Reasonable Rascal
03-22-06, 03:32
Portable Dentistry in an Austere Environment
Robert D. Meyer, DMD, MAGD, ABGD
Steven Eikenberg, DMD, MAGD, ABGD
Abstract
The availability and versatility of portable dental equipment can support the delivery of dental treatment in a wide variety of nontraditional settings. There is an ever-increasing demand for portable dental equipment that is lightweight, dependable, highly transportable, and easy to use and maintain. This article will discuss some of the requirements, features, and considerations in the selection and use of portable dental equipment in an austere environment.
Received: April 24, 2002
Accepted: May 16, 2002
Today there is a greater awareness, the world over, of the importance of good dental care, yet many are unable to receive treatment due primarily to finances, location, or transportation. The military traditionally has been and continues to be involved with portable dentistry for the treatment of its deployed soldiers and for humanitarian assistance missions. The American Dental Association, American Red Cross, Christian Dental Society, World Health Organizations, and numerous other charitable, humanitarian, and volunteer organizations have recognized that dental disease, which affects over 95% of the world's population, is needed everywhere. Children cry themselves to sleep at night with toothaches and adults try to find a way to break off the abscessed tooth so it can be drained, as illustrated dramatically in the movie Castaway when Tom Hanks' character used an ice skate blade and a rock to break his tooth. When dentists provide care to relieve physical suffering, the good will often opens doors and builds bridges for political, social, and religious opportunities.
There is a difference between mobile and portable dental equipment. Mobile equipment refers to equipment that can be moved within a building. This equipment may be mounted on wheels or it may be carried. Mobile equipment is not designed or built to withstand the rigors of repeated shipment or transportation. Portable equipment is constructed to be moved easily. It is packed into a shipping container which is light enough to be carried by one person and small enough to be transported on a commercial airliner as checked baggage or delivered by commercial delivery services. This generally limits weight to approximately 70 pounds in a container that will not exceed 4.0 cubic feet or 65 inches in total height, width, and length. Portable dental equipment also is built and designed to survive rough handling during transit.
The level of dental services to be rendered, transportation limitations, and the environment in which dentistry will be delivered determine the type of equipment and supply requirements necessary to support a portable dental mission. The dental team's first step is to determine the level of dental service to be provided, which may be limited to extractions or expanded to include surgery, hygiene, and endodontics. Next, the team must establish if the equipment and supplies can be reasonably transported into the country by plane, boat, or vehicle and then to the work site, which may be accessible only by foot. Finally, the team needs to ensure that the local environment will support the equipment planned for the mission. This includes matching power requirements with available assets and consideration of indoor vs. outdoor operation. The dental team and planning agency must work together so that expectations match the realities of the situation.
Some dental missions may be limited to the treatment of pain and dental alveolar infections and the removal of nonrestorable teeth that may cause an emergency situation in the future. When dental treatment will be limited, equipment needs are minimal. A battery-operated electric motor handpiece, light source, and sterilization capabilities are recommended as the minimal equipment requirements.
The battery-operated electric motor handpiece is essential and may be the only portable dental equipment needed. Through the authors' personal experience and in consultation with many military and missionary/humanitarian dentists, the portable electric handpiece has proven to be invaluable, both in military field settings and in third world countries where electrical capability is limited or nonexistent. The United States Army has included the electric handpiece as an essential, standard piece of equipment for forward-deployed dentists. It also provides a backup to the conventional operating unit and works very well as an additional surgical operating unit.
The handpiece operates on a small, rechargeable battery, weighs less than 7.0 pounds, is less than 0.5 cubic feet in size, and has enough torque to cut through bone or teeth easily without stalling or experiencing a decrease in bur speed. These handpiece sets contain a spare battery and at least two manufacturers make small, 1.0 square foot solar panels that can be used to recharge one battery while a second, identical battery is used. The portable handpiece is easy to use and will support a straight nose cone for surgical extractions and a slow speed contra angle, with adjustable speeds, for caries evacuation. An irrigation syringe can be used to cool the tooth or bone. If suction capabilities are not available, the patient may need an emesis basin or similar container.
