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Tech Tips #25: Multimeters

Multimeters

A number of items in the dental office are powered by electricity. Many of those things we’ve examined in past issues of Tech Tips (e.g. sterilizers) have a variety of circuits, switches etc. to control function.

Now we will introduce the use of multimeters to help troubleshoot electrical problems. We can’t cover every check of every piece of equipment, instead, we’ll just cover basic steps in meter use.

A multimeter is simply an electrical test meter that will perform several tasks, i.e. voltage tests, both AC and DC, resistance checks, and in some cases, current tests. Basically, there are two types of meters: the analog and the digital. The analog meter has a needle to show readings. Digital meters obviously have a digital readout, are fairly easy to use, and are usually more durable than analog. Some features available are fuse protection, auto-ranging, audible signals and auto off. Ask a knowledgeable friend, or store personnel for help in finding just what you want. As you can see, we are biased toward digital meters and will only cover their use.

Continuity checks: we use the meter to check bulbs, fuses, switches and some circuit components by checking for lack of interruption in the component or circuit. To do this we will use the ohms scale. The ohms scale is usually identified by the “Ω” symbol.

So, get a meter and let’s get started. Usually the meter leads will plug in at the bottom of the front of the meter. Instructions normally accompany your meter showing you where each lead goes. Look for one hole with something like V-Ω. This is where you would insert the red lead whenever you are reading volts, whether AC or DC, or ohms. The other lead should be plugged in to the Common hole.

Now you need to turn the dial on the meter to the appropriate scale, in this case the scale marked with the “Ω” symbol.

Note: If your meter has the auto ranging feature, your meter is set up when you turn the dial to the desired function. If you do not have this feature, more instruction is needed: Generally, your meter scale in the ohms section will have divisions starting with “2”, i.e.200, 2K, 20K and so on. The 200K scale, for instance, would allow you to read up to 200,000 ohms. For most uses, you will need to use only the 200-ohm scale. Notice other divisions for ACV (AC volts), DCV (DC volts), ACA and DCA (amps). Most of us will never need the amps scales, but only the volts and ohms scales.

Checking Fuses, Bulbs, etc.

After setting up your meter to the proper scale (ohms), touch the leads together. The readout should read “000”. Separate the leads and “OL” should appear. Touch the leads to each end of a fuse (to accurately check a fuse, it must be removed from the circuit) if the fuse is good, the reading will be “000”. If your meter has an audible alert, it will sound. If the fuse is defective, the reading will show “open” or “OL”. On a bulb, touch the leads to the tip on the end of the base and to the metal on the side of the base. You can use this simple method to check for an open wire, or power cord or to check a switch, (on-zero, off-open).

How about an experiment to see how we are doing? Let’s check your car battery. It will be DC voltage, so set up the meter for DC. Make sure the red lead is in the VΩ hole, the black lead is in the common. Apply one lead to each post of your car battery, meter set on DCV at the 20-Volt scale. You should read about 14 volts.

AC Voltage

Now you must be careful here. Be certain that your lead only touches one thing, that it is not across another wire, or touching the chassis. To set up the meter for voltage, put the leads as you did for ohms. Turn the dial to VAC (if you are reading common household current, put the dial on 200 VAC). If you are using a meter with auto ranging, you will not need to signify a range. With one lead of the meter on a good ground (look for a ground wire affixed to the component housing, or find a spot on the housing that is bare of paint or debris), then touch the other lead to where voltage should be present. You should read approximately 115VAC. If not, go back in your checking, eventually to the power source and try to find where you lost the power.

You can check a receptacle in you office: AC volts, 200-volt scale, put one lead into the right slot, the other to the left. Is voltage present? If the ground hole (the round one) is on the bottom, the right slotted hole should be “hot”. Check your ground circuit by going from ground to the hot side (you might have to move the lead in the ground hole to an angle to make contact), if you cannot get a reading here, your ground circuit may be faulty.

Electrical Shock– Some Tips on How to Avoid It

Electricity always seeks the shortest path to ground. The human body is a very good conductor, so you must avoid becoming a part of that path.

