All school-based dental sealant programs need the following portable equipment:
Following are descriptions of each type of portable dental equipment and a discussion of factors to consider in choosing each one. Individual program needs and the type of vehicle that will be used to transport the equipment from school to school should be considered when making equipment selections.
Equipment manufactured by DNTLworks
The dental unit should contain high-speed evacuation and an air-and-water syringe with a self-contained water source and waste system. Many dental units also come equipped with an air compressor. Handpieces are not necessary for school-based dental sealant programs since use of unfilled dental sealants and toothbrush prophylaxes are supported by current evidence-based recommendations. 1 Consideration should be given to the unit’s weight, cost, ease of mobility, ease of use, ergonomic compatibility, maintenance requirements, and whether it has a stand. A tripod stand will prevent the unit from wobbling on uneven floors.
If the dental unit purchased does not include an air compressor, a separate unit will need to be purchased. Dry, oil-free air is important for all dental procedures and is essential for the successful application and retention of dental sealants. Most compressors used in dental offices have dryers to ensure that the air used for dental procedures is free of moisture and oil.
Some portable compressors use oil, and others are oilless. Oilless compressors are light and easy to move, but they can be noisy. It’s best to place them as far away from the operatory as possible to reduce the noise level while the compressor is running. When possible, compressors can be located in an adjacent room (extra-long hoses that attach the compressor to the unit can be ordered).
Oil compressors can be heavy and must be loaded and transported carefully, but they are quiet. When transporting an oil compressor, care must be taken to make sure that the oil does not leak into and contaminate the air chamber.
In addition to selecting a compressor type, it is important to consider cost, horsepower, and air chamber size. Compressors with smaller air-storage chambers are lighter and smaller than those with larger air-storage chambers. Compressors with larger air-storage chambers recycle the air less frequently than those with smaller chambers, and they consequently produce less noise.
The dental chair should be durable, stable, light, easily foldable, and adjustable in seat height and chair back tilt. It should also have a carrying case. School-based dental sealant program directors should check the chair’s seat height to make sure it can be adjusted to a level that allows staff to work comfortably. It may be necessary to purchase a heavier chair to obtain one that is ergonomically appropriate. The chair should also allow operators to work from either side, depending upon whether the individual is left- or right-handed. Adjustable headrests can be helpful.
Bright dental lights are important for school-based dental sealant programs, because the lighting in the room where the program is located may be poor. The intensity of dental lights can be assessed by comparing the foot candles of light they produce (a unit of measure of the intensity of light falling on a surface). Operator acceptance, cost, weight, adjustability, ease of bulb replacement, and cost of bulbs are also important considerations. The heat generated from the light is a consideration as well, since school-based dental sealant programs often are located in spaces without air conditioning.
Three commonly used dental lights in school based-dental sealant programs are halogen, fiber optic, and light-emitting diode (LED).
Halogen lights provide a bright and even illumination, are easily focused, and are inexpensive to replace compared to fiber optic and LED dental lights. Halogen lights emit a lot of heat and need to be replaced every 3–6 months. Care must be taken not to touch halogen bulbs, as they need to heat evenly. Traces of oil left from fingerprints can cause uneven heating and decrease bulb life.
Fiber optic lights also provide a bright and even illumination. However, they are costly, and care must be taken when transporting them, as they can be easily damaged. If the bundles in the light’s arm are bent too far or mishandled, they can break, which reduces the intensity of the light over time.
LED lights produce a true white light that is up to 40 percent brighter than the light from halogen lamps. LED lights are energy-efficient and produce no heat in the beam, which improves the comfort of staff and students. LED lights are expensive to replace, but they have a 12- to 25-year life.