The dentist can chose from several portable light sources. Halogen lights located on a goose-neck lamp and mounted on tripods or attached to the chair are satisfactory. However, it may be difficult to adjust the position of these lights and they require a source of generated power. Headlamps are great because they allow the dentist to adjust the position of the beam easily. However, surgical headlamps are expensive and break easily. An inexpensive alternative is spelunker headlamps. These headlamps provide adequate illumination and are more efficient than a flashlight held by an assistant. The least desirable source of light is direct sunlight. The dentist may be able to face the patient toward the sun but the direct sunlight will place the patient and the dentist at risk for a heat injury.
The dentist must make a reasonable attempt to follow universal precautions. In addition to the required personal protective equipment, plans must be made to sterilize instruments and disinfect surfaces. There are commercially available sterilizers that can be placed on an external heat source. These sterilizers essentially are pressure cookers. A four-quart stainless steel pressure cooker fitted with a 30 pounds per square inch (psi) pop-up valve is a simple and dependable portable autoclave. Sterilization is accomplished via the superheated steam under pressure. Simply place six to eight ounces of water in the pressure pot and heat the pot so that the internal pressure remains at 30 psi for 10 minutes.1 This is called flashclave. Almost any heat source that is capable of boiling water will work. If generated power is available, a small electrical heating plate will be sufficient. If there is no generated power, a gas flame, propane torch, camp stove, or open fire will suffice.
Set up a sterilization table where dirty instruments are brought in at one end, with a tub of soapy water to wash them and a tub of clean water to rinse them (Fig. 1). Place the instruments in the pressure pot, flashclave them for five minutes, then release the pressure immediately and dump the hot instruments out where they will quickly air dry and cool. They are ready for use again within minutes.
An autoclave is the ideal method for sterilizing instruments. However, in an austere environment, it is rare to find an autoclave that is in good working order due primarily to inadequate maintenance and corroded components, gaskets, and seals. The pressure pot is carried easily and has never failed to work efficiently, with minimal effort, for the lead author and for numerous other dentists who have used it. The pressure pot is a standard piece of equipment that can be rented from the Christian Dental Society for sterilizing instruments in third world settings. The dental team must be diligent to ensure there is sufficient water in the pot; otherwise, the gaskets may burn and it will be impossible to build up sufficient amounts of pressure. There are liquids that may be used to sterilize instruments; however, this mode of sterilization requires hours.
Planned dental services, such as operative, endodontic, or prosthetic treatment, will require substantially more equipment and supplies than treatment limited to extractions and emergency care only. Patients often request elective hygiene or restorative care. With limited time to treat the myriad of dental needs, treatment must be prioritized but it is rewarding to have the option of fixing an ugly black carious lesion on an anterior tooth of a young patient rather than merely extracting another bad tooth. If possible, the dental team should be able to provide some operative or hygiene care, even if the main purpose of the dental mission is the treatment of pain and infection.
Dental Treatment and Operating Systems (TOS) refers to the wide range of dental equipment that will support operative dentistry. The TOS generally consists of a dental handpiece (high- and low-speed), a water reservoir, a compressed air source to provide water for the air-water syringe and bur coolant spray, and a suction capability. Several companies offer outstanding portable operating systems that provide treatment capability equivalent to that in any modern fixed facility dental clinic. The handpieces can be either an air turbine or electric motor system. Suction may be provided via a separate vacuum pump or a venturi-type suction system, which generates suction with a "compressed air blow-by" method. The air turbine system, when combined with a venturi-type suction system, requires a large volume of compressed air. The compressed air usually is provided by a noisy compressor that requires a significant amount of electric power. Compressed air also can be provided by a compressed air tank (such as a scuba tank or oxygen tank) connected to the operating system.
Although the air turbine systems and venturi suction work very well, the electric motor handpiece systems and vacuum pump suction require significantly less electric power. Electric handpieces that contain fiber-optics and internal air-water coolant spray lines are available commercially. When the electric motor handpiece is placed in a system with a small compressor and vacuum pump, the resulting TOS can be operated with a generator of less than 500 watts or from rechargeable batteries. As a backup, if the generated power supply is interrupted or the compressor or the operating unit breaks, the battery-operated electric motor handpiece may be used to section a tooth, make an access opening, smooth a fracture, or remove decay.
