Dr. Gary Cash: ADA Design Innovation Award winner

by Jean Williams

There were many reasons to stay put rather than leave when Gary Cash, D.D.S., was reassessing his outdated practice space, when his lease had come up for renewal.

Given the choice of moving to a new location or reimagining his current location, Dr. Cash chose to negotiate a 10-year lease on the 1,780-square-foot space and then remodel the space.

“I absolutely love the location,” Dr. Cash said. “It’s sort of in the medical area of Austin, where a lot of physicians, surgeons, and the like, have offices. The layout just really needed a lot of help...”

He’d begun practicing in his native Michigan in 2006 but eventually relocated to Texas in 2011 for the warmer weather. He purchased an existing practice and got to work.

“Austin was just a great fit for me,” Dr. Cash said. “I liked the feel here, and the practice that I acquired was just a really good fit for me. It just sort of fell into place.”

Aside from sprucing up the look of his space during remodeling — with furnishings, decor and accent colors (greens, blues and golden hues) drawn from the Texas landscape — Dr. Cash also realized that practice design was also about creating efficiencies. For example, traffic flow in for the practice needed to be reimagined. While he needed to design the space to be fully compliant with the American with Disabilities Act, he also sought to take better advantage of the light and views of the Austin cityscape through the floor-to-ceiling windows.

For his astute and esthetic choices, voters in the ADA’s third annual Design Innovation Awards chose Dr. Cash’s practice for top honors in the “Remodel” category.

“Patients were stunned,” he said of the remodeling results. “They think it’s beautiful. Very impressed. We always had patient perception and experience in mind. One of their favorite parts is now where dental chairs face the exterior windows, where they get a nice view instead of facing a wall. They like being able to see out the window. It’s a little more relaxing, I think, than seeing dental equipment.”

The views of downtown Austin for patients receiving treatment are a nice perk too, but the reorientation to the operatory chairs and treatment rooms had practical benefits as well. “It also lends to a little bit more privacy, where the patient’s back is to the hallway and the traffic of the office,” Dr. Cash said. “It’s a little more discreet for treatment.”

Patients can confer with Dr. Gary Cash’s staff on their cases in a consultation room that encourages the flow of light through a wall of glass panels.

A view from the front desk is open and airy. A cityscape triptych wall hanging draws eyes to twinkling street lights and the whiz of traffic. Natural light from outside commingles with the interior lighting to bring up the calming effects of muted colors, shades of blacks, grays and hard woods.

Dr. Cash outfitted his laboratory with dental cabinetry from Midmark.

Clean lines and the confluence of natural light beaming in from a wall of windows and interior lighting enlarge the aisle just outside of the operatories. Panels of glass also encourage a more open feeling in the area.

Floor-to-ceiling glass windows form a wall to the outside from the reception area, allowing in copious light that provides illumination throughout the practice and showcasing downtown Austin, Texas.

Sterilization room features top-notch new equipment featuring upgraded autoclave system, instrument washer, and instrument cassette. As well as the warmth of wood dental cabinetry featuring white countertops and stainless steel handles.

Another view inside the sterilization room illustrates how there is a place for everything, allowing for uncluttered openness. The room now features an upgraded M11 by Midmark autoclave system, Hydrim by SciCan instrument washer, and Hu-Friedy instrument cassette.

A major revision to the previous space in Dr. Cash’s remodel was re-orienting the operatories so that patients now face a wall of windows allowing views of the outside and additional privacy during treatment.

Prior to remodeling his acquired practice, Dr. Cash’s operatories feature dental chairs that faced walls. For added patient comfort and treatment discretion, he oriented the chairs to face the floor-to-ceiling windows with views of downtown Austin, Texas.

The office is located on the fourth floor of a multi-unit building. It has four operatories, two for dentist use and two for hygienist use.

“I knew the space well, and I had it in my mind’s eye what needed to be improved in terms of the layout,” he said.

He worked with Fazio Architects, based in Austin, Texas, an architectural design firm that works with dentistry, ophthalmology and medical offices. “We collaborated with the layout, materials selection and they also helped me select a contractor to execute the project,” Dr. Cash explained.

The remodel was completed in May 2021, about a year into the COVID-19 pandemic. The pandemic influenced his schematics in terms of space usage, materials and technology.

“I always had it in my mind’s eye to have a state-of-the-art sterilization area with a very easy to understand sterilization workflow, and with COVID it made us all more aware,” Dr. Cash said. “So, we probably tripled the size of the patient reception room, which gives people a lot more space, and it’s also just more inviting.” The improvements, Dr. Cash added, were noted in the reception area for patients and the traffic flow as patients enter and exit the practice’s operatories. “It’s a more ideal flow,” Dr. Cash said.

He chose solid surfaces as opposed to laminate to optimize infection control. “It’s significantly more of an investment, but it holds up so much better to some of the harsh chemicals that disinfect surfaces,” Dr. Cash said. “Also, I made the choice to go with dental grade cabinetry rather than custom cabinetry. It’s just a lot more durable to sterilization and disinfection.”

Other sterilization improvements include upgrading to a two-autoclave system (M11s by Midmark) and introducing an instrument washer (Hydrim by SciCan) and (Hu-Friedy) instrument cassettes. “It’s something that some offices have and others do not,” Dr. Cash said. “I think a lot of people are at a crossroads to make the decision to incorporate cassettes. If you do incorporate them, it does take a lot of modification to your office space and your workflow in how you process instruments that were used for treatment through sterilization.“

Dr. Cash purchased his dental cabinetry from Midmark as well as two of his operatory chairs. He purchased the other pair of chairs from A-dec and supplies from Benco Dental.

He made his CEREC milling technology visible to patients rather than sequestering it in a lab as he had previously done in the old layout. “Patients really love to see their crowns being milled,” he said. “They are really fascinated and curious about the technology.”

Other technology changes include integrating Nomad X-ray units. “They’re handheld, and they move from room to room,” Dr. Cash explained. “Between those and the digital X-ray (sensors), we expose patients to a lot less radiation when taking X-rays.”

A favorite part of the remodel for Dr. Cash is improved ergonomics in the operatories. “One major change from the previous office layout to the new layout is I have dual-entry treatment rooms,” he said. “You can enter from the left to the right. So, if the assistant is working or visiting with a patient, I don’t have to work around them to enter the room; and, if I am working, they don’t have to work around me to enter or exit the room.”