T h e d e n ta l o ffic e in tra n s itio n
Richard A. Glenner, DDS, C hicago
ecause dentistry, architecture, technology, and interior decoration are constantly changing, the dental office has continually been in tran sition—from outdoors to indoors, from house hold chairs and cabinets to commercially manu factured equipment, from spittoons to plumb ing, from candles to electric lights, and from stand-up to sit-down dentistry. Most early dentists in Europe practiced out doors and, of course, extractions were the most common treatment. Besides the men who set up their offices outside at village fairs, the blacksmiths of the time had a successful side line in dentistry. A few town tooth-drawers or barber surgeons did practice in their own homes or made house calls. Later in America, because of sparse populations and the distance between towns, dentists as well as other pro fessionals and tradesmen became itinerants, often using a room in a local inn for a tempo rary office. In the early 1800s, dental offices were found only in the large cities. Candles and daylight were the major sources of illumination, and household chairs and tables formed the office equipment of the day. There was no commer cially manufactured equipment, no plumbing, and no electricity. By 1880, changes had occurred in methods of practice and greater interest was being taken in saving teeth. Dental offices, even in the small er cities, were well equipped with commer cially manufactured cabinets, chairs, and spit toons. They usually had petroleum lamp or gas lighting. Around the turn of the century, when the transition to plumbing and electricity was bringing new equipment into the operatory, 952 ■ JADA, Vol. 91, N ovem ber 1975
the need for sterility made its impact on den tistry. Therefore, linoleum replaced carpeting, Victorian bric-a-brac was removed for spotless walls, and wooden chairs and instrument cab inets were replaced with metal ones for easier cleaning. Dentists had always worked in clothes fitting the fashion of their era, if not in more elaborate dress. With the concern about steril ity, most began to wear special clinician jackets. Dental laboratories have changed with the advent of new equipment, materials, and tech niques. Laboratories were once small, dark rooms off the dentist's office, but today they are bright, clean, and an integral part of the of-
Dental treatment of a Scythian warrior, fourth century BC. This is the oldest known representation of dental treatment; the pale gold vase was discovered in a grave on the Crimean peninsula in southern Russia. The dentist is shown kneeling before his patient. The vase is in the Hermitage Museum in Leningrad.
fice. Some modern dental laboratories are commercial and are housed in their own build ings. Laboratory equipment has been modern ized along with operatory equipment. Foot lathes for polishing met the same fate as the foot dental engine and were replaced by elec tric dental engines. The early muffle furnace used in the manufacture of porcelain teeth evolved into the wax burn-out furnace heated by gas, which now has given way to automatic furnaces run on electricity. The mouth and bel lows blow pipe used for soldering evolved into the air and gas torch also used for soldering and for melting gold during casting: automatic casting machines are now being used. Work benches are no longer made of wood, but metal. The modern office is bright and air-condi-
tioned, the cabinets of period or contemporary design, and the equipment mobile or stationary. Adding to the color in the office are the new fashions worn by both the dentist and his as sistant. All the progress in dentistry—in treat ment philosophy and innovations, anesthesia, improved materials and equipment, the utiliza tion of assistants, and the expanded knowledge about dental disease—have contributed to change the dental office. About the only thing we can say with some certainty about the office of the future is that it will probably remain indoors.
Dr. Glenner's address is 3414 W Peterson Ave, Chicago, 60659.
Artists have detailed the life and people of their day. From paintings and drawings of the 16th to 18th centuries, we can learn about the type of dentistry practiced, the dental office, and the characteristic dress of the dentist. This is one of the first copperplate engravings using the dentist as a theme; it was made by Lucas van Leyden, a prominent Dutch engraver, in 1523. The patient stands while being treated by an elegantly dressed, wandering dentist of the time. Extracted teeth decorate the brim of his hat. (Some dentists, even up until the 20th century, displayed extracted teeth in their waiting rooms.) The dental instruments and medicaments are placed on the table. This particular dentist practiced his trade outside, although many early dentists did practice in buildings.
