The Tray, Tub, and Cart System

With dental insurance reimbursements being so low, many of us must step up our production in order to make ends meet. In order to handle increased caseloads and still deliver high quality dental care, it is imperative that we set up systems that will allow us to work extremely efficiently. One way to help boost efficiency is by adopting what I refer to as the Tray, Tub, and Cart System. This will put the most common elements of your armamentarium at your fingertips, greatly increasing your efficiency and reducing aggravation.

Trays: Keep It Simple

The tray is for hand instruments that will be commonly used for a particular procedure. At the dental school where I teach, they use an instrument cassette that includes everything but the kitchen sink. It contains more than 20 instruments. Such a setup is not realistic for a small private practice. Most offices do not have autoclaves large enough to fit a cassette of that size, and the capital outlay for multiple instrument sets would be way outside of a normal budget.

I recommend assembling just a handful of common instruments for each particular procedure and keeping them in an autoclavable cassette or a sterile pack that is ready to open onto a sterilizable tray. Plastic trays are very inexpensive and can be easily sterilized. To support these setups, clinicians should also keep a number of individually wrapped instruments that are only used in special circumstances close by.

Tubs: Organizing Commonly Used Materials

Tubs are an extremely convenient method of keeping the most-used materials for procedures within reach. They also make for quick changeovers from one procedure to another and allow for rooms to be quickly set up for the next patient. For proper infection control, ensure that each tub has a securely fitting cover and that all dental assistants are very strict about removing their gloves before lifting the covers to retrieve items from inside.

I recommend having one separate tub for all composite and bonding materials for the entire office. Composite tubs can hold matrix strips, wedges, finishing strips and discs, etching solutions, microbrushes, disposable bonding wells, composite syringe guns, floss, and more. The list goes on and on. Due to the relatively short shelf life of composite materials, clinicians want to make sure that they are giving their patients the freshest material available. Our composite comes in compules. To make life easy, we have a case with multiple compartments where the compules for each composite shade are placed in loose for easy retrieval. All compules for that shade must be totally used up before a new package is opened. This system ensures that we avoid mixing compules with varying expiration dates.

Endodontic tubs are great for holding items such as sterile packs of files, paper points, endodontic sealers, gutta-percha points, medicaments, temporary filling materials, and articulating paper; crown and bridge tubs can contain items such as temporary cements, desensitizers, luting cements, polishing wheels and points, floss, and articulating paper; and surgery tubs can bring together gauze packs, sutures, needle holders, suture scissors, curettes, periosteal elevators, and scalpel blades and handles. All surgical instruments placed in tubs should be stored in sterile pouches. As you can see, the potential contents of each tub is only limited by the needs of one’s workflows and protocols.

Carts: Mobile Storage for Complex Procedures

The third part of the system is the cart. We maintain individual carts for endodontic procedures, extractions, implant surgeries, implant restorations, and emergencies. There should be no need for duplication of expensive instruments, devices, and other supplies. Simply have all of that in a cart that can be rolled from room to room. And the carts don’t have to be pieces of fine furniture. An inexpensive plastic cart from the local discount store more than serves the purpose. Our endodontic cart has the electric handpiece motor, an endodontic heat source unit, and an apex locator perched on the top, and inside, we store our inventory of endodontic supplies, such as hand files, engine reamers, obturation materials, and any other items that may be needed during a root canal treatment. The extraction cart has an entire collection of forceps and elevators for every conceivable surgical extraction need. In the implant surgery cart, we store an assortment of commonly used implants, bone grafting materials, membranes, and surgical instruments, and the electric surgical handpiece unit can be easily set on top of the cart. Our implant restoration cart carries a huge inventory of restorative components for the common implants that we restore. Furthermore, it enables items such as impression copings, scan bodies, healing caps, implant analogs, drivers, and torque wrenches to be kept in one handy place. And finally, the emergency cart has all of the supplies that we hope that we will never need, including the emergency drug kit, various airways, a bag valve mask, sedation reversal drugs, and IV supplies, which are all together so they can be used at a moment’s notice. An ECG unit sits atop the cart, and on the side, I hang a one-page list of common emergencies along with drug names and dosages. We can memorize all of that for a test in dental school, but when a real life-or-death situation hits you hard and fast, it sure helps to have a cheat sheet.

Maximum Performance

Returning to the topic of efficiency, every minute that a treatment room doesn’t have a patient in the chair being actively treated by a professional is lost revenue. Disinfecting a room after treatment is necessary but can be time-consuming. We don’t need to add to that time by having a lengthy setup process as well. With the Tray, Tub, and Cart System, by simply changing out a tray and tub and rolling in the appropriate cart (if needed), you are good to go to seat the next patient.

To make ends meet in a practice that accepts dental insurance, one needs to maximize the amount of treatment that is being performed on any given patient. Oftentimes, that means performing different types of procedures simultaneously, such as combining crowns, root canals, composite fillings, or extractions during the same appointment. Utilizing the Tray, Tub, and Cart System makes switching between procedures a breeze. For example, when a composite restoration is determined to have pulpal involvement requiring root canal treatment, and the patient is in the chair already anesthetized, it is best for everyone involved to go ahead and perform the root canal procedure right then and there. The assistant can easily change out the tub and roll in the endo cart, and then you are up and running. By setting up efficient systems, we can greatly increase production to help combat the scourge of reduced insurance reimbursements and increase the profit we receive from our hard work.

About the Author

Richard P. Gangwisch, DDS, a master of the Academy of General Dentistry and a diplomate of the American Board of General Dentistry, is a clinical assistant professor at the Dental College of Georgia at Augusta University and practices in a Heartland Dental-supported office in Lilburn, Georgia.