Design Of A Dental Clinic

Project and Seminar Material for Architecture

Abstract

Dental care is a vital part of a nation’s economy. The need for a dental clinic in a city in Enugu State has led to the need to design a modern dental clinic that will serve the overall dental care needs of the city’s populace. The aim of this project is to design an efficient and befitting facility that will meet up with acceptable architectural and structural standards which can receive national acclaim. The research methodology employed in this project involves a combination of survey method, archival method and observation method. It will be highly significant as it will be of great benefit to public and will be a relevant contribution to the public well-being, health wise, i.e. serving as a place for dental treatment and dental health education; and most importantly, it will help to reduce the rate of dental carries in the area.

Chapter One

Introduction

1.1 Background to the Study

Tooth decay was low in pre-agricultural societies, the growth in farming society about 10,000 years ago correlated with an increase with the rate of cavities. An infected tooth from Italy partially cleaned with flint tools, aged between 13,820 and 14,160 years old, represents the oldest known dentistry. The Indus Valley Civilization (IVC) has yielded evidence of dentistry being practised as far back as 7000 BC. An IVC site in Mehrgarh indicates that this form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead crafters. The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective. The earliest dental filling, made of beeswax, was discovered in Slovenia and dates from 6500 years ago.

Plate 1.1 Farmer at the dentist, Johann Liss, c. 1616–17

An ancient Sumerian text describes a “tooth worm” as the cause of dental caries. Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the writings of Homer. And as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.

Recipes for the treatment of toothache, infections and loose teeth are spread throughout the Ebers Papyrus, Kahun Papyri, Brugsch Papyrus, and Hearst papyrus of Ancient Egypt. The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses the treatment of dislocated or fractured jaws. In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment. Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics. However, it is possible the prosthetics were prepared after death for aesthetic reasons.

Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws. Some say the first use of dental appliances or bridges comes from the Etruscans from as early as 700 BC. In ancient Egypt, Hesi-Re is the first named “dentist” (greatest of the teeth). The Egyptians bound replaced teeth together with gold wire. Roman medical writer, Cornelius Celsus, wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents. The earliest dental amalgams were first documented in a Tang Dynasty medical text written by the Chinese physician, Su Kung, in 659, and appeared in Germany in 1528.

Historically, dental extractions have been used to treat a variety of dental illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican (resembling a pelican’s beak) which was used to perform dental extractions up until the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century

Plate1.2 Dental needle-nose pliers designed by Fauchard in the late 17th century to use in prosthodontics

The first book focused solely on dentistry was the “Artzney Buchlein” in 1530, and the first dental textbook written in English was called “Operator for the Teeth” by Charles Allen in 1685.

In the United Kingdom there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. The Royal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in the UK than there were in 1921.

1.1.2 Modern Dentistry

Plate1.3 A microscopic device used in dental analysis, c. 1900

It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend (c. 1656 pub. 1690) made an early dental observation with characteristic humor:
‘’The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein ’tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or the Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head’’.

The French surgeon Pierre Fauchard became known as the “father of modern dentistry”. Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was a highly skilled surgeon who made remarkable improvisations of dental instruments, often adapting tools from watch makers, jewelers and even barbers, that he thought could be used in dentistry. He introduced dental fillings as treatment for dental cavities. He asserted that sugar derivate acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth and in the gums could appear in the later stages of tooth decay.

Plate 1.4 Panoramic radiograph of historic dental implants, made 1978

Fauchard was the pioneer of dental prosthesis, and he discovered many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone. He also introduced dental braces; although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist. The French text included “basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from the wider category of surgery”.

Plate 1.5 A modern Dentist’s chair

After Fauchard, the study of dentistry rapidly expanded. Two important books, Natural History of Human Teeth (1771) and Practical Treatise on the Diseases of the Teeth (1778), were published by British surgeon John Hunter. In 1763 he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility of tooth transplants from one person to another. He realised that the chances of a (initially, at least) successful tooth transplant would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation of internal organs. Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients’ gums, one of Hunter’s patients stated that he had three which lasted for six years, a remarkable achievement for the period.

