Regulations with SIGNIFICANT design implications.

Regulations with SIGNIFICANT design implications.

Originally printed in DENTALECONOMICS 04/2012

Jeff Carter, DDS, and Pat Carter, IIDA

Regulatory standards promulgated recently and older regulatory standards with revised interpretations will present challenges when designing and constructing a new facility.

1. Lighting energy budgets — State and local municipalities dictate limits for total wattage of lighting in the dental facility. Though the “medical use” patient lights are exempted, typical lighting energy standards are 1.0 watts per one square foot of facility. Translation of this to a 2,000 SF, four-operatory dental facility would be 20 100-watt incandescent bulbs of artificial light for the interior. With 15 to 20 individual spaces in a 2,000 SF facility, one 100-watt lightbulb makes for a pretty dismal waiting area.
Fluorescent fixtures at 13 watts and LED fixtures at 8 watts produce the same lumens as a 100-watt incandescent lamp, though at a higher cost per fixture (LED fixtures at two to three times higher cost than their fluorescent counterparts).
If your new facility goal is to create an “experiential” environment using lighting design beyond generic clinical fluorescent ceiling-grid fixtures, strategize with your design team and contractor about how you can satisfy energy budgets, control costs, and achieve the desired lighting design impact.

2. Vacuum and compressed air regulated as medical gases — Recently, NFPA code (a national code standard) for medical gases in dental facilities has been expanded to include compressed air and dental vacuum. There is disagreement about these interpretations and variance in application.
Most of us are familiar with stringent code issues involving N2O2 and O2 use and storage within a dental facility. The expansion of med gas standards to compressed air and dental vacuum introduces these additional considerations:
a. Compressed air and dental vacuum “may” be disallowed when embedded in the concrete slab with no accessibility between mechanical units and terminations.
b. Vacuum and compressed air connections to chair-mount delivery units “may” require removable floor access panels to expose vacuum and compressed air lines plumbed to the J-box under the “toe” of the dental chair.
Fortunately, compressed air lines can be run above ceilings and through walls without affecting performance of the air compressor. Soft tubing connections to delivery units can be made through conduits embedded in the slab.
There are multiple concerns when the majority of dental vacuum plumbing is run overhead and then lowered to floor level for connection to delivery and dental equipment units:

• Vacuum pump must be resized for increased performance demand.
• Plumbing runs become more sophisticated to ensure proper sloping and avoidance of sharp turns in lines running back to the vacuum pump(s).
• It is not uncommon to introduce unwanted gurgling noises as vacuum collection fluids are “pulled” up walls adjacent to dental chairs and delivery units, advising additional wall insulation.
• In warm weather regions, there may be a concern for PVC vacuum lines run in plenum ceilings with high temperature extremes. Heat may cause suspended lines to “sag” and potentially loosen solvent weld connections, resulting in degassing of lines and a drop in vacuum performance. A costly solution is to introduce rigid copper vacuum lines in overhead runs.
• Dental chairs and delivery units placed in open bay configurations may require conduit “sleeving” to make elongated runs in the slab and still provide access points to expose vacuum and compressed air lines.
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3. Ongoing confusion by doctors regarding the Americans with Disabilities Act — Unlike the previous two regulatory issues, the “intent” and interpretation of ADA standards in a new or remodeled dental facility is much clearer. Whether you agree with the intent or not, it is a federally mandated requirement:
Regarding compliance with ADA:

• Assume your new facility will be subject to all ADA standards.
• Don’t assume the wheelchair access standard is for patients only and therefore dictates only one complying operatory, restroom, main entry, and parking stall. That is never the case!
• Understand ADA standards are intended to allow wheelchair access to all spaces of the dental facility with the exception of utility and storage spaces.
• Assume staff or patient spaces on multiple levels, including basements, will require an ADA compliant elevator or lift.

Though you would like to assume otherwise, your dental facility must comply with regulatory standards assigned to medical specialty. Understanding this will avoid rework and project cost additions at the time of the permit.