THE READERS' CORNER

Topics include office design and cosmetic finishing.

1. What do you consider the most creative idea you have used in office design?

There was a wide variety of responses to this question. A sample of the suggestions received:

"We have a complete working 1968 Mustang in my waiting room--mounted on the wall."

"Sliding storage shelves (mounted on tracks on the floor) for our models--saves space."

"Placement of my treatment conference room where it can also serve as an update/progress report/parent question-and-answer area."

"The contiguous location of my receptionist, accounts-receivable, insurance, and word-processor offices. They allow a smooth flow between them, and while they are removed from the other areas of office activity, they are still quite accessible when a parent or patient needs access."

"Split waiting rooms. Both are visible from the front desk but have a limited view of each other."

"A computer tracing/case discussion alcove."

"A separate room for the printer and copier to reduce noise."

"Using the 'hub' concept whereby the office manager has aural and visual access to the entire office."

"My office is in a building that has a central courtyard in which there is a garden, a small pond, and a fountain. There are four pairs of exotic ducks and a pair of golden pheasants. The treatment rooms all face the courtyard and have floor-to-ceiling windows. The patients love it!"

"A centrally located private office with views (through one-way glass) to my treatment room, waiting room, and toothbrushing area."

"Each of the rooms in our office is decorated as a different country."

"Having two labs--one 'clean' lab area close to the operatory for alginate, cement, etc., and a 'dirty' lab far from the treatment area for plaster work."

What is the worst idea you have used in office design?

Many of the respondents identified the lack of business office space as their biggest problem in office design. This was closely followed by insufficient room at the front desk for both staff and patients. The third major concern was the lack of storage space, particularly for treatment-related items in the operatory. Comments included:

"Double duty for the same room--for example, the same consultation and office manager's room, or the same records-taking and examination room."

"Our examination room is too open and becomes excessively noisy when the office is busy."

"Our poor front-desk flow design makes it inconvenient for consultation and initial exam patients to make their next appointment."

"Carpeting the treatment room."

"Insufficient storage space on the main level for non-orthodontic items such as mops, brooms, cleaning supplies, etc. The heavy equipment (compressor, vacuum, etc.) used up much of the space needed for the above essential items."

"Using one bubbler between two chairs for patients to share. They splatter water on the other patients when they rinse."

"Overhead model-storage cabinets in the sink area--always banging my head."

Do you use an open treatment bay, individual rooms, or a combination? What are the reasons for your choice?

Half the respondents reported using an open bay, while virtually all the rest used a combination. In fact, many of the clinicians who said they had open-bay operatories also mentioned using private or semiprivate adult examination areas. Some of the explanations given:

"We use an open bay--less movement for me."

"We have an open-bay treatment area with a separate records room, which can be used as an adult treatment room if needed. The open bay allows for more interaction between clients and our team members, and between clients themselves. This creates a less threatening environment, higher trust, and much more fun."

"We use an open bay for reasons of communication, education, and efficiency."

"Our open bay is informal, has a pleasant atmosphere, and allows for efficient supervision of the auxiliaries."

"We have a combination: (1) an open bay for ease of patient flow, cleaning, more economical use of space, and the friendly atmosphere; (2) individual rooms--a records room and a treatment room for debonding, TMJ treatment, and just plain privacy when the patient or the situation demands it."

Where do you store patient treatment records, patient models, computer records, and office supplies?

More than 80% of the practices stored their patient records in the business office/front desk area. Several also used separate storage areas such as basements, homes, or rented space for their inactive charts.

Model storage varied widely. Some offices reported using a central area, often in a hallway close to the treatment area; others spread the models throughout the office; and about one-third had a separate model storage area in the basement or in a remote location.

Computer records were almost universally kept at the front desk or business office, with backups taken home for security.

There was no particular preference in storage of office supplies. Several practices said they kept a current supply where needed, with the reserve in the basement or other storage area.

If you were able to rebuild your office today, what is the most important change you would make?

More space in the front desk/business office area, more storage closer to the treatment area, more space for sterilization, and more space for computer equipment were the four changes mentioned most often. Comments included:

"An enlarged receptionist/business area with an enclosed work area for private business like finances, collections, and difficult patients."

"Keep our sterilization area somewhat separate, rather than open at one end of the clinic, and also make it more centralized so as to cut down on assistant time."

"I would eliminate our central hallway, which wastes space, and add additional consulting areas."

"I would make sure that the financial secretary was close to and had easy access to the front desk."

"A much larger business office--because (particularly) of the need for space for our computer terminals, printers, etc."