G lenner: DENTAL OFFICES ■ 953
Later, dentists began to perform their treatment on a platform. First, the platform was a simple podium; later, more elaborate stages were used, some with wings. The platform was erected so that the dentist and his equipment could be seen above the public. The patient either stood or sat on the stage or in a chair. At fairs just outside of town, a clown, conjurer, or other entertainc attempted to draw the attention of the crowd. Tooth-drawers, quacks, and charlatans, nobly attired, abounded at the fairs, but this dentist seems to be displaying his credentials. Real dental care and treatment were as yet unknown.
This seems to be the first illustration of a dental office in literature; this 16th century woodcut is from "Artzneybuch." The room, apparently in the dentist's home, is small, with a low ceiling. The only sources of light seem to be the door and windows. The dentist probably used the shelves on the wall to hold his instruments The patient is sitting in a household chair of the time.
Although early dental treatment often took place in the home of the dentist or of the patient, extractions particularly were usually done outdoors. This toothpuller, plying his trade in the middle of a group of peasants in the village marketplace, was typical of the early 1700s. The country dentist, with primitive instru ments and inadequate knowledge, usually had an audience.
954 ■ JADA, Vol. 91, N ovem ber 1975
People in the countryside often turned to the village blacksmiths for extractions, as they had for centuries and as they continued to do at times until late in the 19th century. Dentistry was a normal sideline for the blacksmiths in a time in which few properly trained dentists were to be found. The town tooth-drawer was the closest to our modern impression of a dentist. However, his type was rare and his clientele came almost exclusively from the upper classes. He treated his patients in his own home or in the patient's home.
In New York in 1785, John Greenwood, George Washington's dentist, began to practice dentistry in his home on Water St. In early America, most dentists' offices were in their homes. The transition of the offices from the dentists'homes to buildings used specifically for offices included these stages. First, dentists used a room in their homes and then called a specific room their office. Next, a separate entrance for patients, or perhaps a wing of the house, was added. Later, dental offices were located in small buildings that offered space for living quarters in the back or in multiple-story buildings in which several rooms could be leased. Today we are watching another segment of the transition —dentists are opening offices in medical centers in which men from various health professions practice.
Glenner: DENTAL OFFICES ■ 955
Since only large American cities could support a dentist and since treatment was still a luxury for the most part, dental practitioners took to the roads. In the early 1800s, a dentist such as loseph Moore (bottom) packed his instruments, medications, his dental chair—and his family— in his wagon to move from town to town. Some itinerants set up temporary offices in local inns or hotels. Itinerant dentists worked in many parts of the country up until World War I. The painting at top was done by Hedda for Astra Pharmaceutical Products Inc.
956 ■ JADA, Vol. 91, Novem ber 1975
V *.
^
♦ ■y-
' *
y *■
This dental office in the Midwest, about 1830, was a room in the dentist's home. In many of these early offices, a single room was used for both the operatory and waiting room; however, some offices, especially those in large cities were more elaborate. Here, the log under the runner of the rocking chair holds it in position, and the chair faces the window for light. Extra illumination was provided by the candle, on the table, which the dentist would hold up to the patient's mouth. The dental kit (also on the table) may have been nothing more than a group of instruments. The dentist is wearing a Prince Albert coat and fancy vest. The picture is of an exhibit from the 1933 World's Fair in Chicago.
*- A
This is a replica of G. V. Black's office in Jacksonville, III, after the Civil War. At this time, offices had some commercially manufactured equipment such as the chair and cabinet shown here, but there was no plumbing or electricity. A few offices, although still in dentists' homes, contained a separate waiting room and more than one operatory; some had special entrances for patients.
~Y y
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4A
yW -)
Dr. F. C. Holmes of Mangum, Okla, sets out to visit a patient. This small building has two offices—one for Dr. Holmes and another for a physician, Dr. Stone. It must be considered the forerunner to the present medical center building. The dentist and physician probably lived in rooms behind their offices. Besides treating patients in his office, Dr. Holmes also functioned as an itinerant; notice the foot dental engine in the buggy.
This dental office in Boise, Idaho, is in sharp contrast to the offices of just a few years later when sterility became so important. The office has no plumbing and no electricity; a foot dental engine stands in front of the chair, which is facing the window for light. The ornate curtains were there to comfort the patient and make him feel at ease. Did you ever see a dentist extract a tooth while wearing a tuxedo?
