Six Truths About Dental Cabinetry / Millwork

THEORY #1:
Pre-manufactured dental cabinetry offers superior ergonomic design.

TRUTH:
One would expect that to be true.  Unfortunately, that is a profound fallacy!  In fact, many of the products designed and produced by those companies necessitate class IV and class V movements for the assistant and clinician to access equipment and materials; thereby necessitating the temporary loss of physical and visual contact with the patient.  Some designs actually necessitate that the assistant leave his/her stool and bend or kneel to access storage spaces.
Our designs are based on the ergonomic principles of Four-handed Dentistry and maximize efficiency.

Additionally they are designed to include the efficient use and convenient storage of clinical adjuncts, i.e. electrosurge, airabrasion, intra-oral camera, laser, etc..  The cumulative effect is a work environment that is designed for the user(s) as opposed to the user(s) adapting to a pre-conceived, one-size-fits-all design concept.

MOVEMENT:  
I- Fingers only; II- Fingers and wrist; III- Fingers, wrist, elbow; IV- Entire arm and shoulder; V-Torso

THEORY #2:  
Pre-manufactured dental cabinetry is superior to others in fit and finish.

TRUTH:
Impossible!  There is simply nothing better than “the best”. Therefore all that anyone can claim
is that they are using “the best” materials and techniques.  The fact is that the materials that
are available to the dental manufacturers, are available to every designer and fabricator.  Please review and
compare the list with anyone who purports that they offer a superior product, and ask them to demonstrate their claim.

THEORY #3:
Pre-manufactured dental cabinetry is better constructed than that of others.

TRUTH:
Impossible!  There are only a few techniques that merit distinction as quality cabinet construction.  With the exception of “furniture quality” (sophisticated joinery and solid,hardwood construction) there is no difference in the finished product of the carcass (shell) of the cabinet.  Screws, dowels, biscuits and adhesives all result in solid construction.


THEORY #4:
Pre-manufactured dental cabinetry offers superior finishes to those of others.

TRUTH:
Again, impossible!  Although they are in no way superior, there are two factors that could distinguish those products as “different”.
1. They could have their own pattern produced in the surface of a plastic laminate.  To clarify: Plastic laminate is comprised of several layers of craft paper.  The last layer bears a “photograph” of an image (pattern, color, wood grain, etc.). That surface is covered with clear melamine [plastic] to provide a resistant and durable surface- thus the term “plastic laminate”.  Anyone can order “custom” laminate- for a price.  The fact is that it no better than any of the hundreds of plastic laminates available on the open market.
The exclusivity of a “proprietary finish” actually creates problems for two reasons:

A. It restricts the potential to match any adjunctive millwork that might be Positioned in direct adjacency to
the dental cabinetry;

B. Potential for the same pattern to be available years hence could be a concern if that pattern of color is
phased-out.  Should that happen, the ability to replace a door, drawer front or panel with one that would
match the original could be eliminated.

2. They could produce their own injection-molded, door and drawer-front design.  That option is, again, available to all designers and manufacturers.  It’s simply a matter of investing in the die or mold.  Injection-molding is nothing new or innovative.  In fact, that method is used commonly by many manufacturers who produce kitchen and bath cabinetry; as sold in all “Big Box” stores.  Further, the injection-mold concept is more prevalent in the lower-end lines of cabinetry, due to the obvious cost savings.  So a door that appears to be “raised panel” construction is simply formed in that shape.The bottom line is that the integrity of those doors and drawer fronts is comparable to that of all other products.  The only distinction is that the design might be unique in appearance.  For “a price” those features can readily be replicated or improved-upon.  The bottom line is- like the “proprietary laminate”- the mold forms may not be available in subsequent years- a profound example of Planned Obsolescence.

THEORY #5:
Pre-manufactured dental cabinetry is a better value than that of others

TRUTH:
Impossible!  Our designs have consistently been constructed by high-end, custom cabinet shops.  In the majority of cases, the costs for the same volume of storage as that existent in pre-manufactured, dental cabinetry have been half of the cost of pre-manufactured dental products.  When you consider the amount of money that will be invested in cabinetry for treatment, hygiene, sterilization and lab cabinetry, the savings in the physical end products alone is astounding. The ergonomic benefits are virtually limitless.


THEORY # 6:
Pre-manufactured dental cabinetry offers features and functions that are not available anywhere else.

TRUTH:
Not true!  We have done it all:  Glass doors; LED or low-voltage lighting; pneumatic doors; pneumatic  water controls; super-heated “instrument drying” storage space.  These “features” provide no distinctive benefit that can’t be accommodated conventionally or creatively- absent extraordinary cost.  In kind, the hardware that would support the function of a slide-out, pop-up, pivot or hide-away components is available from numerous hardware manufacturers.

THE BOTTOM LINE:
We live in a world of compromise.  Office space selections are commonly based on what is
available and is typically based on- location, size, need, cost and convenience.  Therefore, it is
not unusual for there to be physical conditions that compromise the use of pre-designed cabinetry in optimal
orientation that would maximize function and flow.  We share these thoughts for consideration:

1. To select or design an office around any product or pre-made assembly of products, would be like designing a house around a 7’-2” distant relative.

2. Angled or curved walls, windows, doors and vital equipment all need to be accommodated.  Cabinetry can be custom-designed to maximize the use of the site-specific condition.  

Behold: The Construction Contract

Oddly enough, it’s not the fine print to which you are vulnerable

It would require the text equivalent of “Gone With The Wind” to
adequately describe the details necessary to execute an average dental office construction project. As a result, most contracts- including the AIA [American Institute of Architects] document, defer the “description of services” to the respective construction documents, AKA: drawings, plans, etc. The dreaded fine print in the construction contract, although duly worthy of scrutiny and evaluation, is simply additional legalese intended to protect one or both parties in the agreement. Eyes wide open: no harm, no foul.