"Increase the size of my waiting room. I have three treatment chairs and waiting-room seating for seven. During the after-school rush, I have standing room only when my 3:45, 4:00, and 4:15 patients all arrive together at 4:00 with their brothers, sisters, and entire carpools."

2. What percentage of your child and adult cases would you estimate are cosmetically finished with porcelain veneers, porcelain jackets, bleaching, selective incisal polishing, selective interproximal reduction, anterior bridges, and cosmetic build-ups?

Overall, the respondents reported fairly low percentages of porcelain veneers or jackets. Most replies were in the 2-3% range for children and about twice that for adults.

The cosmetic use of bleaching was even lower, with more than half of the clinicians never using this technique and the rest using it on fewer than 3% of their patients.

Virtually all the respondents employed at least some selective incisal polishing, in percentages ranging from 2% to more than 90%, with the average about 25%. Selective interproximal reduction was used by two-thirds of the clinicians, frequently for 20-30% of their cases.

The use of anterior bridges was relatively rare, averaging 2-3% in children and 5% in adults for those who used them. Composite build-ups were done by most practitioners in about 5-10% of their cases, primarily adults.

Does your practice have written or visual standards for case finishing ? What are your standards for finishing (whether written or not)?

More than two-thirds of the respondents reported having no written or visual standards for finishing. The most commonly mentioned standards included Class I canine and molar relationships, good overjet and overbite, centric relation equal to centric occlusion, a cuspid-guided functional occlusion, and an acceptable profile. Less frequently mentioned were the Andrews Six Keys, upper incisor exposure below the upper lip, parallel roots with good incisor and molar torque, and maintenance of intercanine width.

In what types of cases might you have to compromise your standards?

Sixty percent of the clinicians felt that lack of cooperation was the single most important reason for compromising treatment standards. Thirty percent said that a case with a severe skeletal malrelationship might force a compromise, particularly if the patient refused surgery. Twenty percent identified tooth-size problems as a significant factor. Also mentioned were mutilated occlusions, missing teeth, and unusual extraction requirements.

Do you perform all cosmetic finishing procedures ? If not, which are referred to others?

More than 90% referred all but minor cosmetic procedures, such as selective incisal polishing and interproximal reduction. Fewer than 5% performed their own cosmetic build-ups.

Some representative comments about finishing:

"My standards for finishing are to try to achieve the best possible functional and esthetic result within the limits of patient cooperation, skeletal relationships, and the realm of orthodontic stability."

"All my cosmetic procedures except interproximal reduction and incisal polishing are referred to the patient's general dentist."

"I prefer to have the family dentist do the bonding, etc., unless I do not feel comfortable with their range of treatment modalities. I will do some minor occlusal equilibration, but prefer for full cases to be done by a few select dentists in our area."

JCO wishes to thank the following contributors to this month's column:

Dr. I.L. Aronson, Savannah, GA
Dr. Raymond T. Bedette, Auburn, ME

Dr. John A. Busciglio, Brandon, FL

Dr. Ivan E. Boerman, Grand Rapids, MI

Drs. George E. Davis and David J. Nyczepir,Richmond, VA

Dr. William E. DeVries, Jenison, MI

Dr. Vance J. Dykhouse, Kansas City, MO

Dr. Robert A. Eckelson, Boca Raton, FL

Dr. Rodney F. Golden, College Park, MD

Dr. G. Russell Frankel, Cincinnati, OH

Drs. James Greer and Russell Greer, Lexington, KY

Dr. Jeran J. Hooten, Austin, TX

Dr. Howard D. Iba, Tulsa, OK

Dr. Brian B. Jacobus Jr., Port St. Lucie, FL

Dr. Mark Joiner, Santa Cruz, CA

Dr. James Kohl, Wilmette, IL

Dr. Billy Kyser, Camden, AR

Loyola University Department of Orthodontics,Chicago, IL

Dr. Robert S. Martin, Severna Park, MD

Orthodontic Associates, East Providence, RI

Dr. Donald R. Oliver, Kirkwood, MO

Dr. Eric J. Reitz, Bethel Park, PA

Dr. Ronald S. Rothman, Encino, CA

Dr. Lawrence N. Rouff, Binghamton, NY

Dr. Joanne H. Sasse, Victor, NY

Dr. Louis C. Seikel, Tallmadge, OH

Dr. G. Fred Siersma, Denver, CO

Dr. John L. Spolyar, Sterling Heights, MI

Dr. Michael P. Stebbins, Kalispell, MT

Dr. R.K. Stubbins, Bemidji, MN

Dr. Lamon Stewart, Greenbelt, MD

Dr. Steven Wernick, Bristol, CT