These three pictures show the waiting room, office, and laboratory of Dr. Russell Berthel of Minnesota, about 1900. The dentist has*' become concerned about sterility, as shown by the drape for the patient and the headrest cover. The operatory has no plumbing or electricity, but the laboratory does have electric lights. The average cost of equipping a dental office at the end of the 19th century was about $800! ^
Before the turn of the century, in larger cities such as Minneapolis and St. Paul, land was becoming increasingly valuable. As a result, multiple-story structures were built. Dentists rented small rooms or partitioned larger ones for waiting room, operatory, business office, and laboratory. Many of these dental offices were on the second or third floors, and large signs in the windows advertised the dentist. Often, many dentists worked together under the name of one in the office.
958 ■ JADA, V ol. 91, N ovem ber 1975
This one-story frame building in Wyoming is typical of buildings used for dental offices in small towns, especially in the West. This turn-of-the-century office seems to have had no plumbing, as evidenced by the spittoon attached to the dental chair. All the equipment is commercially manufactured. Although Dr. Thode has not made the transition to plumbing, he is midway in the transition to electricity. Notice that he has both a foot dental engine and an electric dental drill.
G lenner: DENTAL OFFICES ■ 959
The 1898 Victorian waiting room, office, and laboratory of Dr. Henry Arthur King of New York City was pictured in “Dental Items of Interest." Dr. King has made the transition to plumbing (notice the cuspidors), but he still has foot dental engines. This office is also of interest because it contains two dental chairs, which of course face the windows for light. The floors are covered with Oriental carpeting.
960
This dentist has almost completed the transition in equipment. He has an early "electric" dental office with plumbing, but still uses gas lighting. In a fewyears, commercially manufactured electric dental lights began to appear. The commercially made cabinet is of wood, but the office does have a sterile look to it. The flooring is a patterned linoleum. This forward-looking dentist also employed an assistant.
In the decade or two before the Civil War and for some years thereafter, there were sporadic attempts to establish commercial dental laboratories. The first one to develop and expand was the Stowe and Eddy Dental Laboratory, which started in Boston in 1887, and which around 1900 opened a branch in New York City. Outstanding among the early pioneers was Samuel C. Supplee, who opened his laboratory in New York in 1898. Another pioneer was Robert J. Rothstein; on the top is a picture of his Washington, DC, laboratory in 1906. On the bottom is a modern commercial laboratory. (Courtesy of Keress Dental Studio, Inc.)
G lenner: DENTAL OFFICES ■ 961
By 1915, the need for sterility was making an impact. Dr. McFerrin, who practiced dentistry in Nashville, Tenn, is wearing a white coat and used drapes and a headrest cover for his patient. At this time, many dental components were brought together in one unit. The one shown here combined the bracket table with the water cuspidor and drill; there is an arm on it for an electric light. Dr. McFerrin kept his electrical switchboard, even after he obtained his unit, for the other electrical things he needed.
Sterility was all important for the dentist and patient in 1920. Wood cabinets had been replaced with metal ones, and everything had to be white to intensify the impression of cleanliness of the operatory. In this picture there is an electric switchboard, but the need for it disappeared with the advent of modern electrical wiring and the use of the dental unit.
962 ■ JADA, Vol. 91, Novem ber 1975
This dental office of the 1920s included a sterilizing room (left). It was sometimes glass enclosed. The room was located to attract the immediate attention of everyone who entered the office and to impress them with the overall sterility of the office. The office's waiting room is shown at right. In keeping with the sterile look of the operatory and with the change in interior decoration, waiting rooms became simpler. Recently, the "homey" look has again become popular.
Dr.). F. Schmid's operatory in Salem, Ohio, is typical of those in the 1930s. The office has a clean, shiny look to it with its linoleum floor, metal cabinet, chair, and unit. Although a dental light is attached to the unit, the chair is facing the window; whenever possible, dentists used—and still use— daylight. Dental graduates of 1930 invested on the average, when first equipping their offices, $2,867. Of this amount, about 80% was spent for operating room and laboratory equipment, according to an ADA survey of dental practice in 1932. Practically all graduates considered the purchase of a dental chair, cabinet, unit, sterilizer, and dental engine essential. A dental light ranked next in importance. Forty-six percent purchased X-ray machines, but only 8% bought equipment for the administration of gas anesthesia. It is interesting to note that 4% purchased a safe.