If the dental team plans to provide hygiene care, many of the TOS will support ultrasonic or peezo-type scalers. To expand the portable dental setup to include endodontics generally requires radiograph capability but clinical experience and common sense can allow reasonably successful root canals on critical teeth without the aid of a radiograph unit. In an austere environment with portable equipment, prosthetics generally is out of the scope of treatment, although repairing a partial or complete denture or making a temporary crown is very possible using restorative materials.
A portable radiograph unit is extremely useful for any type of dental mission because it increases the operator's diagnostic ability and clinical knowledge, potentially improving the quality of care. There are several commercially available "portable" dental radiograph systems which are packed into cases that are less than 2.0 cubic feet in size and weigh less than 40 pounds.
Radiographic images can be captured on regular film; however, this method requires chemicals and a portable developing apparatus. Another method for capturing radiographic images is self-developing film, which is approximately the size of intraoral periapical film. After the film is exposed, the dentist breaks a seal to release a mono-bath solution that bathes the film for approximately 60 seconds.2 These images will fade after a few months unless the film is placed in a separate fixer solution. The third option for image acquisition is digital sensors incorporated into a laptop computer. These systems are very portable; provide rapid, highly diagnostic images; and eliminate the need for processing chemicals. The computer and sensor can be packed and safely transported in a sturdy briefcase-sized container. The disadvantage of digital equipment is that it is expensive, easily stolen, difficult to repair in the field, and may malfunction in a dusty, humid, or extreme temperature environment.
There are a wide variety of portable patient chairs and operator stools that are durable, lightweight, and provide a high level of comfort for both the patient and the dentist. A folding patient chair brings the patient to the operator, saves the back, makes dentistry more efficient, and is well worth the effort if the additional cost and transportation of the chairs is possible. Almost any chair can be used if the dentist decides to practice "stand-up" dentistry. A folding patio lounge chair also can be used as a patient chair, with a folding chair with a cushion serving as a dental stool. There are dental chairs and stools made from a durable plastic that resembles corrugated cardboard. These chairs are extremely lightweight, inexpensive, and reasonably effective (Fig. 2).
The power requirements of the dental equipment and the local power availability are factors that often are overlooked. The compressor required to power portable air-turbine handpiece TOS, with venturi suction systems, often requires 20 amperes of power. If a generator is used, it must be capable of providing more than 2.0 kilowatts of power. If a local power supply is available, this electrical requirement may overload the local circuit breaker. Even in a modern faculty it may not be possible to plug more than one compressor into a single electrical circuit.
Many areas of the world utilize 240 volt generated power, not the 120 volt commonly used in North America. Some portable dental equipment is designed to accept either 120 volt or 240 volt power; however, most equipment will need appropriate power transformers to operate from a 240 volt power source. These power transformers can be purchased from many electronic stores. To determine the appropriate transformer size, use the following formula: Volts x Amps = Watts. A 120 volt appliance that has an 8.3 ampere power rating will require at least a 1,000 watt transformer. Larger transformers or multiple transformers will be needed if multiple 120 volt appliances such as a halogen lamp, an amalgamator, curing light, and TOS are utilized. Autoclaves and radiograph units require a large amount of power and, therefore, a larger transformer.
In addition to the transformers, it is recommended that a power strip with circuit breaker protection be used to protect against power surges. Also, take heavy 12 or 14 gauge extension cords to run the compressor, since the smaller 16 gauge cords may get hot and burn. Some countries with 120 volt power may have the old-fashioned, nongrounded two-prong plugs. It may be necessary to have three prong-to-two prong adapters. Electrical tape for repairs and splices also is good to have on hand.
If electrical power is not available or is limited to a small generator or single circuit, the dentist may have to utilize equipment that has a lower power requirement. To minimize electrical requirements, a dental treatment system utilizing an electric motor handpiece and a small suction pump instead of an air turbine handpiece and venturi suction may be necessary. A pressure-pot sterilizer also may be a necessity. In addition, the use of other equipment such as a curing light, halogen lamp, amalgamator, and radiograph unit may have to be monitored carefully to stay within the power limitations.
