Th 152526

Moving down from the cheap seats

June 1, 2004
Most of us have been in the cheap seats at a major sporting event.

Most of us have been in the cheap seats at a major sporting event. The dizzying heights of the proverbial nosebleed section can challenge the enthusiasm of the most ardent fan. How many of us at a game have glared with contempt at the occupants of those precious 50-yard line seats directly above our team's bench? Or, sneered as we walked past those pampered few whom occupy courtside at an NBA game? As a child, I assumed the fans in the great seats were just lucky stiffs who probably never worked a day in their life and inherited unbelievable season tickets from a rich uncle who made millions from an invention he drew on a napkin. As an adult, I learned great seats at sporting events were often purchased by lucky stiffs like oral surgeons who went to school for 24 years, were on-call 24 hours a day, and were offering tickets to general dentists as a marketing referral tool.

Our functional and esthetic expectations of seating are highly significant whether they occur at a major sporting event or in a dental office. At a sporting event, the location of your seat in relation to the competition area is typically the most important factor. In your dental office, the seat construction, visual and textural appeal, and placement are equally important. High-quality, well-designed seating will have a positive impact within every space of your facility.

Dental facility seating discussions rarely consider seating beyond the dental patient chair. In fact, the patient's chair is just one of many crucial seating selections required for today's contemporary dental practice. We will start with a review of the latest in dental patient chairs and then examine other seating options to help you, your staff, and patients move down from the cheap seats that may be compromising your office.

Dental patient chairs

I will minimize the theoretical discussion on dental patient chair design and list, from my perspective, the best three dental patient chairs available in terms of quality, function and appearance.

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A-dec 500 — Congratulations to A-dec for "finally" bringing this chair to market. There are a multitude of features in the new A-dec 500 chair that make it far superior to the previous Cascade series. The A-dec 500 is the best combination of a thin back that maintains flaring and convexity to support patient's shoulders. The headrest adjustment knob is very minimal but still allows all critical adjustment factors without being a "knee-banger." The underside of the chair back perimeter is flexible and facilitates your ability to slide knees and thighs underneath. The centerline convex structural element of the chair back (versus the flat ironing board style) does limit how far your knees will slide underneath before colliding with the structural element. Having said that, I found the A-dec 500 receptive to most commonly assumed operator positions.

The A-dec 500 is offered in two upholstery styles — seamless and sewn. I prefer the look of the seamless option. The sewn style is more loosely fitted and may be more comfortable due to pressure point dispersion advantages. The sewn upholstery can shift in relation to the chair frame as patients squirm to acquire the most comfortable position.

Pelton & Crane Spirit 2007 with Advanced Comfort Plush Upholstery — From the patient's perspective, this has to be the most comfortable chair available. The combination of high-density and memory foam allows the chair to mold and shape to the specific contours of the patient. Squeezing this chair's upholstery between your fingers is a similar sensation to squeezing a stress ball. The overall chair design has very clean lines and well-crafted parts and pieces. The Spirit chair back is slightly thicker than the A-dec 500 and will potentially create ergonomic issues in some operator positions. Avoiding the knob style articulated headrest option will aid in your ability to slide knees and thighs under the chair back.

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DentalEZ J/V Generation Chair — While the trend of the entire dental industry is toward flared and thicker-backed dental chairs, DentalEZ continues to hold their position as the leading proponent and manufacturer of narrow and thin-backed chairs. The "ironing board" style of chair is unquestionably the most ergonomic for operator and assistant positioning. This will never change, and the fact that the anatomy of a patient's back will never mirror the shape of a flat "ironing board" will also never change.

In response to this apparent design contradiction, DentalEZ Group has designed the new chair with their exclusive independent tilt motion that allows the patient to be easily and comfortably positioned. Furthermore, this unique feature allows for proper spinal alignment and helps reduce stress on the discs and soft tissue around the patient's spine.

DentalEZ's new J/V Generation chair actually has a thinner, more narrow back than the traditional DentalEZ J-Chair. This allows for less strain on the dentist while facilitating better comfort for the patient. The "hallmark" arm slings of DentalEZ remain a prominent design feature. And while they certainly contribute to the ease of operator ergonomic positioning, they also contribute to the traditional appearance of this dental chair line. Additionally, DentalEZ has added a Comfort-Plus option for those practices looking to add a "cushier" back to address past concerns of patient comfort.

The perfect chair would be a combination of the best aspects of these three chairs. Of course, that is not possible due to competing design factors that balance patient comfort vs. ergonomic positioning. My choice at this time as the best balance of competing design factors is the new A-dec 500 chair. As a leading ergonomic expert, Mary Govoni would choose the DentalEZ J/V Generation chair. As a dental patient undergoing a lengthy procedure, I would love to be embraced by the Pelton and Crane Spirit 2007 chair with Advanced Comfort Plush Upholstery U memory foam can be a wonderful thing.