Glenner: DENTAL OFFICES ■ 963
if*
This is a typical office of the 1940s. Because of World War II, dental offices from 1940 to 1946 remained much as they were in the late 1930s. Even after the war the new equipment closely resembled that manufactured in the prewar years. Real changes did not occur until the 1950s. Notice the electric dental chair and the stool, which shows that dentists in the 1940s did sometimes work sitting down. However, the stools were higher that those used today and the patient was not positioned so far back.
In the 1950s, dental offices still were set up for stand-up dentistry. There were big, elaborate units and dental chairs with conventional headrests and footboards. Dentists who did work sitting down began to tip the chairs back; from this evolved the concept of the contour chair. With the advent of sit-down dentistry, the large units began to disappear in the 1960s because they were generally too high up and far from both the dentist and the patient.
Over the years, most solo practitioners had one to two operatories. In the 1960s, some dental offices became larger because dentists worked together and needed more operatories. This dental office of the 1960s illustrates the transition from stand-up to sit-down dentistry. The modern contour dental chair was designed primarily for sit-down dentistry, whereas the unit is traditional. From this picture, it is obvious why the equipment of today evolved: the unit is too high, the bracket table too far away and too high, and the instruments, including the drills and syringes, too far from the dentist when he is working in a sitting position. Also, the cuspidor, which is part of the unit, would be too far away and too high for the patient.
964 ■ JADA, Vol. 91, Novem ber 1975
$yiT£
d
In the 1970s, new concepts of American dental operatory design are being put forth. Office design depends on the specialty of the practitioner, the type of building that the office is being set up in and whether or not it has windows, and the type of dental equipment the practitioner wants to use. Years ago, the office was designed for "an average practitioner" because a wide variety of equipment was not available. Today, the dentist's instruments can be positioned to the front, to the side, or behind the patient. Also, interior decoration can reflect the individual taste of the dentist. Shown here is a floor plan for a present-day office and a modern operatory with Ritter equipment.
Glenner: DENTAL OFFICES ■ 965
Richard A. Glenner, DDS, C hicago
ecause dentistry, architecture, technology, and interior decoration are constantly changing, the dental office has continually been in tran sition—from outdoors to indoors, from house hold chairs and cabinets to commercially manu factured equipment, from spittoons to plumb ing, from candles to electric lights, and from stand-up to sit-down dentistry. Most early dentists in Europe practiced out doors and, of course, extractions were the most common treatment. Besides the men who set up their offices outside at village fairs, the blacksmiths of the time had a successful side line in dentistry. A few town tooth-drawers or barber surgeons did practice in their own homes or made house calls. Later in America, because of sparse populations and the distance between towns, dentists as well as other pro fessionals and tradesmen became itinerants, often using a room in a local inn for a tempo rary office. In the early 1800s, dental offices were found only in the large cities. Candles and daylight were the major sources of illumination, and household chairs and tables formed the office equipment of the day. There was no commer cially manufactured equipment, no plumbing, and no electricity. By 1880, changes had occurred in methods of practice and greater interest was being taken in saving teeth. Dental offices, even in the small er cities, were well equipped with commer cially manufactured cabinets, chairs, and spit toons. They usually had petroleum lamp or gas lighting. Around the turn of the century, when the transition to plumbing and electricity was bringing new equipment into the operatory, 952 ■ JADA, Vol. 91, N ovem ber 1975
the need for sterility made its impact on den tistry. Therefore, linoleum replaced carpeting, Victorian bric-a-brac was removed for spotless walls, and wooden chairs and instrument cab inets were replaced with metal ones for easier cleaning. Dentists had always worked in clothes fitting the fashion of their era, if not in more elaborate dress. With the concern about steril ity, most began to wear special clinician jackets. Dental laboratories have changed with the advent of new equipment, materials, and tech niques. Laboratories were once small, dark rooms off the dentist's office, but today they are bright, clean, and an integral part of the of-
Dental treatment of a Scythian warrior, fourth century BC. This is the oldest known representation of dental treatment; the pale gold vase was discovered in a grave on the Crimean peninsula in southern Russia. The dentist is shown kneeling before his patient. The vase is in the Hermitage Museum in Leningrad.