Although military-type dental and medical cases provide an effective method of transporting and utilizing dental instruments and supplies, a fishing tackle box, with its multiple compartments, is an inexpensive alternative. A suitcase that opens and closes, placed on its side, serves as a great storage place for instruments and supplies which are readily available but need protection. It is useful to have an abbreviated medical history form, written in the language of the patients being treated. This helps to track the patients, address their chief complaints, and rule out major medical problems like bleeding disorders, heart problems, allergies, and other potential problems the patient might want to tell the dentist about. A postoperative instruction sheet for extractions and an oral hygiene instruction sheet in the native language of the patients also are helpful. Such handouts are available in several languages from the ADA.
Medical waste must be disposed of properly. In an austere environment, sharps can be placed in an old plastic water or soda bottle. Paper products can be placed in plastic grocery bags, which also serve as excellent padding material. At the end of the day, burn it all (Fig. 3). If these items are not burned, people may sort through this infectious material to find items of value that they may be able to reuse. The plastic and latex burns hot enough to melt the needles, leaving only ashes. Liquid wastes from the suction are disposed in bodily waste receptacles like toilets or pits dug into the ground.
Dental supplies and medications can best be calculated on the anticipated number of patients a dentist plans to treat. For example, the average patient will require three carpules of local anesthetic. If the dentist plans to treat 100 patients, 300 carpules will be required. Before a dentist begins to assemble the equipment and supplies required to support the delivery of dental services in a nontraditional setting, a multitude of factors must be assessed to be successful. In his book Portable Mission Dentistry, Ron Lamb advises: know before you go, be prepared, and have a good attitude.3
This discussion has been in generalities; the manufacturers and costs of specific portable dental equipment have been excluded intentionally because there are so many good systems that continually are under improvement. With this base of knowledge, visit dental conventions, which always have multiple displays of portable dental equipment. The Internet has numerous sites for browsing under mobile or portable dental equipment. Magazines list mobile/portable systems under equipment buyers' guides and often the best source of information is from those who have done dentistry in austere environments.
One of the most valuable sources on the development, use, and procurement of portable dental equipment is the Christian Dental Society, which maintains an inventory of portable chairs, units, compressors, and instruments that may be rented for mission use. It also maintains an extensive updated list of dental mission opportunities and is committed to helping volunteer dentists throughout the world.4 4 World Dental Relief maintains a dental warehouse to provide dentists with low cost supplies for volunteer missions.5 The United States Air Force Dental Investigation Service maintains a Web site (www.brooks.af.mil/dis) that contains evaluations on some portable dental equipment.
The opportunities and challenges for providing dental services both at your back door and around the world are boundless. With the current availability of portable dental equipment, quality dentistry can be transported and accomplished anywhere, in any environment. The authors encourage others to set achievable goals, even if they are a little out of the comfort zone. Embark on an adventure to help others, for the rewards and personal accomplishment are beyond description.
Disclaimer
The authors have no financial, economic, commercial, and/or professional interests related to the topic presented in this article.
Author information
COL (Retired) Meyer is former commander of the Army's only airborne dental unit. He now is in private practice in Colorado Springs, Colorado. COL Eikenberg is Commander, Fort Knox Dental Activity.
References
1. Lamb R. Portable mission dentistry. Self-published manuscript;1994:269.
2. Eikenberg S, Vandre R. Comparison of digital dental x-ray systems with self-developing film and manual processing for endodontic file length determination. J Endod 2000;26:65-67.