Portable dental lights are available in multiple configurations. The three most common are lights that are mounted to a stand, headband, or loupe. Stand-mounted versions typically have a focused-beam light on a strong, flexible, gooseneck arm. Headband-mounted and loupe-mounted light sources are worn by operators. These provide a line-of-sight light that reduces eyestrain and the need to reposition the overhead light. Most headband-mounted and loupe lamps are lightweight, usually around ½ oz. Some can even be lighter than ¼ oz. Light intensity can vary between products, so be sure to ask the manufacturer about specific candlepower. Illumination, product quality, comfort, and ease of use should all be considered when choosing loupe lights.
Many headband-mounted or loupe-mounted lights have a cable that connects to a rechargeable battery pack that is small enough to be slipped into an operator’s uniform or scrubs pocket. Some cordless options are also available. A single battery charge generally lasts 5–24 hours, and battery packs take 2–5 hours to fully charge. Be sure ask about the battery’s life expectancy, repair policies, and warranty when considering headband or loupe lights.
As with all other program equipment, consideration should be given to the cost, durability, and repair history when purchasing dental lights.
Example manufactured by Coolview.
Example manufactured by Coolview.
Example manufactured by Xenosys.
School-based dental sealant programs have a range of sealant materials from which to choose (See Types of Sealants under Selecting Dental Sealant Materials) If light-cured sealants are used, the program will have to purchase a dental curing light. These hand-held lights are used to polymerize sealants once they have been applied to the teeth. The most commonly used dental curing lights are halogen and LED. Both come in a variety of body styles and construction.
Halogen curing lights are reliable and have a long track record. They produce a wide light bandwidth, which enables them to cure all materials. Most come with a power cord, which can be cumbersome if the space where the school-based dental sealant program is situated is not well-configured. They generate heat and require a cooling fan, which can be noisy and which makes the lights larger and bulkier than LED curing lights.
LED curing lights are available in cordless or corded models. They are lightweight, small, and have a long battery life due to low power usage. Some have poorly configured light tips or do not offer a selection of light tips. In addition, LED curing lights may shut down from overheating during long curing intervals.
When purchasing dental curing lights, consideration should be given to their features, power density and energy delivered to the tooth and dental sealant material, length of time needed to polymerize the sealant, availability of accessories, shape and angle of the light tip, and the energy source used to power the light.
Example manufactured by 3M.
Operator stools should be light and comfortable and should have adjustable seat and back heights. Ergonomically sound equipment is worth the extra cost, since it impacts staff health, comfort, and productivity, and ultimately, satisfaction and retention.
A few styles of stools fold into carrying cases. If there is sufficient space in the vehicle used to transport equipment, small, lightweight stools that are not specifically designed for portable dental programs can be purchased from dental suppliers. These are less expensive than foldable styles. It is also more convenient to not have to break down and reassemble the stools every time the program moves.
If possible, before purchasing operator stools, program administrators should allow clinical staff to try them out to determine whether the stools adjust properly and don’t tip over when rolled on uneven surfaces. Stools with five casters are more stable than those with four. If stools need to be disassembled for packing, administrators should try to disassemble and reassemble them before purchasing them.
Increasingly, school-based dental sealant programs are using disposable instruments. Their use eliminates the need for sterilizers, ultrasonic cleaners, spore testing supplies, sterilizer bags, sterilizer cleaner, distilled water (if required for sterilizer), and ultrasonic cleaning solution. These factors result in lower start-up and maintenance costs. Using disposable instruments also eliminates the need to conduct spore testing each time the program moves to a new site, improves program efficiency because staff time is not spent cleaning and sterilizing instruments, and significantly reduces the possibility of cross-contamination in the event that the sterilization system is not functioning properly.
School-based dental sealant programs in Baltimore County, MD, have found that the cost of disposable instruments (e.g., mirrors, cotton roll holders) has offset the cost of purchasing, maintaining, and testing a sterilizer.
If a school-based dental sealant program decides to use reusable instruments, the program should use only sterilizers manufactured for medical or dental instruments and supplies to ensure proper sterilization. These can be acquired from dental-equipment suppliers. Different types of sterilizers are available: steam under pressure (also called autoclaves) and dry heat.
