1. Introduction to Mobile Dental Clinics
Mobile dental clinics have come a long way since their inception. Over the years, the concept of mobile dental care has flourished. There are various kinds of mobile clinics that can cater to the varying needs of clients. These diverse types of clinics have not only increased the number of people to whom oral care can be provided, but also led to the generation of employment. The latter feature of mobile dental clinics is particularly beneficial for economies of some of the lesser developed countries.
One of the most common aspects of mobile dental care that we have seen is school-based programs—these focus on providing oral hygiene skills and routine checkups for school children. Such vehicles termed as school-based mobile clinics are driven to schools, where a qualified clinician provides a comprehensive oral health program to the entire class. Arrangements can be made for the child to be seen by a visiting dentist on a later date at a particular school. They fill in required documentation and treat the child later in the day. Often parents of the children are informed of the arrangements and the mobile van provides a backdrop for the children to relate to.
These are not as convenient and widespread as school-based ones, however, these types of dental clinics do provide a need to the people they serve.
2. Basic Components of a Mobile Dental Clinic
Mobile dental clinics are used to care for patients in areas with inadequate or nonexistent dental care. There are three basic components of a mobile dental clinic.
1. Basic components of a mobile dental clinic:
a. Operatories – those providing treatment i. Chair, dental unit (fixture), dental handpieces and instruments, other operatory needs as outlined by the doors of each clinic b. Sterilization – either onboard or provided by the outside facility by scheduled prepackaged supplies c. Patient restroom (even if restroom facilities are available within the institution) d. Work area i. Infection control ii. Instrument processing e. Reception/check-in area i. Computer scheduling and treatment documentation ii. Patient check in and out (forms) iii. Records/staff paperwork
Mobile dental clinics can be classified by the type of vehicle used to provide the mobile dental services. For instance, some clinics may use a truck, such as a van/step van; a trailer, as in a fifth wheel being towed by a large vehicle such as a large van, truck or bus; or a bus or large vehicle in which the dental services take place around the sides of the salon or work area which is also contained in the vehicle. Each of these commonly used mobile dental services is tailored to meet specific needs. It is important to state again that the trailers and vans or bus must be self-contained for all services including utilities (water, gas or compressor, vacuum and power necessary for standard dental practice) and disposal (sewage, biohazard and garbage/waste). Modifications to all services and basic plan should include access by those who are mobility impaired. All basic plans are to include a waiting area or check-in and treatment rooms.
3. Van-Based Mobile Dental Clinics
One of the most common types of mobile dental clinic is the van-based dental practice. There are both positive and negative features associated with this set-up, which we will here describe. Operations within this model are limited to short on-site visits, necessitating advance scheduling and stipulation of payment (public or private insurance, charitable, or direct fee-for-service) at the time a fixed appointment is made, but the clinic can serve as a quick, tangible advertising tool, and the establishment site can be changed with ease, potentially moving to capitalize on varying levels of local demand for dental workers and services. The operatory is generally limited to basic/restorative dentistry, and 4, 5, or 6 days of operation per working week are typical, though there is little data to suggest one or another is a more value-laden use of overhead time.
The rate at which many communities—even relatively affluent, urban ones—construct buildings with wide enough doors to admit a van with enough rear space to serve as a basic dental clinic is discouragingly slow, and most in this field have found it necessary to provide this capital equipment themselves. Specified equipment and support utilities are often custom-designed for or by a given mobile operation. Beyond dental equipment and personnel, each van also typically features an X-Ray machine and processing cabinet, glycol-powered compressor and vacuum, a desk, files, and the capability of accepting utility hook-up, as with the trailer-based model. Mobile dental clinics have been used extensively as a promotional tool and are typically easily relocated to varying sites throughout the week. However, space and electrical requirements are limiting, and fixed appointments must be scheduled, necessitating significant advance planning.
3.1. Advantages and Disadvantages
Advantages of van-based mobile dental clinic:
The van-based mobile dental clinic is designed by the dentist himself and is mobile. The two are combined to form a dental clinic unique in the world. It is a dental clinic on wheels. The van-based mobile dental clinic looks like a special vehicle or a big car from the outside, while looking inside it is just like a dental clinic. It is handy for emergency operations and serves the community with a variety of dental services. It is simple to understand and memorize by the people. It is also a source of advertising while plying on the road or parked in a market. It can be shifted to a more favorable location. The van-based mobile dental clinic is the fruitful result of the modernization of the world in terms of dentistry. It provides better working conditions and facilities for both the dental practitioner and the patient. It is hygienic, comfortable, and well-ventilated. It is free from insects and germs. It is approved by the Department of Health. It is a reduced cost option as it may be self-funded and walks the corridors of every school. This way, total inhabitants can avail of dental services at ease. It is economical and has rigorous maintenance.