110VAC can kill. All arguments aside, more people are killed by 110 volts than any other rated current.

Never assume. Do not assume that a breaker is off, a wire is not hot, and an item is unplugged. Check it out!

Wire is a conductor of electricity. Any metal is a conductor, water and wet objects, green tree limbs will conduct, wet ground, graphite fishing rods and golf clubs will conduct, so do not come into contact with any conductor that might be in contact with electricity.

Be safe – unplug an item or turn breaker off before checking for electrical problems.

Electronics schools teach technicians to keep one hand in their pockets while troubleshooting, and only one person at a time do the work.
When changing a fuse, remove power, change the fuse then restore power.

Just turning a switch off does not remove power. You can still get shocked with the switch off.

Do not stand in water or place yourself in contact with water pipes or other metal objects when working with electricity.

Do not remove the ground lug from an electrical plug.

Whether a piece of equipment is giving trouble or not, always take care to note frayed wires, loose wires, or dried and cracked wires. Watch for burned spots on wires and components, loose or burned outlets, etc.- keep your eyes open.

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Tech Tips #24: Amalgam Separators

The Right Amalgam Separator for You

Dental amalgam has frequently been in the news and the FDA is planning on meeting in December of 2010 to further discuss the classification of amalgam.

While amalgam is a cost-effective restorative material, when introduced into the waste stream, amalgam can be broken down into its constituent components (most often through incineration during the waste treatment process). This can release into the environment the mercury that comprises roughly 50% of amalgam. Regardless of ones feelings on this charged issue, further legislation seems likely.

Many areas require installation of amalgam separators on dental office waste lines. The American Dental Association lists an ISO11143 certified amalgam separator as part of their BMP’s: http://www.ada.org/sections/professionalResources/pdfs/topics_amalgamwaste_brochure.pdf

What is ISO 11143? ISO is the International Organization for Standardization, 11143 is the number assigned to the standard developed by representatives of member countries (including the United States) to determine the requirements for dental amalgam separators and the means to verify (test) the efficiency thereof. A committee comprised of numerous industry experts including manufacturers and dentists spent several years to create the most recent revision of the standard. ISO 11143 requires amalgam separators to remove at least 95% of all amalgam from the waste stream. Many local regulations exceed this requirement asking for 99% removal. While amalgam separators have been in use for a long time (primarily in Europe), the most recent revision of standard 11143 was approved in 2008 so it accurately reflects current concerns and technologies.

When looking for an amalgam separator, the first thing to verify is ISO 11143 certification and at what efficiency. As it is specified in many regional regulations, most separators on the market are certified at or above 99% efficiency (such as all models carried by American Dental Accessories, Inc.) Nonetheless, be certain to verify your local requirements and get certification from the dealer for whatever separator you purchase to verify it meets or exceeds your local requirements. Certification will often need to be made available for local regulators – be it sent in or simply available for any inspectors that may happen to visit (this will vary according to local regulations). Many areas have lists of approved separators, but these are often infrequently updated so while inclusion of a separator on this list is helpful, exclusion is not necessarily conclusive.

Additionally, check your local regulations for any special stipulations covering installation. Do you have a cuspidor? Most areas where cuspidors are frequently used have them specified in the regulations and require the cuspidor also drain into a separator. This would normally require either purchasing a separator that can operate under a gravity feed (such as the AD-1500) or using a vacuum drain kit to connect your cuspidor to the central vacuum.

Next consider capacity. How many operators will the unit serve? Are you a solo practitioner? Do you have an associate? Group practice? How many operatories? Make certain that the system you get has the capacity you need. Most systems are rated for a certain number of operatories and have a longevity based on the total number of users.

Installation Location

Most systems will install in one of two locations, either chairside or at the central vacuum. Chairside systems are generally smaller and will only serve one chair (as the name implies). Often the cost of two or even three chairside systems can be less than one central system. Systems installed at the central vacuum are designed to serve the entire office. Make sure if you get a central system that it is rated for as many operatories as you have. Most separators try to be as compact as possible, but check the dimensions of what you’re getting and compare that to where it will be installed. Make sure you have enough room to install it.

What about cost?

