40 Years in the dental industry By Paul Coughlan 

In 1966, after serving an apprenticeship as an electrical engineer and a further 5 years running an electrical engineering maintenance department, I was offered the opportunity to join F. H. Baxter in Bradford as a dental service engineer – and it was the best move I ever made. Here I am 40 years later still working in the same industry. I joined Baxter’s about a couple of months or so after Peter Baxter (no relation to the company), so we both celebrate 40 years in the industry this year.

In those days F. H. Baxter was a very small manufacturing facility, making flasks for dental laboratories and a few other small lab’ products and an even smaller dental dealership. The service ‘dept’ consisted of two small garages joined together and it was inhabited by the manager, Jim Harvey, one other engineer and myself. F. H. Baxter, later to become Baxter’s of Bradford, had two reps on the road and Peter was responsible for getting the orders out of the door. Baxter’s of Bradford eventually became probably the most successful full service dental dealer in the UK. Take a look at some of the present day dental companies that were spawned from B of B: DB Orthodontics, DB Dental, Orthocare, Optident, Prestige Dental, Dentomax, Trycare to name just a few.

In 1966 the dental profession, and therefore the dental trade, was in a state of flux. Isn’t it always I hear you say? But at that time the dentists’ whole approach to practising dentistry was undergoing some dramatic changes due to some revolutionary developments in equipment and techniques.

USA Influence On Progress

In the late 1950’s a dentist in Washington USA, John V. Borden, had developed and introduced the first high speed air driven dental drill - and that moved the goal posts somewhat.

By the mid 60’s this instrument was in fairly common use in the U.K. and now we had to deal with a handpiece running at speeds around 300,000 r.p.m. With rotational speeds such as these it was necessary to provide a substantial amount of water to cool the bur and to prevent damage to the pulp. This had never been the case in the past, when the only liquid in the mouth was saliva. To make matters worse Killpatrick and Darryl Beach in the States were advocating laying the patient flat out and performing the dental treatment from a seated position. I clearly remember Beach demonstrating the super sleek ahead-of-its-time Spaceline system, and this at a time when virtually every dental surgery had either an old Ritter, Sterling or Rathbone fixed pedestal unit, which stood like a sentinel in front of the window, with a ball engine and a boiling water ‘sterilizer’ bubbling away on a cabinet next to him.

“Never in a million years”, I heard one dentist say in an early seminar on the four handed seated dentistry. “Where is this Utopia” asked another when he had heard about the benefits of working in this fashion.

Well, you could say the rest is history, but it took the development of a number of auxiliary products before we got to the position we are in today.

With the patient lying supine and with a lot of water being deposited in their mouth you needed a means of extracting it – so the aspirator or vacuum system was born. It’s changed dramatically over the years - thankfully - from a vacuum cleaner motor in a cabinet with a sweet bottle to catch the blood, saliva, water and extracted bits and pieces (the unfortunate D.S.A. had the odious task of emptying and cleaning this jar on a daily basis) to a modern sealed motor system with automatic separation of liquids, particles and, more recently, amalgam and mercury.

Sitting in the middle of a room with a patient laid flat out and the dentist and assistant seated was not very efficient. They both had to get up and walk to pick instruments from drawers in free standing cabinets or to mix an impression paste or something similar.

To paraphrase our illustrious leader, Anthony Blair, this is where - ergonomics, ergonomics, ergonomics - came into the equation!

The Emergence of Ergonomics

Modular cabinets gave the surgery designer the opportunity to ergonomically (there’s that word again) arrange the cabinets and the associated work surfaces in a way that allowed the operator and assistant to reach drawers and support surfaces from the seated position with the minimum of movement. The cabinets were flexible enough to cope with the many irregular shaped rooms used by dentists in the UK. Unfortunately, this message seems to have been lost in the mists of time. As, now, when I go into many recently equipped surgeries I see many situations where the location of the chair relative to the cabinets is totally wrong and located too far away from the cabinets and work surfaces. The assistant has to move their stool to reach them. Or a situation with an ‘L’ shaped layout where the cabinet mounted control can’t possibly place the instruments where they should be – right next to the operator’s knee.

Baxter’s went on to produce the first dog leg shaped cabinet layout, The Marquis Concept, another big step forward in surgery design and ergonomics, and fitted it with Corian work surfaces. It was chosen by the Science Museum in South Kensington as the “Dental Surgery of the Future” and was on display at the museum for several years. All this and Corian - in the 70’s over 30 years ago. So what’s new?

Adec dealer Saudi Arabia

Over the years we have seen many different shapes and sizes of dental units appear on the market. Old well established manufacturers have fallen by the wayside, Ritter and Amalgamated Dental, two of the largest in the World to name just two, and new ones such as A-dec and Belmont appear, establish themselves and are now front runners. As equipment sales manager at Baxter’s I was involved with the introduction of the A-dec equipment into the UK in 1976/77. I remember taking the A-dec Micro Cart round to see dentists and dealers and trying to convince them that this little handpiece control block with a piece of rubber trapped in the top and not much bigger than an OXO cube would perform the exact same function as an 8” x 6” steel plate with two solenoid valves, two regulators and a suck back valve would do in a well known European manufacturers unit. It was an uphill struggle at first but it seems to have worked.