Major advances were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year, Francis Brodie Imlach was the first ever dentist to be elected President of the Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery

for the first time.
The alarming rate of oral defects among the populace has created the need to develop the facilities that specializes in taking care of oral diseases and its related problems. The mouth is an important part of the body which helps basically in eating and for communication. Without the mouth, human beings will virtually not be able to feed well or communicate well.

More than 65% of Nigeria’s population cannot afford to get oral treatment outside the country. So, there is a need to have centres to take care of these problems. Recognizing this need, the government of most countries of the world makes it possible for towns and cities to have access to dental care services. Therefore, this project is a proposal of a dental clinic, Enugu, a city in Enugu State, articulating the necessary procedures and analysis to achieve an efficient and suitable design that will serve the overall dental care needs of the city’s populace.

1.2 Statement of Architectural Problem(s)

As a whole, Nigeria has been in lack when it comes to standard dental clinics in various cities and towns of the country. As a result, people with dental issues patronize quacks who do not have the required spaces and equipment suitable for effective dental care. Therefore a carefully well-thought out and befitting design of a dental clinic for Enugu will go a long way in eliminating the aforementioned problems, as there are no standard architectural designs for such a facility in Enugu State.

1.3 Aim of the Study

The aim is to design a functional and befitting modern dental clinic that will meet up with acceptable architectural and structural standards which can receive national acclaim.

1.4 Objectives

The objectives of this project include;

To design a facility that will functionally and aesthetically fulfill the need for a standard modern dental clinic in Enugu State.
To design a modern dental clinic that naturally meets up with both architectural and structural standards.
To provide spaces that are large enough to accommodate the workers and equipments/machinery and encourage a seamless overlap between the two.
To contribute to the architectural beauty of the area and the appreciation of the built environment.
Provision of adequate spaces for various dental treatments.

1.5 Significance of the Study

It will be highly significant as it will be of great benefit to public (people in the area) and will be a relevant contribution to the public well-being, health wise, i.e. serving as a place for dental treatment and dental health education; and most importantly, it will help to reduce the rate of dental carries in the area.

1.6 Scope

The design is for the inhabitants of Enugu and its environs. The design is done basically and specifically for general dental treatments. Therefore, it is not a general hospital for other health issues.

The scope of the project is narrowed to cater for a minimum of 90 patients at at time. Towards this; the following facilities are to be provided in the clinic:-

Area / Entrance Foyer:-

Desk/ Card desk
Waiting Area for 90 people
Card/ Folder Room for 4 staff
Business office

Diagnosis and Treatment

Hygienist office
X-ray unit
3 Sterilization Rooms
Screening and analysis room
Consultation Rooms for dentists
Operatory
Recovery Room accommodating8 beds
2 Nurse Stands

Staff Area

General store
Laundry
2 Changing Rooms and Toilet
Cafeteria for staff

Auxiliary

Storage
Dispensary
Staff Residence
Parking

1.7 Research Methodology

The research methodology employed in this project involves a combination of survey method, archival method and observation method.

The major sources of data were both Primary and secondary sources. Most of these data collected through these sources will be applied effectively.

Some of these methods include;

Interviews: Official face to face conversations with dentists in case study areas.
Literature reviews: to understand the technical terms and requirements associated with the project.
Case studies: analyzing similar existing projects to gain knowledge that will help in the design of the project.
Using google earth which will help in selecting a suitable site and location of the project.
Reading from journals, magazines, textbooks, past research works, etc

1.8 Limitations of Study

The unwillingness of the authorities in some of the institutions visited to release information necessary for this project, which some described as a security conscious act, gave rise to many difficulties encountered in gathering and arrangement of data.
Inadequate detailed technical information on the project from online sources.
Unavailability of standard case studies in Awka that necessitated visiting other towns/region.
Many of the projects studied were either not purpose-built or do not meet up with the scope required of a standard dental clinic.
There are not enough materials (i.e. books, journals, catalogues, photographs and other Media) locally available to source information.
The project research and the project itself have exerted a good deal of financial pressure.