Once you’ve determined what system(s) meet your local regulations and have the capacity you require, you can start to compare costs. When looking at cost, the initial purchase price is only one part of the equation. You should also compare recurring costs, replacement separator cartridges, disposal, and any other maintenance costs. The ADA recommends amortizing costs on an annual basis to determine ongoing maintenance costs.

For example, if one system sells for $700 and has a replacement cartridge that sells for $500 and is expected to last 6 months, you’ve got a projected cost of $1700 for the first year and $1000/year thereafter. If another system sells for $800 with a cartridge that sells for $600 but the cartridge is rated for 18 months, you’ve got a cost of $1400 for the first year and $400/year every year thereafter.

Additionally, some systems include disposal of filled cartridges in the replacement cartridge cost. Be sure to take this into consideration as well.

If you have a waste hauler that already disposes of amalgam scrap (chairside traps etc.) who can cheaply or easily add any filled separator cartridges to the pick-up it may be better to use a system that doesn’t have extra charges added in for disposal. However, if seperate disposal is something that you can’t easily arrange or which will be more costly, having disposal taken care of with the replacement cartridge may be more cost effective for you.

In addition to the purchase price, you may need to factor in installation costs. For units installed at the central vacuum, you will often need to hire a plumber or dental technician to perform the installation for you. An interruption of the (typically) PVC vacuum lines will need to be made, additional lines may need to be routed, the separator may even need to tie into your existing ventilation. Some central systems also use electricity, so additional accommodation may need to be made to provide power to the system. This may also require the services of an electrician. Naturally, central systems will serve the entire office.

If using chairside systems, you will need to install one in each room, so add the costs of the total number of units to determine if this is truly more economical than a central system. Typically, the break-even point is 3 rooms. Chairside units (such as the Asdex AS-9) are normally much simpler to install as they will typically install on the flexible vacuum drain hose from the chairside trap. These systems can often be installed in just a few minutes by untrained staff using little more than a scissors and a screwdriver.

AS-9 installation instructions

As more regulations come into existence, it becomes more important to increase your knowledge of the available options.

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VIDEO EXCLUSIVE – Turbine Repair

We have had several calls from Dentists who are looking for ways to save money in their practice and of particular interest to them has been the ProPress250 Turbine Repair Press (part #25-010) and how it works.

We are proud to present a video demonstration of our turbine repair press.

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1 in 4 Children in CA Have Never Seen a Dentist

In the July issue of Health Affairs, UCLA researchers have published a report indicating that 25% of children 11 and under have never been to a dentist.

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Tech Tips #23: Getting to Know Your Utility Center

Getting to Know Your Utility Center

Your utility center or junction box assembly (j-box) houses the valves and regulators that distribute your air and water sources to your delivery unit.  The j-box may also house  the drains for cuspidor and/or central vacuum system as well as a duplex electrical supply to power your fiber optic systems (or other systems that require electricity).  In other words, the contents of your j-box are probably some of the most important in your operatory.  Let us look in the “box”.

What are the major components in the j-box?

  • Manual Shut-Off Valves: Normally, the manual shut-off valves attach via a 1/2” FPT (female pipe thread) to the pipes that carry the air and water supply from their sources to your operatory.  These shut-off valves look similar to the valves you would find under a sink.  Their purpose is to allow you to shut off the flow of the air and water for servicing and to provide a standard connection to the pipes.
  • Manual shut-off valve (#49-90)

