor plates are equally functional, but require a step out of the room unless the plate processor is in the treatment room (at this time, the only one small enough for this is the Instrumentarium’s Optime).

This is also a perfect time for a unique product, the Isolite. This innovative system is a combination biteblock, cheek and tongue retractor, field illuminator, and suction - all in one. By isolating one entire side, upper and lower, most procedures can be carried out without an assistant (sorry ADAA). Perhaps that is a bit overstated, but it deserves a visit to

Then there is the CEREC CAD/CAM system. The clinical trials and literature now show this is a viable process for crowns, partial coverage restorations, and veneers. The esthetic naysayers have been quieted somewhat following Dr. Rich Masek’s award-winning cosmetic restorations. Other practitioners, such as Mark Morin, also make this system sing. Perhaps by press time, the Schein Evolution 4D will have entered into the marketplace, thus offering another in-office CAD/CAM system. For practices, the beauty of the system is the one-visit completion of a restoration. Imagine a person having to travel 100 miles for a five-minute “recement temp” appointment.

Most of the other tech tools that we discussed are more in line with a dentist’s philosophy of practice and/or clinical needs rather than being necessities for small practices. Style and economics are factors in choosing other technologies. For example, elaborate Web sites with directions to the office on Main Street may not be at the top of the list of items needed for small town offices.

But, doesn’t this also apply to a larger practice? If you don’t have computers in the treatment rooms (many still do not), you are missing an opportunity to streamline your practice and make it more efficient. Many of the tools discussed in this column and other articles cannot function without an infrastructure. Digital photography and intraoral cameras lose some of their luster without in-room viewing capabilities. Digital radiography systems beg for the networked office. But, if you cannot muster the courage or obtain sufficient financing, there are other ways to put digital radiography in your practice. Systems such as LightYear and the Dexis Sharestation can stand alone, and can be moved easily from room to room. Laptop-based systems, although slightly more clumsy, also can be moved. Images can be stored on these self-contained units, or later be incorporated into networks.

This column is a wake-up call to readers who have been pondering some of these ideas while waiting for the right time to pursue them.Think of the dentists and their staffs who drove miles in sub-zero temperatures) to learn how to implement these products into their “far-from-the-mainstream” offices. You can do it, too.

P.S. Special thanks to Dr. John Clayburgh for taking me curling.

Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. He is a mainstay at technology sessions, including annual appearances at the Yankee Dental Congress, and he is an ADA seminar series speaker. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site ( and can be reached by e-mail at [email protected].

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