Dental Office Build-Out: What to Plan For

The most useful planning happens while you can still walk away. A dental attorney writing in Dental Economics advises scheduling a walk-through with a contractor who has dental experience to verify that the space can be converted without major obstacles, such as structural or plumbing issues. A healthcare real estate attorney goes further, advising that the lease contain a precise construction plan verifying that your HVAC, plumbing, electrical and other needs fit the building's capacity.

Assemble the team early: a dental equipment dealer or planner, an architect, a mechanical, electrical and plumbing engineer and a contractor who has built dental offices. Your lease may limit who you can hire, since some landlords approve your architect and contractor and others require their own. Find out before you commit to anyone.

A dental office is a small plant with a clinic attached. Each of these systems needs a route from a central point to each operatory, and the route is what makes a suite easy or difficult. Equipment makers publish their own requirements, so size everything from the actual equipment list, not from a general rule.

• Water and drain lines. Each chair and sink needs supply and waste connections. Drains need slope, which limits how far they can run and may mean opening the floor.
• Vacuum. Suction lines run from each chair to a pump, usually in a mechanical room. Noise, venting and exhaust location all matter.
• Compressed air. Lines run from a compressor to each chair. Ask your engineer about air quality, drying and how to keep the compressor's noise and heat away from patients.
• Power and data. Expect dedicated circuits for equipment and data lines for imaging and records.
• HVAC. A compressor room and sterilization area produce heat. Operatories and waiting areas may need separate zones.
• Floor drains and wet areas. Whether you need floor drains, and where, depends on your equipment and your local plumbing code. Ask your engineer and local inspector.
• Nitrous oxide or other gases. If you use them, ask about storage, piping and venting early. State and local rules vary, so have your engineer and state board confirm what applies.

On a ground floor, lines may run in or under the slab. On an upper floor, they may need to pass through the floor to the suite below. Either way, ask the landlord what it allows before you draw a plan around it.

There is no single national answer for shielding a dental x-ray installation. Requirements vary by state, and sometimes by equipment. Compare how three states treat the same question.

• North Carolina's guidance says all planned locations for dental x-ray units require a shielding plan review before installation, completed by a qualified service provider for intraoral units.
• Minnesota exempts dental facilities with only intraoral capability from its shielding review, but the state requires a plan for cone beam CT, panoramic and cephalometric equipment before new construction or remodeling or if the equipment is new to the facility.
• South Carolina says dental intraoral units generally do not require plans, but dental cephalometric, TMJ and dental CT units do, and it warns not to assume a new plan is unneeded.

Registration is a separate question. Illinois, for example, requires the operator of a radiation installation to register it with the state agency before it is placed into operation. Before your plans are final, ask your state radiation control program what it needs for your specific equipment, and ask a qualified physicist or service provider to prepare whatever is required. Then build the review time into your schedule.

Wastewater is the other regulated system. EPA's Dental Effluent Guidelines, at 40 CFR Part 441, say dental offices that place or remove amalgam must operate and maintain an amalgam separator, must not discharge scrap amalgam or use certain kinds of line cleaners, and must submit a one-time compliance report to their Control Authority.

The rule has limits. It does not apply to dental dischargers that exclusively practice certain specialties, including oral surgery, orthodontics, periodontics and prosthodontics, or to some other situations. It says a new source must file its report within 90 days of introducing wastewater into a publicly owned treatment works. Your local wastewater utility or state agency may be your Control Authority, so contact it early. Rules can change, so confirm the current requirements with them and leave space in your plan for the separator.

Other waste matters too. Sharps and other medical waste are regulated mainly by states, according to EPA, so ask your state agency and vendor about storage in the suite.

Many build-out problems are lease problems in disguise. Raise these in the term sheet, so you are not left negotiating over them after you have committed.

• ✓May we cut or core the slab, and on what conditions, including work on the floor below?
• ✓May we put a compressor, vacuum pump and exhaust where we need them, including any exterior or roof penetrations?
• ✓Is there enough water, sewer and electrical capacity, and will the landlord confirm that in writing?
• ✓Who owns the improvements, and are we required to remove them at the end of the term?
• ✓What allowance or rent abatement will the landlord provide, and what does the allowance cover?
• ✓Who chooses the architect and contractor, and what fees does the landlord charge for review?
• ✓When does rent start if permits or inspections are delayed?
• ✓Can we work after hours when noise, odor or water shutoffs would affect other tenants?

Build-out costs vary with the space, the number of operatories, the equipment and your market, so this guide gives no per-foot figure. Get a priced plan for each finalist from a contractor with dental experience, and keep a contingency for what is found when the floor is opened. Add equipment, design fees, permits and moving costs separately from construction.

Schedule deserves the same honesty. Ask your contractor and equipment dealer for a realistic range, including long-lead equipment and any state reviews, and think about what happens if the new office is late.

A fallback like that is easier to arrange when you plan for it early. TAG helps dentists negotiate the allowance, the rent start date and the holdover terms that give a build-out room to run late, with your design team handling the technical side.