Operator and assistant stools

Unlike the above dental patient chairs that are also at the top of the price range, my favorite operatory stools made by Link Ergonomics are priced below many of the larger manufacturers' competing stool options. Link stools (referred to as task chairs by Link) have a nice clean look and great ergonomics. Model #185AB is an excellent choice for operators and model #185ABR is an excellent choice for assistants. Link stools can be purchased direct from Link Ergonomics at (800) 424-5465.

Unfortunately, outside the clinical area, there is often little consideration paid to the functional requirements and esthetic impact for seating in staff and patient areas. And if you are thinking it doesn't really make any difference, you might be surprised by the feedback from staff who sit all day in an inappropriately sized or proportioned chair or a patient who sits and assesses (and don't think they aren't) how you feel about their comfort or experience as they await treatment. So let's venture out of the clinical area and take a look at the rest of your facility's seating options with the help of my wife and business partner, Pat Carter, IIDA. Pat has more than 25 years experience as a licensed interior designer focusing exclusively on dental office design.

Waiting room seating

The number of seats available to patients only becomes a problem when you suddenly don't have enough. In a growing practice, this would seem hard to avoid. There is a way to anticipate the seating requirement, however, before you glance into the waiting area to see patients standing or, worse, sitting in each other's lap. A guideline that is still effective is 1.5 to 2 times the count of dental chairs (4 operatory chairs = 6 to 8 waiting chairs) for 20 patients per day or less (general dentists, for example) or 2 to 2.5 times the count of dental chairs for 60 to 80 patients per day (8 chairs = 16 to 20 waiting chairs). The number of patients you would see on a busy day and the potential for spouses, children, or "others" who require seating other than the appointed patients should both be considered when assigning a count of seating. Also, if you plan to expand the number of dental chairs in the future, then plan on a similar expansion for the waiting area.

Once the seating count is appropriate, then other considerations become significant to the patient's "experience" and ultimately to your furniture budget. Once your seating count exceeds six chairs, consider changing the seating type. For example, a waiting room for 12 with arms and legs of the same style chair lined up around the walls of your waiting room will convince your patients that it is more about getting enough seats than about creating any kind of relaxing, inviting experience for them as they wait. Urgent care waiting areas and bus stations have the same look. Conversely, loveseats combined with lounge-sized seating (28 inches wide) and "standard" armchairs (24 inches wide) will not only provide seating types that can accommodate larger-sized patients (something important to consider) but will achieve a more inviting impact. Segregating seating areas for six to eight in larger seat count waiting areas will also maintain a greater sense of comfort for patients versus a "sea" of seating (even with different types of seating).

Lastly, the investment in furniture can be a surprise if you haven't purchased commercial furniture in some time. "Office to go" retail stores exist to support the budget-minded, "it's just a chair" type of buyer. However, if you really want to create an impact for your patients that reinforces the high-quality dentistry of your practice, then you probably want to look beyond the $150 chair with square oak arms and standard herculon fabric. If you agree, then it may be time to update your budget presumptions. For example, pricing for a quality contract armchair can cost quite a lot ($ 450 to $1,000 per chair) and is a reflection of the scale (size) of the furniture piece, the wood type and finish applied, the chair style and design interest (curved or carved wood frames will be higher than squared shapes), and finally the durability.

To achieve the best esthetics, the dollars invested in your furnishings should be congruent with the investment made in dental, business equipment, and the dental facility itself. Incongruency in furniture selection can be distracting and ultimately sabotage your esthetic efforts (inexpensive-looking or poorly scaled furniture in a nicely appointed space or expensive looking furniture in a painted, uninteresting space).

Business area seating

Function becomes a primary consideration in this category of seating. The task chair for business administrative staff should be just as thoughtfully selected as the clinical operator stools. Functional criteria to consider include width and depth of the task seat, lumbar support for the back, flexibility in positions for the user, and durability. Just as in dental patient chairs, the greater the comfort (size or scale of the task chair) and the greater the flexibility (ability to move the seat and back to a variety of positions) translates to a greater investment.

Avoid the urge to run down to the local furniture mart and pick up the $89 black fabric secretarial stool, unless you don't really care about the seating flexibility or the longevity of the stool (because you will be replacing it year to year as it falls apart). Investing in a quality task seating type ($450 to $600) will pay back in durability and higher staff comfort and productivity. More than any other seating type, this is one that should be "test driven" before buying. Have your local business furnishings company deliver some options to the office for staff to "try on" for several days of work, then purchase the style that best meets the needs of most of your staff. Watch for arms that may get in the way of countertop computer keyboard access and consider polypropylene (black plastic) backs that can save on material that becomes worn over time by hitting a sharp plastic laminate countertop edge.

