Rise of the machines

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1923
If your dental unit looks like this, it is safe to say it is time for an upgrade.
If your dental unit looks like this, it is safe to say it is time for an upgrade.

In these straitened financial times, how often should you be updating your capital equipment? The answer isn’t as straightforward as you think, says A.M. Walsh

When the OPG machine at Dulwich Dental stopped working recently, the practice had to make a decision. Spend up to $80,000 to repair it, or simply buy a new one for a little more? Despite the cost, to not replace the machine was simply not an option given the service it provides.

This kind of decision is not as straightforward as it used to be. It seems that dentists are feeling the pre-recession pinch as much as anyone. According to the Australian Dental Industry Association (ADIA), equipment sales fell by 12 per cent in 2012. Apart from those who have opened entirely new practices, most dentists have all the tools they need to provide professional care, but with increased competition for patients, are there some things dentists can’t afford not to replace?

“Intraoral imaging is now simple and fast. Add to that the development of 3D imaging and what that technology can do for a practice.” – Sharmaine Crooks, Australian Imaging manager

One area where ADIA’s figures show a plateauing in sales is in imaging equipment, indicating that X-rays and CT scans are the kind of procedure dentists feel offer better diagnostic ability as well as value for money.

Sharmaine Crooks, manager of Australian Imaging, agrees that sales have been steady for her company. “Intraoral imaging is now simple and fast. Add to that the development of 3D imaging and what that technology can do for a practice. Even the most basic of practices can diagnose and treatment plan in one consultation, making the technology not only of clinical importance, but commercially also,” she says. “Showing the technology is a real selling point for the practice.”

“You need to keep up with current trends, and not work on outdated equipment. It’s a standard of care. Whatever we purchase has to have a benefit to the patient.” – Dr Peter Dayman, Dayman Dental 

Dr Fadi Dalati of Dulwich Dental in Sydney’s inner-west is already a convert to this approach. “When an X-ray is needed, a lot of patients are quite surprised that all they have to do is walk down the hallway to another room. It saves them time, and it saves us time too because we can give them a diagnosis sooner. It’s unfair to a patient to tell them to go away and have an X-ray then come back in a week. We can make a diagnostic decision pretty much immediately.”

State of the art gear makes for an efficient practice.
State of the art gear makes for an efficient practice.

Dr Peter Dayman of Dayman Dental in Sydney’s Potts Point also relies on an OPG machine for best practice, but that doesn’t mean not keeping an eye out for better technology. “You need to keep up with current trends, and not work on outdated equipment. It’s a standard of care. Whatever we purchase has to have a benefit to the patient. A lot of equipment is sold to you on the basis that it will make you a lot of money. What’s most important to us is whether it works and provides a service we don’t have.”

For both dental practices, a CT scanner is probably their next purchase, although neither is rushing into it. “A CT scanner can cost you anywhere up to $250k which is a large amount of money to outlay,” says Dr Dalati. “It might not be anywhere near as productive for the patient in getting an accurate record, and the time you actually spend with the machine getting the scan done, compared to something more conventional you can get with an OPG.”

Dayman Dental has the same cautious approach. “In terms of standard of care and what other people are talking about, I think the CT scanner is probably the next thing to have,” says Dr Dayman. “We’re pretty happy with our OPG machine but if we had to replace it, the CT would be the next purchase. Eventually the numbers stack up and it makes sense to do it.”

The cost of major equipment has to flow onto the patient, and this means a lot to a practice. “There’s an imaging centre 15 minutes from our practice and it doesn’t cost the patient anything because they’re able to bulk bill it,” says Dr Dalati. “Obviously if we purchase a CT scanner, we’ll have to charge the patients more.”

Dr Dayman agrees. “Purchasing expensive equipment that doesn’t directly benefit the patient can have the danger of over-servicing by a dentist, which is not something we want to do,” he explains.

A shorter life span also means more pressure on billing a patient. Crooks says: “Most imaging equipment will still work after 10 years but generally would have been superceded by a new product that is either easier to use, better quality, faster, cleaner or cheaper.”

In contrast to digital equipment, a dentist’s chair can have a long and very productive life, especially if it’s maintained well. Simon Taggart, marketing manager of A-dec Australia, cites his company’s attitude to retaining customers: “Our equipment is manufactured to accommodate future technology. This provides for integration or upgrading of existing technology into our dental units. For instance, our new LED light product is capable of being retrofitted to chairs we have manufactured dating back to 1993.”

Digital equipment will still work, but will become outdated.
Digital equipment will still work, but will become outdated.

At Dayman Dental, this regular maintenance has shown its benefits. “We’ve had our autoclave for 20 years, we’ve had one chair for 20 years. Usually you have to replace your chairs every 10 years because they just disintegrate,” says Dr Dayman.

This is not the case for all equipment, however. Sharmaine Crooks says she’s surprised at the low uptake rate by dentists on service contracts for major equipment, compared to other health professionals. “Perhaps it’s because dentists use their tools more than doctors and expect them to be replaced more often,” she says.

With more dentists set to graduate over the next few years, coupled with a tightening economy, investing in big-ticket items might be even more closely scrutinised. Positive word of mouth is essential in committing to a purchase.

“You might get told about a certain piece of equipment by your friends,” says Dr Dayman. “Anecdotal evidence is the first way you might get interested in a piece of equipment, then you’d do your own research.”

Compared to this time last year, patient numbers are definitely quieter, Dr Dalati says. While this won’t translate into not purchasing that new OPG, it certainly has an impact. “Dentists do have a bit of a habit of buying shiny new equipment but it’s a question of whether something that costs hundred-thousand dollars is actually going to provide better care,” he says. “That’s always going to be our prime concern.”

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