Disadvantages of van-based mobile dental clinic:
The van-based mobile dental clinic is little clumsy in use and inelegant in appearance. It has negligible seclusion. Its area of set-up and working is too restricted. Stairs are needed to enter. It is abundantly heavy in its structure. There are limited dental habitués due to privacy issues. Bilateral doors can disturb the dental profession. If two units are to be set up on the upper floor, they will disturb one another while walking to and fro. Retightening is also possible. The van-based mobile dental clinic can be hit by any vehicle. The dust from the road is too high. Units Demo is also less. The danger of vandalism is at heights. The risk of overall casualties is also too elevated. Deterioration is ultimately high. It is time-taking in its designing and creation.
3.2. Features and Equipment
A. Features 1. Need to comply with vehicle operation standards set by the United States Department of Transportation (USDOT), including the Federal Motor Vehicle Safety Standards (FMVSS). 2. MWCs are typically large vans and characteristically have good design for layout, ready to use for healthcare, and provide a thermostat regulated temperature – heated and cooled. 3. MWCs have several different dental chair models that are used exclusively for MWCs; these are characteristically mounted on the floor. 4. MWCs provide patients with privacy. 5. MWCs use portable x-ray machines, either digital or analogue. 6. An MWC has the capability of overnight “Dockside Operations” (docking) in a warehouse or commercial property complete with power, water, and sewer. 7. Depending on the number of dental chairs, dental operators, and the mobile access point, an MWC can serve up to 50 patients per day.
B. Equipment An MWC offers patients a full range of dental services that you might find in a traditional free-standing dental clinic. Some of these services include, but are not limited to: 1. Portables – A) Dental Units: Electric Control B) Dental Lights: LED or Halogen C) Dental X-ray Machines: Electric (Digital or Analogue) 2. Build-ins: D) Dental Compressors: Electric E) Autoclaves: Steam Heat Electric (STERRATs) F) Trade Name Intraoral Ultrasounds (Cavitrons) G) Handpiece Cleaner and Lubrication Equipment (Autoclaving) H) Handpieces (High Speed and Low Speed) I) Digital Intra-oral Cameras J) Nitrous Oxide Sedation Chairs, Scavenger Systems, and Nitrous Oxide detection systems K) Anesthesia Equipment L) Intra Oral Sensors (Digital Dental X-rays) M) Panoramic Dental X-ray Machine that captures Orthopantograms (OPGs) N) Laptops for digital charting and digital dental radiology.
4. Trailer-Based Mobile Dental Clinics
Following this, the second category of mobile dental facilities, i.e., trailer-based mobile dental clinics, is growing more and more popular. Unlike the typical Winnebago-style vehicles, trailers are not like a car or truck and can’t be used to drive away when not in use. Mobile dental trailers will typically be parked in a particular location and will stay there for a day or more, sometimes up to several months, during which they function as a dental clinic. Based on the length of the clinic, the trailers tend to have retractable or slide-outs. These listings may be moved or taken back into the trailer, making transportation simpler.
Advantages of Using Trailers as Mobile Dental Clinics: – Trailers can be roomier, more luxurious, and often more likely to ensure patients’ demographic makes it usable. – Although these are portable, a trailer that is often shaken or shifted risks damaging the human body. Trailers may be compact, but they’ll often be fitted with overnight bunk areas for the mobile crew to sleep and rest as much as possible. It may also make use of generators in places where there is no electricity to offer amenities such as climate control and lights to rise for the crew. – Since the platform is detachable from the truck, trailers are somewhat more flexible with plenty of lower heights and more convenient to install. – Trailers may be used to provide dental care for people in other countries.
Disadvantages of Using Trailers as Mobile Dental Clinics: – While fairly compact, 53-foot trailers may have their restrictions in communities and cities, so it’s necessary to make careful preparation in advance to make things up.