3. Lamb R. Portable mission dentistry. Self-published manuscript;1994:Chapter 2
4. Christian Dental Society, P.O. Box 177, Sumner, IA 50674; 800/CDS-SENT; www.christiandental.org.
5. World Dental Relief, 609 North Main, P.O. Box 747, Broken Arrow, OK 74013; 918/251-2612; www.dentalrelief.com.
General Dentistry, September/October, Vol. 50 No. 5
Robert D. Meyer, DMD, MAGD, ABGD
Steven Eikenberg, DMD, MAGD, ABGD
Abstract
The availability and versatility of portable dental equipment can support the delivery of dental treatment in a wide variety of nontraditional settings. There is an ever-increasing demand for portable dental equipment that is lightweight, dependable, highly transportable, and easy to use and maintain. This article will discuss some of the requirements, features, and considerations in the selection and use of portable dental equipment in an austere environment.
Received: April 24, 2002
Accepted: May 16, 2002
Today there is a greater awareness, the world over, of the importance of good dental care, yet many are unable to receive treatment due primarily to finances, location, or transportation. The military traditionally has been and continues to be involved with portable dentistry for the treatment of its deployed soldiers and for humanitarian assistance missions. The American Dental Association, American Red Cross, Christian Dental Society, World Health Organizations, and numerous other charitable, humanitarian, and volunteer organizations have recognized that dental disease, which affects over 95% of the world's population, is needed everywhere. Children cry themselves to sleep at night with toothaches and adults try to find a way to break off the abscessed tooth so it can be drained, as illustrated dramatically in the movie Castaway when Tom Hanks' character used an ice skate blade and a rock to break his tooth. When dentists provide care to relieve physical suffering, the good will often opens doors and builds bridges for political, social, and religious opportunities.
There is a difference between mobile and portable dental equipment. Mobile equipment refers to equipment that can be moved within a building. This equipment may be mounted on wheels or it may be carried. Mobile equipment is not designed or built to withstand the rigors of repeated shipment or transportation. Portable equipment is constructed to be moved easily. It is packed into a shipping container which is light enough to be carried by one person and small enough to be transported on a commercial airliner as checked baggage or delivered by commercial delivery services. This generally limits weight to approximately 70 pounds in a container that will not exceed 4.0 cubic feet or 65 inches in total height, width, and length. Portable dental equipment also is built and designed to survive rough handling during transit.
The level of dental services to be rendered, transportation limitations, and the environment in which dentistry will be delivered determine the type of equipment and supply requirements necessary to support a portable dental mission. The dental team's first step is to determine the level of dental service to be provided, which may be limited to extractions or expanded to include surgery, hygiene, and endodontics. Next, the team must establish if the equipment and supplies can be reasonably transported into the country by plane, boat, or vehicle and then to the work site, which may be accessible only by foot. Finally, the team needs to ensure that the local environment will support the equipment planned for the mission. This includes matching power requirements with available assets and consideration of indoor vs. outdoor operation. The dental team and planning agency must work together so that expectations match the realities of the situation.
Some dental missions may be limited to the treatment of pain and dental alveolar infections and the removal of nonrestorable teeth that may cause an emergency situation in the future. When dental treatment will be limited, equipment needs are minimal. A battery-operated electric motor handpiece, light source, and sterilization capabilities are recommended as the minimal equipment requirements.
The battery-operated electric motor handpiece is essential and may be the only portable dental equipment needed. Through the authors' personal experience and in consultation with many military and missionary/humanitarian dentists, the portable electric handpiece has proven to be invaluable, both in military field settings and in third world countries where electrical capability is limited or nonexistent. The United States Army has included the electric handpiece as an essential, standard piece of equipment for forward-deployed dentists. It also provides a backup to the conventional operating unit and works very well as an additional surgical operating unit.
The handpiece operates on a small, rechargeable battery, weighs less than 7.0 pounds, is less than 0.5 cubic feet in size, and has enough torque to cut through bone or teeth easily without stalling or experiencing a decrease in bur speed. These handpiece sets contain a spare battery and at least two manufacturers make small, 1.0 square foot solar panels that can be used to recharge one battery while a second, identical battery is used. The portable handpiece is easy to use and will support a straight nose cone for surgical extractions and a slow speed contra angle, with adjustable speeds, for caries evacuation. An irrigation syringe can be used to cool the tooth or bone. If suction capabilities are not available, the patient may need an emesis basin or similar container.