1.9 Study Area; Enugu State

Plate. 1.6 Map of Nigeria with Enugu state highlighted Plate. 1.9.2 Map of Enugu State
Source – nigeriamasterweb.com

Enugu, usually referred to as Enugu State to distinguish it from the city of Enugu, is a state in southeastern Nigeria. Its capital is Enugu from which the state – created in 1991 from part of the old Anambra state – derives its name. The principal cities in the state are Enugu, Agbani, Agwu, Udi, Oji River and Nsukka.

Enugu State is one of the states in the eastern part of Nigeria. The state shares borders with Abia State and Imo State to the south, Ebonyi State to the east, Benue State to the northeast, Kogi State to the northwest and Anambra State to the west.

Enugu, the capital city of Enugu State, is approximately 2½ driving hours away from Port Harcourt, where coal shipments exited Nigeria. Enugu is also located within an hour’s drive from Onitsha, one of the biggest commercial cities in Africa and two hours’ drive from Aba, another very large commercial city, both of which are trading centers in Nigeria. The name of the state derives from its capital city, Enugu. The word “Enugu” (from Enu Ugwu) means “the top of the hill”. The first European settlers arrived in the area in 1909, led by a British mining engineer named Albert Kitson. Enugu State had a population of 3,267,837 people at the census held in 2006 (estimated at over 3.8 million in 2012). It is home of the Igbo of southeastern and few Idoma/Igala people in Ette (Igbo-Eze North) of Enugu State, Nigeria.

1.9.1 Enugu North

Enugu (/ei nu:gu/) ( Igbo : enugwu) is the capital of Enugu state in Nigeria. It is located in the southern Nigeria. The city has a population of 722,664 according to the 2006 census. The name Enugu is derived from the Igbo words Enu Ugwu meaning “hill top” denoting the city’s hilly geography. The city was named after Enugwu Ngwo, under which coal was found. Despite its name meaning hilltop in the Igbo language, Enugu lies in the foot of an escarpment and not a hill. Enugu in located in the Cross River basin and the Benue trough and has the best developed coal in this area. Enugu’s hill at the extreme may reach an elevation of 1000 metres (3300 feet). Highlands surrounding Enugu for the most parts are underlain with sandstone, while lowlands are underlain by shale.

Being in the tropical rain forest zone of Nigeria, Enugu experiences two distinct seasons brought about by the two predominant winds that rule the area; the southwestern monsoon winds from the Atlantic Ocean and the northeastern dry wind from the Sahara desert. The monsoon winds from the Atlantic create seven months of heavy tropical rains, which occur between April and October and are followed by five months of dryness – November to march. The average temperature in this city is cooler to mild (60 degrees Fahrenheit) in its cooler months and gets warmer to hot in its warmer months (upper 80 degrees Fahrenheit) and very good for outdoor activities with family and friends or just for personal leisure.

Enugu has good soil-land and climatic conditions all year round, sitting at about 223 metres (732 feet) above sea level, and the soil is well drained during its rainy seasons. The mean temperature in Enugu State in the hottest month of February is about 87.16 °F (30.64 °C), while the lowest temperatures occur in the month of November, reaching 60.54 °F (15.86 °C). The lowest rainfall of about 0.16 cubic centimeters (0.0098 cu in) is normal in February, while the highest is about 35.7 cubic centimeters (2.18 cu in) in July. (www.wikipedia.com 2014)
The site for the proposed dental clinic is located at the Independence Avenue, Independence layout, Enugu north, Enugu State, Nigeria. Its soil type is predominantly sandy-clay soil and it is made up of different vegetations. The facility can be accessed from relatively all parts of the area.

Chapter Five

5.0 Design Synthesis

5.1 Design Concept

Design concept is simply defined as idea(s) behind a design. It is the underlying or generating thought, idea, philosophy, method or process for a design proposal. (Dictionary of Architecture and Building Construction. 2008).
Concept formulation is basically the process of obtaining an explicable vocabulary of architectural forms and spatial relationship that is a true reflection of the goals and objectives of the client as sought to be represented by the building (Uji, Z.A; 2002:42).

White (1979) considers a concept as a mental image resulting from or formed out of perception and analysis of the problem and contracted to represent the building morphology. This means therefore, that the mind of the designer is very crucial in the context of concept formulation. White (1979) suggests that concepts may first come to the designer in the form of words or visual images (or both at once). The transformation of an emerging concept into the visual mode brings it closer to it being expressible in the physical or building mode.

