Tag Archives: dental equipment maintenance

  • Practice Tips #77: Getting Comfortable With Nitrous

    Nitrous Oxide (N2O) can be a valuable addition to the dental office analgesia armamentarium. Having a patient that is relaxed can lead to more successful outcomes.

    N2O is delivered to the patient via a nosepiece or “hood.” Various equipment manufacturers have their own designs of hoods that are designed to be used either with or without a “scavenger system” (#71-30 or #71-301).

    Scavenging Circuit

    A scavenger system is designed to evacuate exhaled gases to minimize contamination of the ambient air within the operatory. The scavenger is connected to your vacuum system (via the HVE) to pull the gas away and vent it to the outside atmosphere (along with your main central vacuum vent).

    To prevent the vacuum from pulling all of the gas before the patient can aspirate (and receive the benefits), all scavenging systems have a vacuum valve and gauge incorporated into the system. This valve controls the level of vacuum so the excess gas can be safely evacuated while the patient still receives an appropriate dose of N2O.

    The gauge pictured below is typical of such devices. It has inlet and outlet connectors for the vacuum line, a control valve to adjust the flow, and a gauge to indicate the current flow setting. Note the green “safe” area indicated on the face of the gauge. Most systems incorporate clear labeling like this to make it easy to set the gauge correctly.

    71-28

    As the scavenger connects to a HVE valve, there is typically a 7/16” o.d. fitting at the end of the scavenger circuit. All HVE’s sold in the US are designed to take a standard 7/16” tip. This is also the size of the various aspirator tips on the market. These are standardized sizes.

    The hood, however, will vary considerably from manufacturer to manufacturer. Most hoods will have two “inlet” connections for gas to flow to the patient’s nose from the flowmeter. If using a scavenger, there will also be one or more “outlet” hoses pulling the excess (and exhaled) gas away from the patient (and operatory). As an additional means of limiting flow (in addition to the vacuum valve and gauge already discussed) these “outlet” hoses are typically smaller in diameter than the “inlet” hoses. As these hoses fit over connectors, they are measured by inside diameter (i.d.). Whenever you need to replace one of these hoses, always measure the inside diameter to be sure of the proper size. Unlike HVE tips, there can be some variance here so it’s important to know what you have.

    The Accutron scavenger circuit and hood has four connections. This system is also used on Belmed nitrous units. It uses two inlet hoses of 3/8” i.d. (these hoses connect to the side of the hood) and two outlet hoses of ¼” i.d. (these hoses connect to the scavenger “hub” that snaps onto the front of the hood).

    Practice-Tip-77_hood-hoses

    The use of nitrous oxide in your practice can be an important tool in offering your patients a relaxing experience, enhancing recall rates, and resulting in more successful procedures. The scavenging circuit plays an important role in your anesthetic system, allowing you to safely deliver a controlled flow of nitrous oxide and oxygen to your patient, while keeping staff protected.

    Nitrous systems aren't a necessary component of your dental practice, but they can be beneficial. The use of nitrous oxide in your practice can be an important tool in offering your patients a relaxing experience. A relaxed patient will result in more successful procedures enhancing recall rates. The scavenging circuit plays a crucial role in the use of nitrous oxide, allowing you to safely deliver a controlled flow of nitrous oxide and oxygen to your patient while keeping staff protected.

  • Practice Tips #70: Get Your Bearings

    The turbine is the heart of the high-speed handpiece and bearings are the heart of the turbine.

    Bearings are the most common failure point of a turbine and are often the primary differentiator between one turbine and another.

    Way back in  Practice Tips #22, “High-speed Handpiece Design,” we covered all of the components that make up a complete bearing assembly. For ease of reference, we’ve included the diagram of a bearing assembly below. For further explanation of the components, check out Practice Tips #22.

    Today, we’re going to look at some of the different bearing materials and designs on the market.

    Many turbines use stainless steel bearings that require lubrication. The balls, inner ring, outer ring, and shield are all made of stainless steel. The ball cage will be made of a polymer (there are a few more variations within this broad category and different types of polymers for the cage, but all these permutations require lubrication).

    Stainless steel bearings have been in use for decades and are a proven design with good performance and good reliability. They are manufactured in large quantities for dental turbines and many other industries so cost is comparatively low. As these turbines incorporate metal bearings in metal housings, they require lubrication. Most handpiece lubricants on the market are designed to withstand the rigors of sterilization, but these turbines should still be lubricated every time they are used (see our handpiece maintenance products here). Lubrication after using and before sterilization is generally adequate, but consult the manufacturer of your turbine and lubricant to determine if post sterilization lubrication is required as well.

    Many turbines currently on the market are advertised as “lube free.” There are 2 primary methods of manufacturing lube free bearings:

    • Using a lube free material (i.e. ceramic)
    • Pre-greasing the bearings and sealing them to “lock” the grease in (sometimes referred to as Life Time Lube or LTL)

    LTL bearings are still the same basic stainless steel design so they share many of the features of standard stainless bearings. The greasing and sealing process adds to the cost (and they aren’t manufactured in quantities like the standard bearings), so they will add to the cost of the turbine or handpiece that uses them. The sealing process, also, prevents debris from getting into the center of the bearing assembly and on the actual steel balls, so maintenance is a little easier. Nonetheless, these bearings (or, more accurately, turbines that incorporate these bearings) still need to be cleaned after every use and before sterilization.