The dentist can chose from several portable light sources. Halogen lights located on a goose-neck lamp and mounted on tripods or attached to the chair are satisfactory. However, it may be difficult to adjust the position of these lights and they require a source of generated power. Headlamps are great because they allow the dentist to adjust the position of the beam easily. However, surgical headlamps are expensive and break easily. An inexpensive alternative is spelunker headlamps. These headlamps provide adequate illumination and are more efficient than a flashlight held by an assistant. The least desirable source of light is direct sunlight. The dentist may be able to face the patient toward the sun but the direct sunlight will place the patient and the dentist at risk for a heat injury.
The dentist must make a reasonable attempt to follow universal precautions. In addition to the required personal protective equipment, plans must be made to sterilize instruments and disinfect surfaces. There are commercially available sterilizers that can be placed on an external heat source. These sterilizers essentially are pressure cookers. A four-quart stainless steel pressure cooker fitted with a 30 pounds per square inch (psi) pop-up valve is a simple and dependable portable autoclave. Sterilization is accomplished via the superheated steam under pressure. Simply place six to eight ounces of water in the pressure pot and heat the pot so that the internal pressure remains at 30 psi for 10 minutes.1 This is called flashclave. Almost any heat source that is capable of boiling water will work. If generated power is available, a small electrical heating plate will be sufficient. If there is no generated power, a gas flame, propane torch, camp stove, or open fire will suffice.
Set up a sterilization table where dirty instruments are brought in at one end, with a tub of soapy water to wash them and a tub of clean water to rinse them (Fig. 1). Place the instruments in the pressure pot, flashclave them for five minutes, then release the pressure immediately and dump the hot instruments out where they will quickly air dry and cool. They are ready for use again within minutes.
An autoclave is the ideal method for sterilizing instruments. However, in an austere environment, it is rare to find an autoclave that is in good working order due primarily to inadequate maintenance and corroded components, gaskets, and seals. The pressure pot is carried easily and has never failed to work efficiently, with minimal effort, for the lead author and for numerous other dentists who have used it. The pressure pot is a standard piece of equipment that can be rented from the Christian Dental Society for sterilizing instruments in third world settings. The dental team must be diligent to ensure there is sufficient water in the pot; otherwise, the gaskets may burn and it will be impossible to build up sufficient amounts of pressure. There are liquids that may be used to sterilize instruments; however, this mode of sterilization requires hours.
Planned dental services, such as operative, endodontic, or prosthetic treatment, will require substantially more equipment and supplies than treatment limited to extractions and emergency care only. Patients often request elective hygiene or restorative care. With limited time to treat the myriad of dental needs, treatment must be prioritized but it is rewarding to have the option of fixing an ugly black carious lesion on an anterior tooth of a young patient rather than merely extracting another bad tooth. If possible, the dental team should be able to provide some operative or hygiene care, even if the main purpose of the dental mission is the treatment of pain and infection.
Dental Treatment and Operating Systems (TOS) refers to the wide range of dental equipment that will support operative dentistry. The TOS generally consists of a dental handpiece (high- and low-speed), a water reservoir, a compressed air source to provide water for the air-water syringe and bur coolant spray, and a suction capability. Several companies offer outstanding portable operating systems that provide treatment capability equivalent to that in any modern fixed facility dental clinic. The handpieces can be either an air turbine or electric motor system. Suction may be provided via a separate vacuum pump or a venturi-type suction system, which generates suction with a "compressed air blow-by" method. The air turbine system, when combined with a venturi-type suction system, requires a large volume of compressed air. The compressed air usually is provided by a noisy compressor that requires a significant amount of electric power. Compressed air also can be provided by a compressed air tank (such as a scuba tank or oxygen tank) connected to the operating system.
Although the air turbine systems and venturi suction work very well, the electric motor handpiece systems and vacuum pump suction require significantly less electric power. Electric handpieces that contain fiber-optics and internal air-water coolant spray lines are available commercially. When the electric motor handpiece is placed in a system with a small compressor and vacuum pump, the resulting TOS can be operated with a generator of less than 500 watts or from rechargeable batteries. As a backup, if the generated power supply is interrupted or the compressor or the operating unit breaks, the battery-operated electric motor handpiece may be used to section a tooth, make an access opening, smooth a fracture, or remove decay.