fice. Some modern dental laboratories are commercial and are housed in their own build ings. Laboratory equipment has been modern ized along with operatory equipment. Foot lathes for polishing met the same fate as the foot dental engine and were replaced by elec tric dental engines. The early muffle furnace used in the manufacture of porcelain teeth evolved into the wax burn-out furnace heated by gas, which now has given way to automatic furnaces run on electricity. The mouth and bel lows blow pipe used for soldering evolved into the air and gas torch also used for soldering and for melting gold during casting: automatic casting machines are now being used. Work benches are no longer made of wood, but metal. The modern office is bright and air-condi-
tioned, the cabinets of period or contemporary design, and the equipment mobile or stationary. Adding to the color in the office are the new fashions worn by both the dentist and his as sistant. All the progress in dentistry—in treat ment philosophy and innovations, anesthesia, improved materials and equipment, the utiliza tion of assistants, and the expanded knowledge about dental disease—have contributed to change the dental office. About the only thing we can say with some certainty about the office of the future is that it will probably remain indoors.
Dr. Glenner's address is 3414 W Peterson Ave, Chicago, 60659.
Artists have detailed the life and people of their day. From paintings and drawings of the 16th to 18th centuries, we can learn about the type of dentistry practiced, the dental office, and the characteristic dress of the dentist. This is one of the first copperplate engravings using the dentist as a theme; it was made by Lucas van Leyden, a prominent Dutch engraver, in 1523. The patient stands while being treated by an elegantly dressed, wandering dentist of the time. Extracted teeth decorate the brim of his hat. (Some dentists, even up until the 20th century, displayed extracted teeth in their waiting rooms.) The dental instruments and medicaments are placed on the table. This particular dentist practiced his trade outside, although many early dentists did practice in buildings.
G lenner: DENTAL OFFICES ■ 953
Later, dentists began to perform their treatment on a platform. First, the platform was a simple podium; later, more elaborate stages were used, some with wings. The platform was erected so that the dentist and his equipment could be seen above the public. The patient either stood or sat on the stage or in a chair. At fairs just outside of town, a clown, conjurer, or other entertainc attempted to draw the attention of the crowd. Tooth-drawers, quacks, and charlatans, nobly attired, abounded at the fairs, but this dentist seems to be displaying his credentials. Real dental care and treatment were as yet unknown.
This seems to be the first illustration of a dental office in literature; this 16th century woodcut is from "Artzneybuch." The room, apparently in the dentist's home, is small, with a low ceiling. The only sources of light seem to be the door and windows. The dentist probably used the shelves on the wall to hold his instruments The patient is sitting in a household chair of the time.
Although early dental treatment often took place in the home of the dentist or of the patient, extractions particularly were usually done outdoors. This toothpuller, plying his trade in the middle of a group of peasants in the village marketplace, was typical of the early 1700s. The country dentist, with primitive instru ments and inadequate knowledge, usually had an audience.
954 ■ JADA, Vol. 91, N ovem ber 1975
People in the countryside often turned to the village blacksmiths for extractions, as they had for centuries and as they continued to do at times until late in the 19th century. Dentistry was a normal sideline for the blacksmiths in a time in which few properly trained dentists were to be found. The town tooth-drawer was the closest to our modern impression of a dentist. However, his type was rare and his clientele came almost exclusively from the upper classes. He treated his patients in his own home or in the patient's home.
In New York in 1785, John Greenwood, George Washington's dentist, began to practice dentistry in his home on Water St. In early America, most dentists' offices were in their homes. The transition of the offices from the dentists'homes to buildings used specifically for offices included these stages. First, dentists used a room in their homes and then called a specific room their office. Next, a separate entrance for patients, or perhaps a wing of the house, was added. Later, dental offices were located in small buildings that offered space for living quarters in the back or in multiple-story buildings in which several rooms could be leased. Today we are watching another segment of the transition —dentists are opening offices in medical centers in which men from various health professions practice.