  • Master On/Off Valves: You will find one master on/off valve (master block) on each of the air and the water main lines.  The master on/offs allow the air and water to flow when the delivery unit is on and stops the flow when the unit is off.  A “relieving” or exhausting master toggle (normally in the delivery unit head) activates these valves with an air signal (see our issue on toggles). The master valves are normally connected directly to the manual shut-off valves with a 3/8” brass compression fitting.  If a self-contained water system (bottle) is used as the only source of water to the unit, you may not have a master valve on the waterline (or even have a water line plumbed into the operatory).  In such circumstances, it is normal to have only one master valve – on the airline.
  • Regulators and Gauges: The regulators precisely control the pressure of the air and water supply going to the delivery unit.  There will be one regulator for air and one for water.  These regulators will have a pressure adjustment should you need to adjust the air or water pressure.  Normally this adjustment valve is screwed in (clockwise) to increase the pressure and out (counter-clockwise) to decrease the pressure.  Whenever adjusting the pressure, make certain to have an “active flow”- most easily accomplished by holding down the air or water button on your syringe while adjusting the corresponding regulator. The gauges display the pressure of air or water in pounds per square inch (PSI) being sent to the unit.  For most units, proper supply pressure is 80 PSI for air – 40 PSI for water.
  • Filters: The filters are usually incorporated into your master valves but can be incorporated into the regulators or exist as separate inline entities.  The main line filters are some of the most important items in the junction box but also the most commonly overlooked.  Generally, the filters will be in round housings.  The filters stop “particulates” from entering your unit.

Master valve with regulator built in (#05-54)

This is a common master valve with the regulator built in (our #05-54). As indicated, the filter is under the round housing at the end (this is also where this valve attaches to the manual shut-off). The knurled housing simply unscrews to expose the filter element.

Master valve with clear filter (#05-558)

This is another common master valve. The cylindrical housing shown on top in the photo contains the filter. This housing may be clear, white, chrome, or other colors as well. The filter is accessed by unscrewing the brass knob on top and then lifting the housing off. This is the type often used in A-dec junction boxes. The brass fitting to the right in the photo is for attaching this valve to a manual shut-off.

There are many other configurations possible, but your master on/off valves will normally be connected directly to the manual shut-offs, the regulators will have a gauge associated with them, and the filters will be within a round housing which may be incorporated into another valve.

Take a minute to find the filters in your junction boxes. They should be checked at least quarterly to be sure your units stay clean and working well. Replacing the filters annually will assure they work well.

NOTE: Always make certain to shut off the air and water at the manual shut-offs before checking your filters. You will also want to exhaust the line pressure by depressing & holding both buttons of your air/water syringe until all flow stops.

Why are these valves and regulators important?

Today’s dental units require a regulated source of air and water to run correctly.  You may experience problems if your air and water are not set at the correct operating pressures. Premature turbine failure, erratic handpiece performance, leaking of air or water, and other problems can all result from unregulated or improperly regulated air and water. The master valves shut off the flow of air and water to the unit when not in use to minimize wear and tear and reduce the risk of damage should a unit leak after hours. The master valves also provide the necessary fittings to connect to your main air and water lines and will have multiple outlets to direct the air and water to the various valves within your unit.

Do I have to service these valves?

These valves should last a long time before they need replacing.  However, the filters that are usually incorporated into them will need regular service.  If you notice a drop off in air or water pressure to your unit, it is possible the filters have become clogged and are restricting flow to your unit.  Simply replace the element.

To test this, grab your air/water syringe.  Press the air button while looking at the gauges in your junction box (not on your unit).  If the air pressure drops off by 15 pounds, you should replace the air filter.  Do the same thing for the water.  Press the water button while looking at the gauge in the junction box.  If water pressure drops off by 10 pounds, replace the water filter.

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Amalgam Seperators, the FDA, and Your Practice

Here are the facts:

  • On December 14th, the FDA will again revisit the scientific issues surrounding dental amalgam.  Many States have established their own regulations, but the government may rule as Canada did, establishing mandatory amalgam seperator installation, sooner rather than later.
  • Dental amalgam has already been banned in Norway, Sweden, and Denmark, traditionally countries that have been ahead of the curve in terms of protecting the environment (it’s still unclear how amalgam restorations impact the host but many European countries restrict use in pregnant women and young children.  Still, the dentist might be at the most direct risk as a result of amalgam dust).
  • When amalgam escapes into wastewater, the EPA estimates that treatment facilities capture about 90%, but the amalgam is then disposed in landfills, through incineration, or in agriculture.  Through those processes, the mercury  contaminates land, vegetation, air, and bodies of water.
  • The Mercury Policy Project (MPP) has identified dentists as the largest polluter of mercury into wastewater.  Moreover, dental amalgams contribute one-third of the mercury waste.
  • High exposure to mercury has been linked to cardiovascular disease, autoimmune effects, diminished intelligence, reduced memory function, mental retardation (to exposed fetuses), and so on; we probably don’t understand the real impact of low exposure to mercury (still, there are very direct links to the aforementioned ailments in industrial waste dumping areas).