If the dental team plans to provide hygiene care, many of the TOS will support ultrasonic or peezo-type scalers. To expand the portable dental setup to include endodontics generally requires radiograph capability but clinical experience and common sense can allow reasonably successful root canals on critical teeth without the aid of a radiograph unit. In an austere environment with portable equipment, prosthetics generally is out of the scope of treatment, although repairing a partial or complete denture or making a temporary crown is very possible using restorative materials.
A portable radiograph unit is extremely useful for any type of dental mission because it increases the operator's diagnostic ability and clinical knowledge, potentially improving the quality of care. There are several commercially available "portable" dental radiograph systems which are packed into cases that are less than 2.0 cubic feet in size and weigh less than 40 pounds.
Radiographic images can be captured on regular film; however, this method requires chemicals and a portable developing apparatus. Another method for capturing radiographic images is self-developing film, which is approximately the size of intraoral periapical film. After the film is exposed, the dentist breaks a seal to release a mono-bath solution that bathes the film for approximately 60 seconds.2 These images will fade after a few months unless the film is placed in a separate fixer solution. The third option for image acquisition is digital sensors incorporated into a laptop computer. These systems are very portable; provide rapid, highly diagnostic images; and eliminate the need for processing chemicals. The computer and sensor can be packed and safely transported in a sturdy briefcase-sized container. The disadvantage of digital equipment is that it is expensive, easily stolen, difficult to repair in the field, and may malfunction in a dusty, humid, or extreme temperature environment.
There are a wide variety of portable patient chairs and operator stools that are durable, lightweight, and provide a high level of comfort for both the patient and the dentist. A folding patient chair brings the patient to the operator, saves the back, makes dentistry more efficient, and is well worth the effort if the additional cost and transportation of the chairs is possible. Almost any chair can be used if the dentist decides to practice "stand-up" dentistry. A folding patio lounge chair also can be used as a patient chair, with a folding chair with a cushion serving as a dental stool. There are dental chairs and stools made from a durable plastic that resembles corrugated cardboard. These chairs are extremely lightweight, inexpensive, and reasonably effective (Fig. 2).
The power requirements of the dental equipment and the local power availability are factors that often are overlooked. The compressor required to power portable air-turbine handpiece TOS, with venturi suction systems, often requires 20 amperes of power. If a generator is used, it must be capable of providing more than 2.0 kilowatts of power. If a local power supply is available, this electrical requirement may overload the local circuit breaker. Even in a modern faculty it may not be possible to plug more than one compressor into a single electrical circuit.
Many areas of the world utilize 240 volt generated power, not the 120 volt commonly used in North America. Some portable dental equipment is designed to accept either 120 volt or 240 volt power; however, most equipment will need appropriate power transformers to operate from a 240 volt power source. These power transformers can be purchased from many electronic stores. To determine the appropriate transformer size, use the following formula: Volts x Amps = Watts. A 120 volt appliance that has an 8.3 ampere power rating will require at least a 1,000 watt transformer. Larger transformers or multiple transformers will be needed if multiple 120 volt appliances such as a halogen lamp, an amalgamator, curing light, and TOS are utilized. Autoclaves and radiograph units require a large amount of power and, therefore, a larger transformer.
In addition to the transformers, it is recommended that a power strip with circuit breaker protection be used to protect against power surges. Also, take heavy 12 or 14 gauge extension cords to run the compressor, since the smaller 16 gauge cords may get hot and burn. Some countries with 120 volt power may have the old-fashioned, nongrounded two-prong plugs. It may be necessary to have three prong-to-two prong adapters. Electrical tape for repairs and splices also is good to have on hand.
If electrical power is not available or is limited to a small generator or single circuit, the dentist may have to utilize equipment that has a lower power requirement. To minimize electrical requirements, a dental treatment system utilizing an electric motor handpiece and a small suction pump instead of an air turbine handpiece and venturi suction may be necessary. A pressure-pot sterilizer also may be a necessity. In addition, the use of other equipment such as a curing light, halogen lamp, amalgamator, and radiograph unit may have to be monitored carefully to stay within the power limitations.