So if the answer is right there in big bold print: Construction jargon, both large and small print- is only an agreement stating that your contractor will “provide… in accordance with the services to be provided is “‘doc-u-ment: [is] an original or pages containing dream-inducing images of your future office- formerly referred to as benign “plans” or “drawings”- will heretofore to be known as “exhibits of the contractual agreement”. And here’s the kicker: The author of those documents is not a required signatory on the contract.

In most cases there is no agreement. This often results in costly change-orders. Yes, change-orders are sometimes unavoidable. But,
they should be limited to things like unforeseen site conditions- not to be the expected norm. I’ve witnessed projects that grew by as much as 30% in cost overruns- that’s $90,000 on a $300,000 project, and 98% for those costs were predictable, preventable or at least known potentials to be included in the construction cost proposal. No excuses.

We were recently asked to review plans that were prepared by another firm. The results of that review, although daunting, are immaterial. But, I will note that the first sheet in the set of drawings contained a large text table listing services, dates and trades- for change-orders*. Talk about your “red flags”. Also, visible in blazingly bold print were disclaimers exempting the designer from the responsibility of anything from building and life-safety code
compliance to construction detail- deferring them to be addressed in the field or “by others”; thereby placing the bulk of responsibility on the contractor. But, despite this complete communication and budgetary disconnect, the client was prepared to sign a construction contract that left them vulnerable to extensive additional costs. Close call.

Analogously, construction is much like dentistry. Both will have a superior result when thoroughly prepared and detailed. So, I would like to site an example of the deficiencies that are quite common in construction documents. The drawings referenced above did note that a backflow preventer should be installed “per code”. That would be perceived by many lay people as having met the obligations associated with compliance and inclusion as a budgetary line item. The fact is that the directive did not include: location [at water source/inline to defined locations]; whole-house or dedicated run; size; manufacturer; model number; associated plumbing specifications [hard-plumbed/air gap/vacuum breaker]; testable/non-testable; also some towns require more than one. The cost differential could easily span costs of predictable, and preventable, cost overrun. Professional design fees are fractional by comparison.

Besides construction details like those noted above, it is vital that all materials be defined in advance. This is necessary for two budget-related reasons: 1. The cost of the products have an obvious impact on the budget; 2. The labor associated with the installation of different products can vary significantly. This information is typically provided on the drawings and are referred to as construction lighting and finishes, at the very least. This data takes the guesswork out of construction cost estimating, and aids in the process of value-engineering (substituting a similar product of a lower cost) if needed. For example, a door schedule will contain the following: height; width; thickness, detail (flush/raised panel/inlay/glazed) construction (hollow-core/solid-core) species; stain/finish; lights (glass- full/partial, divided); type of frame (wood/metal/etc.); direction of swing, type and finish of hardware; rating (fire protection). The cost differentials can range in the thousands of dollars. You may have wanted cherry or maple doors with a distinctive grain. But, the budget may only allow for standard Douglas fir. Imagine first-class dentistry in an average facility. Oh! That’s what you’re moving from.

So, that brings about another irretrievable forfeiture- quality.

Besides accommodation for growth and improved operational function, the most desired result is the achievement of an enhanced professional image- The “wow” factor. If you plan and budget for a granite transaction counter (as opposed to plastic laminate) it is likely that the cost would be quite manageable; particularly if other products and services provided in the contract are valueengineered [if necessary] to make that accommodation.

Clearly your attorney will protect you from the potentially harmful legal vernacular of the contract with the general contractor or construction manager. But, who is governing the content of the construction documents for the actual services that the contractor has agreed to perform? No one. But, all costs are yours to absorb- because you agreed to pay for them; whether by definition or by tacit acceptance of the designer’s documents. In a nutshell, you
have given the designer a blank check to spend as they see fit with no accountability or remorse. There is very good reason and practicality to hire a professional. They are the only ones who are capable of actually defining and managing your project and the associated costs of development.

A footnote to hiring a professional designer- make certain that they are not deferring any services like MEP (mechanical, electrical and plumbing) to a third party. It is essential that the designer have a full and articulable understanding of all equipment and associated construction materials and services. Without that knowledge, they will be unable to effectively control and manage the project.

Please note that most of the contractors with whom we have worked are honest, hard-working and accommodating people. Regardless, they are in business to make a living, and can’t perform their services for free. Consequently, if additional work is required as a result of missing or insufficient information, they are entitled to be compensated for that work. That’s the good news. For that small percentage of unscrupulous contractors- caveat emptor!

Lastly, the contract to which your attorney’s attention should be directed is the one between you and your designer. Paramount within that agreement are two major concerns: 1. Beware of disclaimers- professionals “own’ their work. 2. Request verification that they are capable of providing the necessary construction details that will allow you to establish and adhere to a budget. Take heed, and God-speed. schedules; which includes door, window, plumbing,

Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, Garrett has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at http://www.dentaldesign.pro/. or LinkedIn: http://www.linkedin.com/in/garrettludwigcontractual fine print is essentially harmless, you might ask how you might otherwise be vulnerable. TheDocuments. The signed contract itself- replete with its legalconstruction documents” and you will “pay…”[and pay, and pay]. As such, the actual contract for thecontained in the Construction Documents. To wit, according to Merriam Webster aofficial paper relied on as the basis, proof, or support of something.” Those prettythree-party communication (client, contractor, designer) prior to the signing of the twopartyseveral hundred dollars. That’s just one small, but costly, example of a very

Behold: The Construction Contract