    Last of all, there are ceramic bearings. Ceramic bearings are actually made of a ceramic silicon nitride, so they have a very smooth low-friction surface. The low-friction surface removes the need for lubrication and also minimized heat build-up during use. They, also, withstand high temperatures very well, so they withstand repeated sterilization better than stainless steel bearings.

    Both LTL and ceramic bearings will run at higher rpm than stainless bearings and are better able to handle higher air pressure (they typically require in excess of 40 psi drive air pressure). The higher rpm can help these turbines cut faster so some practitioners feel they perform better (naturally, this is subjective).

    In summary, the materials and techniques used to manufacture lube free bearings are more costly than standard stainless bearings, so these bearings (or the turbines that incorporate them) often cost twice as much as turbines that need to be lubricated. It’s up to the practitioner if the advantages are worth the expense.

  • Practice Tips #69: Delivery System Installation

    Before we get started, we want to reiterate our number one objective with Practice Tips (and when you call us): to empower your practice with basic maintenance, installation, and repair knowledge, so that you're not paying full-service distributors exorbitant fees on a regular basis. While taking the time to familiarize yourself with your equipment will have a learning curve, you'll be glad you did. Once you get it down, you'll be saving lots of money and will feel more in control of your practice. Without further adieu:

    Installation of Beaverstate Delivery Systems

    A)  INSTALLING THE JUNCTION BOX (MASTER/REGULATOR VALVES)

    1. You should have both air and water lines of ½” pipe with male thread pipe extending up through the floor typically 1” into the operatory. Wrap the threads with Teflon tape. Attach two manual shut-off valves to your air and water pipes (these are provided with your junction box assembly). You may optionally use a water bottle as the sole source of water to your unit and avoid plumbing a water line into the operatory. If a water line is in place but will not be used, turn the water line off using the installed manual shut-off or cap the line.
    2. Install new junction box enclosure over the pipe connections in your floor. Simply set the steel enclosure in place and secure to the floor using appropriate fasteners.
    3. Unscrew the nuts from the compression fitting ends of the manual shut off and slip over the nipple fittings of the master on off/regulators included in the junction box assembly. The regulators will be set by the factory with one preset for air, the other for water. The air valve will be marked with an “A” and have a yellow valve cap; The water valve will be marked “W” with a blue valve cap.
    4. Slip the ends of the nipple fittings into the manual shut offs. Slide the nut and sleeve back to the shut off and screw back on.  Tighten the nuts with an open-end wrench.

    B)  MOUNT THE UNIT TO YOUR POST

    1. Using a post level, make certain that your pole is straight and level. Adjust as necessary. If a light is at the top of the pole, unplug and remove the light by pulling up. Carefully set the light aside and out of the way.
    2. Keep the unit wrapped and bundled as it shipped to you, only removing the large plastic bag from the unit.
    3. With the unit arm over your shoulder and control head behind you, slide the collar at the end of the arm over the top of the post and down to the position desired. NOTE: the arm must be perfectly level to move down the post. As soon as the arm is out of level, it will lock in place with a simple friction mechanism. With the weight of the unit over your shoulder, a lone individual should be able to lift and maneuver the delivery system. An assistant may also be used to help support the unit until you get it onto the pole.

    C)  CONNECT THE UMBILICAL LINES

    1. Attach the color-coded hoses from the umbilical to the regulators as shown in the diagram below. The yellow line from the umbilical will attach to the barb marked “to master on/off switch”. This barb may have a scrap of yellow tubing attached, remove this scrap as it is only in place to help mark this barb. The brown line from the umbilical will attach to the small plastic “T”, which is already attached to two small brown lines attaching the two master valves together.
    2. The other lines will attach to the remaining barbs of the air and water valves as appropriate. There will be both ¼” o.d. and 1/8” o.d. clear lines to attach to the air valve and a ¼” o.d. line to attach to the water valve.

    D)  TEST FOR FUNCTION

    1. Fully open the manual shut-off valves.
    2. Turn the unit master toggle valve to the “on” position.
    3. The on/off indicator on the front (side of some models) should be colored to indicate the unit is “on.”
    4. Check the gauges in the junction box. The air valve should indicate 80 psi, the water valve 40 psi.
    5. Depress both buttons of the air/water syringe and spray into a bucket or sink. The syringe will likely sputter some as air is purged from the water line. Hold both buttons down until you achieve smooth and even flow.
    6. While holding the buttons of your syringe down, again check the pressure on the valves in the junction box and verify they are holding their set pressure (80 psi for air, 40 psi for water). If the pressure changes it will need to be adjusted.
    7. You will need to adjust the pressure using an allen wrench on the adjustment screws at the ends of the valves. These screws are held in place by lock nuts. Loosen the lock nut with an open end wrench before adjusting the adjustment screw. IMPORTANT: Continue to depress BOTH buttons of your air/water syringe while adjusting your pressure. The air and water must be flowing for you to affect a change in the pressure.
    8. Screw the adjustment screw IN (clockwise) to increase the pressure and OUT (counter clockwise) to decrease the pressure. Even a small adjustment can have a large impact on your pressure. Turn the adjustment screw no moore than 1/4 turn at a time. Let the air and/or water flow for a full 30 seconds before further adjusting.

    E)  ENJOY YOUR NEW DELIVERY SYSTEM

    Your new delivery system is now installed and ready for use!
    Installing a delivery system is a quick and easy way to save while improving your office.