What can you do?  While the ADA and EPA have debated this issue for many years, it’s becoming increasingly clear that amalgam seperators are a best practice if the use of amalgam is necessary in a restoration.  To prepare our customers who haven’t already installed an amalgam seperator, we will be adding a blog entry outlining the installation process.  Finally, there is a pdf file on our tech support page that will explain the differences of some popular models, including the SolmeteX Hg5, Asdex models, and AD-1500.  We hope to continue offering valuable advice in this crucial facet of dentistry.  As always, please call us with any dental equipment installation questions: 1-800-331-7993.

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Studies Show bib clips as potential source of contamination

There have been several reports lately concerning contamination of bib clips in the dental office. A recent study at the University of North Carolina at Chapel Hill showed contamination in as many as 20% of bib clips tested. Additionally, the study cited the following:
“Of concern was the presence of bacterial species normally present only in the oral cavity on 14 of the 50 bib chains sampled
- Of significant concern were overt pathogens Staphylococcus aureus, and the enteric bacteria, Escherichia coli.”

There have also been recent articles in The Dental Advisor and Dental Economics discussing this issue.

Fortunately, American Dental Accessories, Inc. offers autoclavable bib clips for as low as $3.45 each (in quantities 6+). .

Eliminate fears of this potential source of cross-contamination.

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Tech Tips #22: Highspeed Handpiece Design

Highspeed Handpiece Design

You use your handpiece every day. It’s one of the most important pieces of equipment in the dental office, but how does it work?

As you probably know, a typical highspeed handpiece uses air to rotate a cutting bur at about 350,000 rpm’s. These instruments are among the fastest spinning turbines in the world.

Midwest, Star, KaVo, NSK and Lares own about 90% of the US handpiece market although there are over 50 different makes and models available from various manufacturers throughout the World. Nonetheless, all of these manufacturers use the same basic design.

Various Makes of Turbine

Various Makes of Turbine

The typical handpiece is connected to an air hose. As you press on the foot control, air enters the handpiece through the back. The air moves up the body of the handpiece within a small tube. The air then enters the head of the handpiece where the turbine is housed. It is the turbine that performs all the work of the handpiece. The handpiece itself is just a handle to provide a means of controlling the turbine (as well as serving as a conduit for air to drive the turbine and air and water to cool the surface being cut). In fact, in manufacturer circles, a handpiece without a turbine is called a “shell”- as it’s really just a hollow case. The heart and soul of the handpiece is the turbine. The standard components of a turbine are shown in the following diagram:

Typical Turbine Components

Typical Turbine Components

At the center of the turbine is the spindle (#1 in the diagram above), this is the shaft that spins. Inside the spindle is the chuck (#2 in the diagram above), this is a hollow tube that holds the bur, which of course does the cutting. As you can see in the diagram, the chuck has little slits at the end. These slits allow the chuck to compress as it moves forward inside the spindle to grip the bur. On standard chuck handpieces (like that shown above) the chuck is threaded (as is the inside of the spindle) and a bur wrench is used to rotate the chuck screwing it farther into the spindle and compressing the end. For autochuck handpieces (e.g. push button) the chuck is not threaded, but rather spring loaded and includes a mechanism that allows manipulation of the chuck forward or back to open and close the end to grip (or release) the bur.

Placed on the middle (from front to back) of the spindle (it’s actually pressed in place) is the impeller (#4) this is what catches the air causing the turbine to spin.

As you can see the spindle and impeller are fairly simple solid pieces of metal (usually stainless steel or aluminum) and thus, rarely fail. Chucks will occasionally fail as they can fracture where the slits are, but this is still relatively uncommon.