Concept should therefore be appropriate, support the major intention and goal of a project as well as respect the unique characteristic of the project. The basic characteristic of a bus terminal is that it provides a system for transitory process-the continuous flow of passengers, freight and vehicle arriving and departing, as well as a system for static processes-those of administration, workshop and other related services. The idea is that the static process ensures an organised and continuous flow of the transitional process by creating a situation of orderliness, comfort and safety to maintain optimal fluidity expected in any successful terminals.

From the review of literature, the researcher observed that the circulation pattern in bus transportation system could be likened to circulatory system in human body. When the contracts it pushes the blood out into two major loops or cycles. In the systemic loop, the blood circulates into the body systems bringing oxygen to all its organs, structures and tissues and collecting carbon dioxide waste. In the pulmonary loop, the blood circulates to and from the lungs, to release the carbon dioxide and pick up new oxygen. The systemic cycle is controlled by the left side of the heart, the pulmonary cycle by the right side of the heart.

Hence the concept of this scheme aims at symbolizing such circulation pattern. The terminal will be pictured as the heart of transportation process.as with the human heart, all channels of flow converge on it and it provides the associated service required for smooth flow through its operative vessels. Just as the heart is separated into chambers which perform their individual functions, the bus terminal will be sectioned through zoning of activities and as the heart has its attendant organ (lungs) which stocks up blood with oxygen, the terminal will have attendant facilities like the workshop and filling station that should ensure that the vehicles are serviced. Among it various functions, the terminal will act as a sorting point. Just as the human heart separate deoxygenated blood from oxygenated blood, the terminal is expected to separate arriving passenger from departing passenger as well as shield them from vehicular traffic. Although the circulatory system is made up of two cycles, both happens at the same time, such should be the case in the proposed bus terminal as arrival and departure should go on simultaneously.

5.1.1 Massing and FaçAde

The façade concepts conceived from the design concept, that of designing a structure that is characterized by gaiety and would depict elegance. To achieve this, a cheerful selection of materials for both the interior and exterior spaces was made. For the exterior walls, the researcher made use of the combination of well screeded wall coated with paints and a minimal glazing. This combination results in a façade that clearly sends out the intended message-‘dental clinic’.

In massing the researcher made use of different forms, which are undulating in nature giving a sense of movement thus producing a cheerful and friendly looking structure.

5.2 Design Contributions

The problem in developing nations is that of inadequate financial and human resources coupled with the pressure by priorities given to other health sub-sectors and with today’s renewed interest in sustainability. A standard dental clinic should provide the following facilities; treatment, diagnostic and a research Centre.

The exterior architecture of any structure serves as the first introduction to that facility for its users, in this case, patients, their families and other visitors.

Therefore, the image displayed by this medical health facility would be one that embodies a warm, familiar and home-like nature. It should speak serenity, hospitality, safety, security, and calm, to mention but few.

The first step to achieving this image is to ensure that the overall facility is broken down into multiple residential scaled interconnected buildings instead of one large institutional edifice.

5.3 Recommendation

An efficient dental clinic is an essential requirement for the successful development of the economy of any nation and . To ensure efficiency in this system, its operational base must be able to function effectively. The connection between the different parts of the system must be designed to ensure the smooth flow of the system.

Having realised these, adequate attention should be given to the understanding of the circulation requirements of a dental clinic design and operations as this will go a long way in achieving effective operation and circulation network.

5.4 Conclusions

Dental Clinics in Enugu is of course a necessity. Among other things, it will provide adequate facilities which will fulfil requirements of teeth care, reduced tooth decay, reduction of tooth infection, dry mouth, deformities of the teeth, which a small make shift clinic cannot provide. Thus it will improve the health, physical and sometimes mental activities of the inhabitants of Enugu, the surrounding suburbs and villages and the nation at large, thereby decongesting existing small scale make shift facilities.

Application of all the relevant principle in this report will result in the design and construction of an edifice that will act as a catalyst for the introduction of standard dental clinic in Enugu especially for other similar project that will spring out later. Hence, in a suitable architectural language, the complex should usher in a new commercial place which will be international in standard.