Glenner: DENTAL OFFICES ■ 955
Since only large American cities could support a dentist and since treatment was still a luxury for the most part, dental practitioners took to the roads. In the early 1800s, a dentist such as loseph Moore (bottom) packed his instruments, medications, his dental chair—and his family— in his wagon to move from town to town. Some itinerants set up temporary offices in local inns or hotels. Itinerant dentists worked in many parts of the country up until World War I. The painting at top was done by Hedda for Astra Pharmaceutical Products Inc.
956 ■ JADA, Vol. 91, Novem ber 1975
V *.
^
♦ ■y-
' *
y *■
This dental office in the Midwest, about 1830, was a room in the dentist's home. In many of these early offices, a single room was used for both the operatory and waiting room; however, some offices, especially those in large cities were more elaborate. Here, the log under the runner of the rocking chair holds it in position, and the chair faces the window for light. Extra illumination was provided by the candle, on the table, which the dentist would hold up to the patient's mouth. The dental kit (also on the table) may have been nothing more than a group of instruments. The dentist is wearing a Prince Albert coat and fancy vest. The picture is of an exhibit from the 1933 World's Fair in Chicago.
*- A
This is a replica of G. V. Black's office in Jacksonville, III, after the Civil War. At this time, offices had some commercially manufactured equipment such as the chair and cabinet shown here, but there was no plumbing or electricity. A few offices, although still in dentists' homes, contained a separate waiting room and more than one operatory; some had special entrances for patients.
~Y y
>» -y tY
►iKA~:
4A
yW -)
Dr. F. C. Holmes of Mangum, Okla, sets out to visit a patient. This small building has two offices—one for Dr. Holmes and another for a physician, Dr. Stone. It must be considered the forerunner to the present medical center building. The dentist and physician probably lived in rooms behind their offices. Besides treating patients in his office, Dr. Holmes also functioned as an itinerant; notice the foot dental engine in the buggy.
This dental office in Boise, Idaho, is in sharp contrast to the offices of just a few years later when sterility became so important. The office has no plumbing and no electricity; a foot dental engine stands in front of the chair, which is facing the window for light. The ornate curtains were there to comfort the patient and make him feel at ease. Did you ever see a dentist extract a tooth while wearing a tuxedo?
These three pictures show the waiting room, office, and laboratory of Dr. Russell Berthel of Minnesota, about 1900. The dentist has*' become concerned about sterility, as shown by the drape for the patient and the headrest cover. The operatory has no plumbing or electricity, but the laboratory does have electric lights. The average cost of equipping a dental office at the end of the 19th century was about $800! ^
Before the turn of the century, in larger cities such as Minneapolis and St. Paul, land was becoming increasingly valuable. As a result, multiple-story structures were built. Dentists rented small rooms or partitioned larger ones for waiting room, operatory, business office, and laboratory. Many of these dental offices were on the second or third floors, and large signs in the windows advertised the dentist. Often, many dentists worked together under the name of one in the office.
958 ■ JADA, V ol. 91, N ovem ber 1975
This one-story frame building in Wyoming is typical of buildings used for dental offices in small towns, especially in the West. This turn-of-the-century office seems to have had no plumbing, as evidenced by the spittoon attached to the dental chair. All the equipment is commercially manufactured. Although Dr. Thode has not made the transition to plumbing, he is midway in the transition to electricity. Notice that he has both a foot dental engine and an electric dental drill.
G lenner: DENTAL OFFICES ■ 959
The 1898 Victorian waiting room, office, and laboratory of Dr. Henry Arthur King of New York City was pictured in “Dental Items of Interest." Dr. King has made the transition to plumbing (notice the cuspidors), but he still has foot dental engines. This office is also of interest because it contains two dental chairs, which of course face the windows for light. The floors are covered with Oriental carpeting.
960
This dentist has almost completed the transition in equipment. He has an early "electric" dental office with plumbing, but still uses gas lighting. In a fewyears, commercially manufactured electric dental lights began to appear. The commercially made cabinet is of wood, but the office does have a sterile look to it. The flooring is a patterned linoleum. This forward-looking dentist also employed an assistant.
In the decade or two before the Civil War and for some years thereafter, there were sporadic attempts to establish commercial dental laboratories. The first one to develop and expand was the Stowe and Eddy Dental Laboratory, which started in Boston in 1887, and which around 1900 opened a branch in New York City. Outstanding among the early pioneers was Samuel C. Supplee, who opened his laboratory in New York in 1898. Another pioneer was Robert J. Rothstein; on the top is a picture of his Washington, DC, laboratory in 1906. On the bottom is a modern commercial laboratory. (Courtesy of Keress Dental Studio, Inc.)