Adec chair in Saudi

Infection Control

I suppose the next big change; not counting the many changes in clinical materials, in the dental equipment field would be the ever increasing need for and the move towards better control of infection. Over forty years I have been in dental surgeries that I would not have my dog treated in. On the other hand I have been in some excellent establishments that were absolutely first class with very well organised and efficient infection control protocols.

A video produced in the USA called “If saliva was red” caused quite a storm when it was first shown in the US. A little later it caused a similar storm here in the UK. They coloured a patient’s saliva with a red dye and then filmed a treatment session and showed all of the areas that were contaminated by the red dye after the session. It was quite an eye opener and made dental professionals and the trade aware of just how easy it was to transfer an infection from one person to another. Around this time it was also shown that contaminated saliva could be sucked back from the patients mouth into the dental handpiece and, as in those days, most dentists only used one handpiece for the entire day, that same contaminated saliva would then be sprayed back into the next patient’s mouth.

In the early 90’s a BBC Panorama program featured this infection risk and overnight handpiece sales (and autoclaves) went through the roof. Handpiece manufacturers, such as W & H, Kavo and Bien Air thought all their Christmases had all come together. It triggered even more design changes on dental units and handpieces.

As a result of these exposures equipment manufacturers started to use materials that could easily and regularly be wiped down with a disinfectant surface cleaner, all equipment had smooth easy clean contours, upholstery was seamless, where possible everything was foot operated instead of by hand, the principle being the less you touched the less the risk of cross infection. Barrier protective products appeared and the risk of spreading infection was greatly reduced. Equipment manufacturers changed their control systems from those that had a retraction system (which in the past had always been thought of as a feature) to non-retracting systems. Self contained water systems appeared on dental units on the (mistaken) understanding that this would reduce the risk of biofilm build up. Class A air gaps were built into the cuspidor flush system to prevent back syphonage and to eliminate the risk of contaminating the nation’s water supply. Strangely enough, both of these two features were actually demanded in a water bye law that dates back to 1945.

All of these infection control requirements, you could say were timely, except that the situation demanded them.

Still on the infection control theme, the NHS, particularly in Scotland, is pushing hard to remove decontamination equipment from the dental surgery and to re-locate it in a dedicated decontamination room, ideally equipped with washer or better still washer/disinfector and ‘B’ class autoclave. In many practices, because of room layout, this will be difficult to achieve, but at least it is a push in the right direction.

Sterility

The change in ‘sterilization’ over the past forty years has been slow to say the least. From ‘a wipe on the coat’ to the boiling water ‘sterilizers’ and on to the dry heat ‘sterilizer’ was a long slow transition. Cold ‘sterilization’ came along somewhere in between. As none of these methods can be validated you can’t really call them sterilizers. Although the steam sterilizer has been around since the 1800’s it is only in relatively recent years that it has become the norm. Speaking of Norms, the European Norm, or standard, for bench top steam sterilizers was only ratified, after fifteen long years of debating, in June 2004. This standard then became the British Standard late in 2005. When it takes fifteen years for something as important as this it makes you think. What we now know as a result of this standard is that there are 3 types of benchtop steam sterilizers, the type N, which is what 90% of UK dentists are using now, and is for the sterilization of solid, unwrapped or pouched instruments for immediate use, ie no storage or transportation; the type ’S’, and there are several different versions of this, which may or may not have vacuum, are for the sterilizing of specific loads – but not all loads, and the manufacturer must specify the acceptable load and the unacceptable load; the type ‘B’ is the sterilizer that performs to the same protocol as a ‘Big’ hospital sterilizer, some of which are big enough to walk in to. This type can sterilize any kind of load you care to put in it, provided of course it doesn’t melt first. Seriously, solid, hollow, wrapped, double wrapped and textiles, just as they would in a major hospital. This is the future.

Clinical Illumination

I suppose things that you notice most over a 40 year span are the more visual items of equipment, things that literally catch your eye – like dental lighting. The operating light has improved no end. In the sixties I came across an operating light that consisted of a tube hanging from the ceiling with a cocoa tin and a 40 watt bulb in it. That was the operating light. From the 4 point light of the 50’s and 60’s through the Ash Solarite of the 60’s and 70’s through to the modern lights producing light output of around 25,000 – 30,000 lux. Add to that the improved high output ambient lighting, such as the D-Tec lights, loupe lighting and modern glass optic dental handpiece lighting and the dentist can see into the oral cavity better now than he has every done before. X-Ray equipment has also come on in leaps and bounds over the last few years, thanks to digital imaging. There was a time when the only x-ray unit available on the UK market was the Philips Oralix. It was virtually a monopoly. Now there are more than you could imagine. All diagnostic x-ray films would be manually processed by dipping them in developer and fixer in a dedicated dark room – a slow process. When S.S. White introduced the first panoral machine the Panorex it was a big breakthrough in imaging. Now there are many different manufacturers of this type of imaging equipment – all with the advantage of instant digital images on a screen right in front of the patient. Then of course we have the intra oral camera, again with instant images so the patient can easily see before and after shots of the treatment.