4.1. Advantages and Disadvantages
Benefits: The first advantage of a trailer-based clinic compared to a converted vehicle is its size. Vehicle-related trailers generally include a larger surface area and a greater number of approaching patients, as shown by the survey responses. This way, it can provide the appropriate mechanical, electrical, air conditioning and patient areas with physical compartments. In this way, dental clinics established on converted vehicle chassis under the control of the MTMM (Mobile Type Medical Module) criteria in a veanst must be robust and comprehensive. However, areas such as a toothbrush-dedicated space and toilets do not seem to have been responded to the clinic’s belief about the area in vehicle-based dental clinics. Moreover, trailers can be installed on hospitals and outdoors with water supply, while trailers that separate sewage collection and do not have a toilet capacity in the vehicle provide a similar treatment capability to zero waste.
Monitor other studies in the context of this study to evaluate the technical options and SWOT (strength, opportunities, threats, weaknesses) analysis that can or cannot be selected at the same time. In line with these analyzes, they can be determined to be an efficient option in terms of the patient. The comfort and satisfaction of the patient response is that the treatment is very effective as a result of the process. Dental services are very expensive, and caries prevention, diagnosis and treatment outside of schools offering dental care in developing countries where oral disease times are common and there are inadequate income. Providing mobile topics is a low cost, practical and effective alternative. If oral diseases are not preventive in the world, patient sensory network diseases will be prevented as devices will be built. Local preventive procedures in the dental treatment area are important. In order to be successful, families and society do not have the necessary information in educational institutions. To support such institutions, programs outside schools are significant elements of primary dental care and are considered a good method. Profitable health care for the population covered by these programs. It is thought that mild repair and primary corrective treatments are the most effective way to implement the program at the same time. Dental repair treatments are widely practiced in school-based clinics.
4.2. Features and Equipment
Trailer-based mobile dental clinics have the following features:
Hydraulic System – This features a diesel generator mounted at the front of the trailer that supports two air compressors to give it a triple 5.4 SCFM pair. The ergonomic hydraulic system allows you to load and wheel the entire dental clinic on location without exerting much effort. The system is supported by air brakes and tow hitches that can also be tied into a current hydraulic system if you have a dedicated unit on standby. With a wide range of adjustable options, these pieces of compact dental clinic equipment are able to cater to any mouth. Dedicated to the convenience of both patient and dentist, the comprehensive design ensures easy movability. The hydraulic system also features a diesel generator mounted on the ground towards the front of the trailer to draw no electric current. The industry-exclusive Fresh Water Cooling System ensures consistent water temperature in the unit and the discharge line during operation. The built-in showers help keep the dental clinic clean and professional-looking for years to come.
Tractor unit mobile dental clinic equipment features the following: The Articulating Air Brake Support Legs give greater capacities for weight distribution and are able to absorb better than necessary impact than any other dental equipment out there. The Axle with Air Rides allows the dental office to travel at ease with the use of air suspension. The all-aluminum, 5th wheel-mounted dental office measures 50’ long x 94” wide x 91” high. It offers 4 operatories. Each operatory boasts stainless steel countertops, a Thermo-Stor® iM33 sterilization center, a customer chair, and a doctor’s cart. Other than that, its digital X-ray package features two visible X-Ray units placed in each operatory, two sensor holders placed on the wall for all adult patients receiving full mouth series, four SNAP X-Ray sensors, and Wacom pen tablets. What is more, displaying a 20KW Kubota Generator; a York 4-ton roof-mounted HVAC system; a Werther Model WCV65/15 120-gallon air compressor with air drying system all in the ceiling lifts and tilts. In addition, other highlights include an electrical service system sporting load center breakers, electrical controls and GFCI outlets, a big patient entrance with a 50”x37” poly-sliding window with screen, an RGB back-lit interior sign, and a 20-foot aluminum hydraulic sidewall to be able to operate inside an enclosure. It retails for US$325K, while the cabin and office only minus the control room is sold at just US$300K.