Although military-type dental and medical cases provide an effective method of transporting and utilizing dental instruments and supplies, a fishing tackle box, with its multiple compartments, is an inexpensive alternative. A suitcase that opens and closes, placed on its side, serves as a great storage place for instruments and supplies which are readily available but need protection. It is useful to have an abbreviated medical history form, written in the language of the patients being treated. This helps to track the patients, address their chief complaints, and rule out major medical problems like bleeding disorders, heart problems, allergies, and other potential problems the patient might want to tell the dentist about. A postoperative instruction sheet for extractions and an oral hygiene instruction sheet in the native language of the patients also are helpful. Such handouts are available in several languages from the ADA.
Medical waste must be disposed of properly. In an austere environment, sharps can be placed in an old plastic water or soda bottle. Paper products can be placed in plastic grocery bags, which also serve as excellent padding material. At the end of the day, burn it all (Fig. 3). If these items are not burned, people may sort through this infectious material to find items of value that they may be able to reuse. The plastic and latex burns hot enough to melt the needles, leaving only ashes. Liquid wastes from the suction are disposed in bodily waste receptacles like toilets or pits dug into the ground.
Dental supplies and medications can best be calculated on the anticipated number of patients a dentist plans to treat. For example, the average patient will require three carpules of local anesthetic. If the dentist plans to treat 100 patients, 300 carpules will be required. Before a dentist begins to assemble the equipment and supplies required to support the delivery of dental services in a nontraditional setting, a multitude of factors must be assessed to be successful. In his book Portable Mission Dentistry, Ron Lamb advises: know before you go, be prepared, and have a good attitude.3
This discussion has been in generalities; the manufacturers and costs of specific portable dental equipment have been excluded intentionally because there are so many good systems that continually are under improvement. With this base of knowledge, visit dental conventions, which always have multiple displays of portable dental equipment. The Internet has numerous sites for browsing under mobile or portable dental equipment. Magazines list mobile/portable systems under equipment buyers' guides and often the best source of information is from those who have done dentistry in austere environments.
One of the most valuable sources on the development, use, and procurement of portable dental equipment is the Christian Dental Society, which maintains an inventory of portable chairs, units, compressors, and instruments that may be rented for mission use. It also maintains an extensive updated list of dental mission opportunities and is committed to helping volunteer dentists throughout the world.4 4 World Dental Relief maintains a dental warehouse to provide dentists with low cost supplies for volunteer missions.5 The United States Air Force Dental Investigation Service maintains a Web site (www.brooks.af.mil/dis) that contains evaluations on some portable dental equipment.
The opportunities and challenges for providing dental services both at your back door and around the world are boundless. With the current availability of portable dental equipment, quality dentistry can be transported and accomplished anywhere, in any environment. The authors encourage others to set achievable goals, even if they are a little out of the comfort zone. Embark on an adventure to help others, for the rewards and personal accomplishment are beyond description.
Disclaimer
The authors have no financial, economic, commercial, and/or professional interests related to the topic presented in this article.
Author information
COL (Retired) Meyer is former commander of the Army's only airborne dental unit. He now is in private practice in Colorado Springs, Colorado. COL Eikenberg is Commander, Fort Knox Dental Activity.
References
1. Lamb R. Portable mission dentistry. Self-published manuscript;1994:269.
2. Eikenberg S, Vandre R. Comparison of digital dental x-ray systems with self-developing film and manual processing for endodontic file length determination. J Endod 2000;26:65-67.
3. Lamb R. Portable mission dentistry. Self-published manuscript;1994:Chapter 2
4. Christian Dental Society, P.O. Box 177, Sumner, IA 50674; 800/CDS-SENT; www.christiandental.org.
5. World Dental Relief, 609 North Main, P.O. Box 747, Broken Arrow, OK 74013; 918/251-2612; www.dentalrelief.com.
General Dentistry, September/October, Vol. 50 No. 5