Consultation room seating

Today, we are designing the consultation room with built-in cabinetry and peninsula desk surfaces to accommodate the technology that is becoming a mainstay of treatment presentations. Function and esthetics play a part in an optimum selection for the seating in this area as well. Functionally, it must be easy for patients of all sizes to access the seating, pull up to the desk/table surface and view the information being presented. A side chair (without arms) is an optimum chair type that allows easy access (eliminating the need to pull a chair completely away from a table edge to seat yourself) and is highly recommended in smaller consult areas. If space allows, armchairs do provide an added benefit of support to the seated, viewing patient. Make sure the arm heights will clear the desk's edge.

A moveable task chair (or managerial chair) for the dentist or staff can be an optimum choice in the same space, allowing greater ease of movement in the seated position to access computer screens, pull information from a cabinet, or pull closer to a patient. Just as in the business area task seating, the range of pricing on managerial chairs can be quite surprising ($ 650 to $ 1,200). Pricing is generally a reflection of the material (fabric or leather), the base frame (purchase five-prong bases for best stability), the frame materials (metal or polypropylene), scale of the seating (24- to 28-inch widths); and flexibility of the seating unit (e.g. separate tilt and swivel at seat and back). This is another "test drive" candidate because of the variety of seating comforts and flexibilities available in this seating type. Business furniture companies are happy to offer floor samples for loan to be sure you meet your seating expectations.

Doctor's office seating

Yes, your office too should be given seating attention, assuming you have a private office. And if you do, then investing in a quality chair that offers high esthetic and functional flexibility is important. Granted, there are plenty of responses that would thwart such a notion — "I'm only in there a few hours a week. Why invest in a quality chair?" It's because you are in the dental operatory chair all those other hours. A comfortable and beautiful executive chair that makes you relax is a great reason you should invest.

The executive chair is typically the highest investment seating furniture piece because of the scale (seat and back width and seat height), chair mechanics (tilt and swivel mechanisms), and materials options available to you. You can expect to invest $ 650 to $ 850 in a managerial height chair (seat back height to your shoulders) and $ 850 to $ 1,200 for an executive height back (seat back at a head rest height). And if you really want nice, there is nothing like the smell of leather.

Staff room seating

Finally, the staff room has become an integral part of the dental facility. Unless space just doesn't allow, the old days of considering this a non-productive space are faded and dentists have embraced the benefits of an on-site space that accommodates lunch in (and back to work!), continuing education, staff huddles, etc. All of this leads to the seating in the staff area as a response to the function use and application.

In offices that are squeaking out a staff area for a small table and four chairs, design considerations for other forums other than bologna sandwiches at the noon hour qualify staff seating at less expensive metal options or less expensive wood type (beech) frames, smaller scale (18- to 20-inch wide seats), and with or without fabric ($89 to $ 200 per chair). For those of you who want to upgrade the staff area to a multifunctional space, you may need to consider other options of seating. For flexible use of the space, stacking chairs are an optimum choice, allowing storage of seating that can be pulled into the room during a workshop presentation, or removed and easily stored when not needed. Stacking chairs are available in wood as well as metal frames with stylish departures from the squared, hollow, metal-framed stack seating typical in large hotel conference arenas. Again, pricing can range in response to scale (20 to 24 inches wide typically), frame material (wood or metal), styling, and fabric (or lack thereof).

Regarding the esthetics of the staff area seating, this can vary widely from dentist to dentist. Ultimately the users of the staff area and the functional applications will drive the esthetic decision. If your staff area is in fact to be the quick in and out room for lunches only, then a metal frame with polypropylene shell seat may be the smartest choice ($ 60 to $100). After all, who wants to hang out for very long in this type of seating? On the other hand, comfort, flexibility, and style may be more important in a staff area that receives your evening dental study club or consultants who do all-day presentations to you and your staff. If so, seating to meet these higher esthetic expectations will range in cost from $200 to $350 on average.

Investing your hard-earned dollars in high-quality, well-designed seating that is strategically located throughout your facility communicates to patients and staff that they are special and deserving of choice seats on the 50-yard line or courtside of a great sporting event. Of course, you might also encounter a cynical 12-year-old who thinks you inherited all your wonderful seating from a rich uncle.

Dr. Jeff Carter is co-owner of the Practice Design Group, based in Austin, Texas. PDG specializes in providing architectural, interior design and equipment, and technology integration services to dentists nationwide. Dr. Carter may be reached at (512) 295-2224 or by email at [email protected]

Contract furniture contacts

Unlike dental patient chairs, there are countless contract furniture lines offering traditional to contemporary styling. So many in fact, making a selection can become confusing and overwhelming. That said, some furniture lines (with Web sites) to consider that offer a range of styles, scale, and durability for dental office application are:

More budget-minded lines

Chairmasters, Inc. —
Loewenstein —
Whitehall —

Medium to medium-high lines

Carolina Business Furniture —
Paoli —
David Edward —
Davis Furniture Industries —
The Gunlocke Company —

Medium-high to high lines

Brayton International —
Bernhardt Design —
Cabot Wrenn —