On either side of the impeller are bearings (#’s 3 & 5 above). But aren’t those solid cylinders in the diagram? Bearings are little metal balls, aren’t they? Well, yes and no. Technically, what we have are bearing assemblies; these are what allow the turbine to spin (by reducing friction). The following diagram is a cross-section of a typical bearing assembly:

Bearing Cross-section

As you can see, the bearing assembly, or “bearing” as referred to in the handpiece world, consists of several components (including the balls you expect). At the heart of the assembly are the actual ball bearings. These are generally stainless steel, although ceramic bearings are being widely used as well. The bearings ride around an inner ring (as it’s labeled in the diagram) called the inner race. There is a slight groove (raceway) on the outside of this ring that the ball bearings roll in. The inner race is generally the strongest part of the bearing assembly as it is what is pressed onto the spindle.

There is then a cage that holds the balls at equidistant intervals around the inner race. This keeps the turbine balanced. Think of an old washing machine with the clothes all on one side. The “clunk clunk” of the washer is caused by the erratic rotation due to improper weight distribution. The cage keeps the turbine spinning smoothly as it maintains an evenly distributed load (more on load later).

Bearing cages can be made of a variety of materials, generally, they are a polymer (i.e. plastic) and are usually the most fragile component of the entire turbine. The plastics used are very resistant to heat and have very low-friction as they directly contact the actual bearings.

Outside of the cage is the outer race. Just as with the inner race, there is a groove in which the bearings ride. The outer race rests on (the two o’rings #8’s in the turbine diagram) which in turn rest against the inside of the handpiece head.

The entire bearing assembly is then closed off with a shield (as shown in the diagram). The shield is designed to keep debris from entering the cage and getting onto the bearings. Naturally, if debris gets onto the bearings it can throw the entire turbine out of balance, putting stress on the cage which then fails allowing the bearings to “clump” and causing the turbine to spin erratically (and eventually stop spinning completely).

All of these components are extremely small and thin. Whenever replacing a turbine, make certain you have removed all of these components of you old turbine from the handpiece. It’s very common for an o’ring, outer race, or shield to adhere to the inside of the handpiece head (or end cap). Note also, that all of these components are simply pressed together using a bearing press and held together with friction. This is why a press is required if you wish to repair your own handpieces, saving you money.

There are two more components to the turbine above, first of these is #9 a wave (thrust) washer– sometimes called a loading spring. The Quiet Air turbine diagram shown above is one of the only standard chuck turbines to use a washer. Washers are normally only used on autochuck handpieces to provide lateral tension, keeping the turbine pressed against the end cap to facilitate actuating the chuck. If you have trouble after installing a turbine that uses a washer, sometimes you can remove the washer and have the turbine function well. It is not uncommon (particularly with age) to get a slight build up within the handpiece head or to have the push button or other mechanism that actuates the chuck start to vary some from the original specs so the washer can impede proper function. The washer above is bent to provide additional tension, sometimes the washers used are flat and simply serve as spacers.

#7 in the diagram is the end cap. Technically, this is not part of the turbine. The end cap simply threads onto the back of the handpiece head to hold the turbine in. The end cap will also include the button (or lever) that is used to activate the chuck on autochuck turbines. The back bearing will usually seat into the end cap of the turbine. To simplify installation, some manufacturers include end caps with their turbines, providing them already seated on the rear bearing of the turbine. Whether or not an end cap is included with a turbine will not have any effect on the function of the turbine itself. It’s a matter of convenience and it can impact the price, of course. As mentioned previously it is extremely common for components of worn turbines or bearings to get stuck in the end cap, so always inspect the end cap thoroughly when replacing a turbine. Also, many end caps (like the Quiet Air shown) have a groove into which one of the o’rings will seat. Always replace this o’ring when installing a new turbine. You will probably need to use a scaler of explorer to remove the old o’ring.

As you can see, turbines are fairly complex assemblies, particularly the bearings.

Now that we know how a turbine is made – what does this mean to you?

With the insight we have into design, now we can look at what causes failure.

