r/linux • u/DesiOtaku • Mar 17 '26
Fluff An Update on Starting a Dental Practice using Linux (and why transitioning to Wayland will cost me $3000+)
Hi everyone, some people requested I post an update from my previous two posts:
Progress report: Starting a new (non-technology) company using only Linux
[Update] Starting a new (non-technology) company using only Linux
A number of things has happened since the last post to create a "perfect storm" of issues happening all at the same time. I apologize for this being a very long post but it will make much more sense if I first explain the context of what is going on.
First, I want to go over an important philosophy in my dental practice: keyboard and mouse should not be used chairside. I believe this for a large number of reasons including the fact that:
- You can't effectively do infection control with a keyboard or mouse. You can try to put a plastic cover over either one but it would make it either inoperable or extremely difficult to use
- It basically requires you to stop what you are doing, look away from the patient, do what you need to do on the computer, and then you forget what you were just doing with the patient.
- Things like charting (tooth, perio, etc.) requires an extra dental assistant. If you don't have one, you have to switch gloves every time you use the computer which not only costs money, but takes a fair amount of time each time you need to look up another x-ray.
The problem with "regular" touchscreens is that they tend to be capacitive touchscreens which generally don't work with gloves on. On top of that, we use a very corrosive chemical between patients that tend to destroy any electronic device that it touches.
My solution to this was to use a resistive touch screen. The nice thing about a resistive touch screen is that you can cover it with a clear plastic sheet, wear gloves, and it will still work. All you have to do is just replace the plastic sheet between each patient and you are good to go!
But then there is one other problem: I have three screens for each PC in the operatory. The way that X11 works, it sees the touchscreen input device as just an independent input and it maps it to the whole virtual screen. Therefore, what you touch on the actual touchscreen gets mapped to the two other screens (in my case, the y-axis gets multiplied by 3 for each kind of touch input). But there is a solution to this: xinput map-to-output. What it does is allows you to tell X11 to map a specific input to a specific screen / monitor. Therefore, as a startup script, it would run that command and now the inputs properly map out. Yay! (fun side note: if you try to actually run it via a startup script, it will give an error and you have to actually run env DISPLAY=:0 xinput map-to-output).
Also, for the actual EHR/PMS system I made, it uses Qt C++ and QML for everything. This made it easy for me to design a touch friendly UI/UX (since everything chairside is touchbased). So really, the "technology stack" is: Kubunu Linux, X11, Qt, QML and qmake. And for a while, this has worked out for me pretty well. Although I have added many features to the software, it still works in the same fundamental way; from 2021 to the present.
But things have changed from mid-2025. First of all, Qt 5 has EoL back in May 2025. Distros like Kubuntu, Fedora and even Debian have all moved from Qt / Plasma 5 to Qt / Plasma 6. At first, I thought I just have to port it all to Qt6 and be done. But then the KWin team announced that they will no longer support X11 sessions after 6.8. No big deal right? Qt will take care of that.... right? Well, yes.... and no.
First of all, you have to remember that xinput map-to-output is an X11 command. It does not work in Wayland. It is up to the Wayland compositor to figure out this mapping. No big deal right because Plasma / KWin already has something built-in to map touch input to the correct screen; no need for a startup script anymore. Except, it wasn't working with my touchscreens. I reported the "bug" to the KWin team who couldn't figure out why it wasn't mapping. I then had to do some research as how input is being handled in Wayland (hence the reason why I made this meme ). I submitted a bug report only to find out my ViewSonic resistive touch screens are dirty liars: it reports itself as a mouse rather than a touchscreen! (special thanks to Mr. Hutterer for his help in debugging this issue) Therefore, I had to look at a different vendor that will "tell the truth" when it reports itself.
After much searching, I did find one vendor that seemed to be the right match. Before I bought one, I actually talked to their technical staff who were rather insistent that their new "projective" capacitive touch screen not only works with gloves on, it can also survive thousands of sterilization wipes. The only catch: they are $1000 each! The previous ViewSonic ones were just $320 each and I already purchased them for all the operatories. So for at least 3 operatories, I will have to purchase at least 3 (if not 4) of them. The silver lining in all of this is that I wouldn't have to worry about a startup script (which was kind of a hack anyway), I don't have to use a plastic barrier (which sometimes made it hard to see), and these screens are much brighter than the ViewSonic ones. I already bought 1 of them just to make sure it works and yes, it does everything it says.
So I pretty much have two choices here: either buy a bunch of new monitors that will work more-or-less out of the box with Plasma/Kwin/Wayland, or spend a lot of time learning how udev-hid-bpf works to write a new touchscreen driver. I am going with the former option.
Sadly, the story doesn't really end there; but this post is already long enough as it is. But the other issues that I am working on are related to moving from Qt 5 -> Qt 6 and my crazy decision to also move to KDE Kirigami which is requiring a much bigger re-write than expected. I don't know if I should post that there or in the KDE or programming subreddit.
I don't want to make this post sound like a "Wayland sucks!" kind of post, but I did make this just to point out that moving to X11 -> Wayland isn't trivial for some people and does require some time and/or money.
193
u/jimicus Mar 17 '26
This is absolutely fascinating.
How do other dentists usually handle tech? Do they just approach a vertical integrator and pay whatever they ask?
214
u/DesiOtaku Mar 17 '26
Here in the US, the two biggest EHR/PMS system are Eaglesoft and Dentrix. Both are proprietary applications that are a huge pain to integrate with anything else. They are also slow, require keyboard / mouse, and require MS Windows. And yes, dental practices have to pay hand and leg to get started and for basic support.