G lenner: DENTAL OFFICES ■ 961
By 1915, the need for sterility was making an impact. Dr. McFerrin, who practiced dentistry in Nashville, Tenn, is wearing a white coat and used drapes and a headrest cover for his patient. At this time, many dental components were brought together in one unit. The one shown here combined the bracket table with the water cuspidor and drill; there is an arm on it for an electric light. Dr. McFerrin kept his electrical switchboard, even after he obtained his unit, for the other electrical things he needed.
Sterility was all important for the dentist and patient in 1920. Wood cabinets had been replaced with metal ones, and everything had to be white to intensify the impression of cleanliness of the operatory. In this picture there is an electric switchboard, but the need for it disappeared with the advent of modern electrical wiring and the use of the dental unit.
962 ■ JADA, Vol. 91, Novem ber 1975
This dental office of the 1920s included a sterilizing room (left). It was sometimes glass enclosed. The room was located to attract the immediate attention of everyone who entered the office and to impress them with the overall sterility of the office. The office's waiting room is shown at right. In keeping with the sterile look of the operatory and with the change in interior decoration, waiting rooms became simpler. Recently, the "homey" look has again become popular.
Dr.). F. Schmid's operatory in Salem, Ohio, is typical of those in the 1930s. The office has a clean, shiny look to it with its linoleum floor, metal cabinet, chair, and unit. Although a dental light is attached to the unit, the chair is facing the window; whenever possible, dentists used—and still use— daylight. Dental graduates of 1930 invested on the average, when first equipping their offices, $2,867. Of this amount, about 80% was spent for operating room and laboratory equipment, according to an ADA survey of dental practice in 1932. Practically all graduates considered the purchase of a dental chair, cabinet, unit, sterilizer, and dental engine essential. A dental light ranked next in importance. Forty-six percent purchased X-ray machines, but only 8% bought equipment for the administration of gas anesthesia. It is interesting to note that 4% purchased a safe.
Glenner: DENTAL OFFICES ■ 963
if*
This is a typical office of the 1940s. Because of World War II, dental offices from 1940 to 1946 remained much as they were in the late 1930s. Even after the war the new equipment closely resembled that manufactured in the prewar years. Real changes did not occur until the 1950s. Notice the electric dental chair and the stool, which shows that dentists in the 1940s did sometimes work sitting down. However, the stools were higher that those used today and the patient was not positioned so far back.
In the 1950s, dental offices still were set up for stand-up dentistry. There were big, elaborate units and dental chairs with conventional headrests and footboards. Dentists who did work sitting down began to tip the chairs back; from this evolved the concept of the contour chair. With the advent of sit-down dentistry, the large units began to disappear in the 1960s because they were generally too high up and far from both the dentist and the patient.
Over the years, most solo practitioners had one to two operatories. In the 1960s, some dental offices became larger because dentists worked together and needed more operatories. This dental office of the 1960s illustrates the transition from stand-up to sit-down dentistry. The modern contour dental chair was designed primarily for sit-down dentistry, whereas the unit is traditional. From this picture, it is obvious why the equipment of today evolved: the unit is too high, the bracket table too far away and too high, and the instruments, including the drills and syringes, too far from the dentist when he is working in a sitting position. Also, the cuspidor, which is part of the unit, would be too far away and too high for the patient.
964 ■ JADA, Vol. 91, Novem ber 1975
$yiT£
d
In the 1970s, new concepts of American dental operatory design are being put forth. Office design depends on the specialty of the practitioner, the type of building that the office is being set up in and whether or not it has windows, and the type of dental equipment the practitioner wants to use. Years ago, the office was designed for "an average practitioner" because a wide variety of equipment was not available. Today, the dentist's instruments can be positioned to the front, to the side, or behind the patient. Also, interior decoration can reflect the individual taste of the dentist. Shown here is a floor plan for a present-day office and a modern operatory with Ritter equipment.
Glenner: DENTAL OFFICES ■ 965