As already discussed, generally it is the bearings (specifically the bearing cage) that will fail first in a typical turbine. What causes bearing failures are as follows (in order of frequency/likelihood):

  1. Build up of debris
  2. Excessive air pressure
  3. Excessive temperatures during sterilization
  4. Side load stress (we mentioned load above)
  5. Use of bent burs or a bur that isn’t fully seated

“Load” as the name implies, is weight or pressure. “Side load” is pressure applied to the inside of the bearing assembly in a perpendicular direction. Side load is usually the result of cutting with the side of the bur. “But I cut with the side of the bur all the time- can’t you do a crown prep?” Now we get into a more subjective area.

Naturally, cutting with the side of a bur is an everyday occurrence and should not damage your turbine or bearings. The key is that you allow the bur to cut. If you find yourself leaning into the bur, putting a lot of pressure on the side of the bur (say 5-10 pounds or so) this is creating side load. If you press on the end of the bur, the opposite end (which is in your turbine) will be pressed in the opposite direction (like a lever). This pushes on the inner race of the bearing compressing one side of the bearing assembly creating localized increased friction, which leads to imbalanced rotation which stresses the cage ultimately causing fracture and failure. Remember your Newtonian physics: for every action there is an equal and opposite reaction- the more you press on your bur, the more you press on your bearings.

Ideally, you need to allow the bur to cut and simply follow the bur as it does so. Do not press on the bur at all. The reality is that some pressure is required, but try to keep it fairly light to avoid stressing your bearings. Of course, worn or dull burs won’t cut as well, so they are more prone to induce side load. When side-cutting, always try to use a sharp and fresh bur or diamond.

The good news is that excessive side load will not necessarily lead to immediate bearing failure. Occasional pressure is expected and should not have a dramatic effect on turbine life. However, constant or frequent pressure certainly will. For some, saving a minute on a crown prep is worth the cost of more frequent turbine replacements, this is something you need to decide for yourself.

Generally, side load will have a greater impact on the rear bearing than the front bearing. If you replace your own turbines and notice that it’s usually the rear bearing that falls out in pieces (while the front bearing appears ok), you might consider trying a lighter touch when cutting with the side of your bur.

Using a bur that is bent or that is not fully seated into the turbine can also cause excessive side load. Naturally, a bent bur will not maintain concentricity and will wobble, stressing the bearings.

Using a bur that isn’t fully seated can cause side load as the weight at the front of the turbine is less than that at the back. This will not have as much of an impact on balance, but can still stress the front bearing (as it is normally doing most of the “work”). On standard chuck handpieces, this can also cause the chuck to fracture.

Excessive temperature should be self-explanatory. All dental handpieces are now made to be heat sterilized in accordance with the CDC. They should be sterilized in a steam or chemical vapor sterilizer at a maximum of 275° F (135° C). Dry heat sterilizers operate at much higher temperatures and should never be used on handpieces. You should check your sterilizer regularly for overheating with a lag thermometer. Generally, if your sterilizer is overheating, you will probably have damage to other items in the office, but it is not unusual to notice it in your handpieces first.

Most manufacturers recommend running their handpieces at about 35 psi (for highspeeds). Generally, anything in excess of 40 psi will cause damage to the bearings. Always check with the manufacturer for their recommendations, of course and try to stay within 5 psi. Some practitioners like to use air pressure over 40 PSI to achieve better cutting power. Remember, these bearings are very, very small and their components (especially the cage) are fragile. While the cage may not fail right away, you will experience premature failures, shortening the excepted life of the cartridge if you use higher air pressure than recommended. As with side loads, everyone must decide the value of increased speed vs. shortened turbine life for their method of practicing. While higher pressure will normally result in higher rpm’s, it will also usually result in shorter bearing (turbine) life.

Last of all, debris buildup inside of the bearings can cause premature failures. Debris will accumulate on the bearings causing the turbine to become imbalanced, stressing the cage and other bearing components leading to failure. The shield helps protect the bearings but debris can still accumulate on the outside of the turbine and imbalance it as well. Regular and proper maintenance is crucial to handpiece performance and longevity. See our issue of Tech Tips devoted to maintenance for more information.

Turbines are assembled under very tight tolerances all of which are to assure concentricity is maintained. All of the causes of failure will negatively impact concentricity in one way or another. Once again, the bearing components are very small and actually fairly delicate, particularly when you consider the speed of 350,000 rpm (or more). It doesn’t take much stress before they can be damaged.