5. Bus-Based Mobile Dental Clinics
Another approach that is less often used in the United States is to deliver care through a bus. Mobile dental clinics that operate from a bus-based platform have been used in various parts of the world for some years. A variety of buses can be converted into mobile dental clinics to provide dental care. There has been only one study conducted related to bus-based dental vans. There are key issues to consider for developing a bus-based mobile dental clinic. The following are some of the key concerns and issues that need to be addressed:
Advantages: – Supreme mobility: Can travel anywhere in the country – Greater clinical space because of ability to tow trailers that would hold diagnostic and sterilization equipment – Better for public presentation – Fits the dental school model of multi-chair clinic – Requires little or no van modification – Is similar in cost to a standard mobile dental clinic – Better patient access, comfort
Disadvantages: – Very expensive to purchase and operate with high operational costs – Parking concerns— should have concluded that one has to plan the route carefully – Can only park in certain areas – Requires a second vehicle or vehicles – Heavier vehicle
The interest in a bus-based vehicle version of a mobile dental clinic may be because the dental school wants or needs to do some form of outreach with a full-service corner dental unit and dental chairs. These units would typically be used in more populated areas. This solution does not help solve dental access problems in more remote regions where dental care is unavailable. Due to the high cost, few buses (5%) are bus-based clinics. The majority are small dental utility vans. These differ from the standard van conversions by being longer, having more or more complex dental units, or both. Buses cost more to run and are not practical in terms of deploying more of these four-wheeled buses.
5.1. Advantages and Disadvantages
Advantages and disadvantages of bus-based mobile dental clinics
Available space varies significantly (14-57m2), so the range of services offered at each bus is different. It is also logically more difficult to offer advanced treatment on smaller buses where there is limited storage capacity for equipment. The embodied energy per capita of the buses is jumpstarted, but they are still significantly higher than the other pillars. Buses have a higher environmental impact on climate change and the non-renewable energy balance than the other types of ED. This is largely due to the high fuel consumption of the buses used.
Bus-based services are economically beneficial, but due to the high environmental impact, they used to be non-viable. However, since LCHNG engines and synthetic gas are cheaper and more sustainable, this is no longer the case. During operation, patient satisfaction with bus-based ED is relatively high. Patients prefer buses as they are larger and do not induce claustrophobia like mobile containers. Any issues regarding privacy with a shared waiting area should be resolvable. The only two disadvantages to buses noted are: lack of modern technology and long waiting lists. The extended waiting lists can be attributed to the low capacity of buses to treat patients. Buses are sociable and ideal for conductive patient education as they allow talks and practical demonstrations to be given on board. The geriatric, general, endodontics, oral surgery, and orthodontic buses make use of their video equipment to educate children and adults, improving health awareness. Buses can go to farm and factory workplaces and are dually useful for this as they travel with bilingual staff who speak Hindi, Polish, Latvian, Russian, Portuguese, Spanish, Punjabi, and Slovene. Buses also carry translators for most nationalities. The bus dental service is involved in running both full-day seminars and half days using the video equipment designed for eight delegates, providing an excellent facility at conferences and exhibitions.
5.2. Features and Equipment
Focus Bus-based mobile dental clinics offer a limited range of dental services. They do not need a power system or water tanks. Plus, they do not require hydraulic lift hardware since they are not driven on the road with the operator on board. They still need to be owned or leased, for the operator will need to drive them to the clinics. They are also normally equipped to plug into the buildings in which they operate.
Standard Features Most bus-based mobile dental clinics will have two dental operatories, a private office, a reception area with a waiting room, and a bathroom. Some may also have a wheelchair lift, but they are designed to operate at buildings accessible to those with physical disabilities. One of the standard features of a bus-based dental mobile clinic is an engine. They need to have an engine so the operator can drive the clinic from one site to the next. Hence, bus-style clinics plug into the building for electricity. Another feature of several of these is the fact that the engine is housed in an engine compartment. It can be accessed from outside lower down the side of the bus. These are not labeled or indicated on the floor plans because they are standard. These units are easier to maintain for several reasons. Grease does not escape from the drive shaft onto the floor, and there are no fumes or smells from engine oil. Components are easier to get to for maintenance and repair. It also makes disassembly of the engine for major repairs easier.
Typical Equipment Bus-based mobile dental clinics can be equipped with the same dental equipment as larger mobile dental and medical units, but they will require greater accommodations. This is because all the dental equipment is mounted higher off the floor and so requires greater headroom. The following dental equipment is in a bus-style mobile dental clinic standard module: two rear-mounted dental delivery systems, an air compressor, a vacuum pump, an amalgam separator (where indicated to site equipment, is not required by the Federal Government), and light bases. Finally, bus-based mobile dental clinics may be equipped with a wheelchair lift or stair lift. They may, but it is not typical. Units may have a lift if the operator is planning to provide more comprehensive dental services in underserved areas because it might serve more patients, including those in wheelchairs.