Steam-under-pressure sterilizers. Steam-under-pressure sterilizers allow for the sterilization of a wide range of materials. Temperature, pressure, and time are the main factors in this process. The higher the temperature, the greater the pressure, and the shorter the sterilization cycle. There are two basic types of steam sterilizers—gravity displacement and pre- and post-vacuum.
Gravity-displacement sterilizers generate steam within the chamber and force air out through an escape valve. This process forms the moist heat that kills microorganisms. During the sterilization process, cool air pockets can form and prevent the sterilizer from reaching the required temperature for complete sterilization. In addition, gravity-displacement sterilizers may cause instruments to corrode. Furthermore, if sterilized instrument packs are handled before they are completely dry, the instruments can become contaminated from microorganisms that penetrate the wet pack. Wet instrument packs can also be torn or punctured easily.
Pre- and post-vacuum sterilizers, sometimes referred to as pre-vacuum sterilizers, pump air out of the chamber before the steam enters, creating an environment that allows faster and more thorough steam penetration than gravity-displacement steam sterilizers. Pre-vacuum sterilizers also include a cycle that removes moisture, resulting in a dry instrument pack, thereby reducing chances that instruments will be contaminated.
A process called “flash steam sterilization” is a disinfection method available on most steam sterilizers. Flash sterilization should only be used for instruments or other solid items that will be used immediately. To avoid contamination, instruments are not wrapped and must not be transported or stored. It is also important that the instruments are adequately cleaned before they are sterilized. Flash sterilization has been used frequently in operating rooms when changes in planned surgical procedures occur, when limited instrument inventory is available, or when instruments are dropped. Because school-based dental sealant program staff seldom face circumstances similar to those present in operating rooms and because of the high risk for instrument contamination, flash sterilization is not recommended for school-based dental sealant programs.
All steam-under-pressure sterilizers require adequate ventilation. Recent advances in steam-under-pressure sterilizers include increased use of digital instrumentation and monitors, which need to be protected from high heat and moisture. Basic, solid-state steam-under-pressure sterilizers may be more durable and reliable than more technologically advanced ones.
Example manufactured by Tuttnauer.
Dry-heat sterilizers. Dry-heat sterilizers employ high temperatures to destroy microorganisms. These sterilizers are considered effective and safe for metal instruments because the process does not cause rust or corrosion. There are two kinds of dry heat sterilizers: (1) the traditional “toaster oven” style, which take 1 hour to sterilize instruments, and (2) the COX Dry Heat Sterilizer, which can sterilize instruments in 6 minutes.
Selecting a sterilizer. In selecting a sterilizer, school-based dental sealant program directors should consider the following factors:
All dental instruments should be decontaminated before they are sterilized. The ultrasonic cleaner is an effective tool for removing blood, saliva, and debris from dental materials before sterilization. Size, weight, and cost are all considerations in selecting an ultrasonic cleaner.
Example manufactured by L&R Ultrasonics.
In addition to budgeting for the equipment listed above, school-based dental sealant programs should also budget for the following items, as needed:
A variety of containers are required for storing and moving supplies and equipment. Eighteen-gallon storage bins, wheeled toolboxes, or craft carts are durable and can double as counter space.
Example manufactured by Rubbermaid.
Example manufactured by Craftsman.
Example manufactured by Blue Hills Studio™ .
Fans help control temperature and provide ventilation. Schools are often warm. Warm temperatures accelerate the setting time of self-cured dental sealants. If the sealant material sets so quickly that more than one mix is required for the quadrant or half mouth being sealed, costs increase. Staff and students will also be more comfortable if the room is cool and well-ventilated.
Dollies, carts, and hand trucks are helpful in moving portable equipment into and out of schools.
Example manufactured by Safco.
Because outlets are not always conveniently located, electrical outlet strips with circuit breakers and heavy-duty extension cords are important. In older school buildings, long extension cords are sometimes necessary to plug equipment into outlets on different circuits to avoid overloading electrical systems.