A few other tips:

Never run cold water over handpieces to achieve rapid cool downs after sterilization. Rapid cool downs could cause warping of handpiece components and you could also introduce contaminants onto your sterilized instruments.

You should never run your handpieces without burs. Doing so could cause damage to the spindle/chuck assemblies. This is more important with standard chuck turbines.

For autochuck handpieces (push button or lever) lubricate the chuck at least once a week to keep it clean and functioning well. Debris can clog the chuck and interfere with holding the bur.

A Quick Note on Electric Handpieces:

Most electric handpieces use similar designs to slow speed attachments. That is, there is a drive shaft which meshes directly with a gear in the turbine assembly, rather than an impeller that catches air. They still have bearings and, as discussed above, bearings are what typically fail. The same precautions apply to electric handpieces as pneumatic handpieces when operating (other than air pressure, of course). Beware of side loads, keep them clean, don’t use bent burs etc.

With electric handpieces, it’s even more important to avoid damaging your bearings as the electric motor will continue to yield the same rpm’s and torque at the bur even if your bearings have failed. To maintain this performance, however, an electric handpiece will need to work harder and can overheat. See the FDA’s article on “Patient Burns from Electric Dental Handpieces” for more detail.  Be sure to handle your electric handpiece with care too.

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Increasing Dental Practice Profit Through Sales or Cost Cutting?

In 2009 alone, Americans spent $10.5 billion on cosmetic solutions, so it’s no wonder why dental offices have moved to tap into this market.  Nonetheless, There is a blurry line between offering cosmetic solutions and routine check-ups. The Washington Post reports that many patients are not responding well to smile makeover pressure during visits, and for good reason.  With only about 40% of the US population having dental insurance and 15% under/unemployment, many patients are reluctant to spend $5,000 on treatments like Invisilign.  Recall the feeling that you may get when dental reps employ aggressive tactics to sell CEREC machines or other dental equipment that may or may not improve your overall practice.  Pressure can alienate, and while many dentists seek dental equipment from less pushy dental sales reps, the same can happen with your patients.  So what can be done?

Given the subjective nature of cosmetic treatments, it’s best just to educate and leave the decision up to the patient.  Make sure every employee in the office is aware of your no-pressure policy, since in a lot of cases the alienation may not come from the dentist.  If the practice is under pressure to increase the bottom-line, the best way to accomplish this is by the following:

1) Market the practice - the most inexpensive and effective way to advertise is online through Search Engine Optimization (focusing on keywords like, “Dentist in insert-your-city-here” )or third-party patient/customer resources (e.g, encourage satisfied patients to write reviews on sites like Yelp).

2) Empower yourself – Instead of being at the mercy of large dental supply companies, learn simple maintenance and repairs that can extend the lives of your dental equipment, like handpieces, chairs and units.  On-site dental support can cost $100-$150 per hour, so cut down on unnecessary service calls.  Remember American Dental Accessories offers complimentary technical support at 800-331-7993.

3) Rethink Dental Supply Purchases – While it’s important to have a relationship with a dental supply company that you trust, that doesn’t mean you need a rep that frequently comes into your office.  Shop around and try the best dental supply company that works for your practice (you may find that several fit the way that you operate).  For example, American Dental Accessories has recently started selling bulk toothbrushes that rival leading brands at over 40% below other dental supply companies–this alone can save a practice $1,000’s a year.  Moreover, stay dynamic with dental equipment and supply purchases–after all, there might be a better option out there for your practice.

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Link found between treating gum disease and diabetes

The BBC reports that dentists might be able to play an integral role in helping to control blood sugar levels by treating gum disease.  Edinburgh University scientists believe that the bacteria in the mouth, which increases inflammation, may inhibit insulin effectiveness, thereby increasing blood sugar levels.

Since over 24mm people (and growing) in the US have diabetes, this is a good fact to know since gum disease is a relatively easy condition to treat.  Further evidence to support the body’s overall health in relation to oral hygiene.

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