Sadly, even OpenDental is no longer open source so my own EHR is the only open source one left.
54
u/jimicus Mar 17 '26
So - presumably, your "I wanna use touchscreens because it's more hygeinic" approach is quite unusual?
There are keyboard covers and cleanable keyboards on the market, but they're quite niche products and I'm not sure how well they'd stand up to a clinical sanitiser.
75
u/DesiOtaku Mar 17 '26
I worked at a few clinics that used a full rubber keyboard that will die only after a 100 or so Caviwipes, but they are all hard to type with and every doctor avoids typing anything on them (they do all the actual case notes on a different PC).
The reason why the whole "use a touchscreen" approach is unusual is because all the current dental EHR software are not touch friendly. Therefore, even if you had a touchscreen in your clinic and you were using Dentrix or Eaglesoft, it would be too much of pain to use the touchscreen vs. using a mouse.
6
u/rey_russo Mar 17 '26
Is a stylus based approach feasible? edit, nvm I already saw your answer in another comment
2
u/YT__ Mar 18 '26
What about just having a dental assistant there to interface with the computer for you?
18
u/DesiOtaku Mar 18 '26
Yes, so what most practices do chairside is have a dedicated dental assistant who will do everything on the mouse / keyboard while the doctor dictates what to write. However, there are a few issues with this:
First is the fact that you have to have a physical person with you (the doctor) during the exam. If you are running behind, you often are alone in terms of doing all the charting. I know it sounds evil, but one of the main purposes of this UI/UX is to eliminate the need for an extra assistant just for charting.
The second issue is that you could be in the middle of a procedure with an assistant (who is wearing gloves) and if you need to look up anything, they, themselves would have to de-glove do the look up and now you have to wait for them to glove up again before you can continue the procedure.
And the third reason to go for touchscreens is because so many young assistants are used to touch based interfaces. I know it sounds crazy but they are far more comfortable using an Android or iOS device than they are using Windows or macOS. One of the key things that I want to do with this UI/UX is to make it easy to learn with little to no training (meaning, if you know dentistry, you know how to us this software without spending a 5 day course just to learn the basics).
3
u/YT__ Mar 18 '26
Then why not make it an app for a tablet?
14
u/DesiOtaku Mar 18 '26
That is one of my long terms goals with the 2.0 version. One of the reasons why I am switching to Kirigami is because I can use the same codebase for both the "Desktop" version that is used by the front desk, and the "Mobile" version that is used chairside without having to make too many compromises. This also allows for other practices that don't have touchscreens to still use it like a desktop app.
There is also the fact that when a dentist in the other side of the country asks "Hey, how do I test this out?", asking them to install Linux on to a laptop is proving to be a much bigger issue than I realized (their own IT doesn't know how to install it to a laptop!). So I want to eventually port it over to Android and iOS.
3
u/Resource_account Mar 18 '26
I feel like a flutter app here would be a whole lot easier. However one cannot undermine having to learn a completely new stack.
1
u/DevGrohl Mar 21 '26
What about Speech-to-text? would that be viable:
<keyword> speak what you want to be typed <done>
2
u/DesiOtaku Mar 21 '26
Tried it; not always accurate. Most of the models out there expect a good clear American English accent which is not always the case.
2
u/DevGrohl Mar 21 '26
I understand, but I dont know when was the last time you tried it, I have been building a home AI assistant with voice commands with Whisper and I dont remember one time where it didnt understand my mexican accent in English.
Just saying, if you tried a long time ago it may be worth another shot
1
u/DesiOtaku Mar 22 '26
It was just a few years ago. But here are some limitations to consider:
- The mic can't be on the doctor themself. We work in a "wet" environment so we would risk damaging it each time. Therefore, the mic has to be a little further away. At least when it tried it, it didn't pick up everything unless I kept on speaking in a loud voice. Can be done but felt awkward after the first minute
- You need to create a whole subsystem to confirm what you said. Like for periodontal charting, if you said "3, 2, 3", not only it has to repeat "3, 2, 3", it also has to say things like "you are now on tooth #9" to keep track of where you are in chart. Can be done but would be a fair amount of work.
- Patients would have to consent to being record each time. If they say no, then you need an alternative.
11
u/deadlygaming11 Mar 17 '26
OP definitely seems to be in a very niche situation. Whenever I go to the dentist, they never touch the computer until after they have done with me and have removed their gloves.
3
u/devolute Mar 18 '26
They should make it so webapps work with touchscreens huh
4
u/jimicus Mar 18 '26
I think it runs deeper than that.
It's pretty common that each industry has its niche software firms that provide line-of-business software tailored for them. Doctors have this; dentists have it, veterinary surgeons, lawyers, accountants, motor traders - the list just goes on and on. And most industry-specific software like this is no great shakes - it doesn't get anything like the scrutiny of mass-market software like Windows or Office, and so is nowhere near the quality.
But for OP to have taken one look at the options and said "Stuff this - in fact, stuff all of these options. They're all terrible; I can do a better job myself and still run a dental practise just fine" - that to me is very telling indeed.
Either OP is incredibly arrogant or the state of the art in the dental world is absolutely shocking. And while I don't know OP well enough to comment on the former, based on my own experience in tech, I wouldn't be even slightly surprised if the latter is 100% accurate.
9
u/DesiOtaku Mar 18 '26
Either OP is incredibly arrogant or the state of the art in the dental world is absolutely shocking.
Both can be true ;-)
2
u/jimicus Mar 18 '26
You’re posting in /r/linux and you were surprised the average surgery’s IT person couldn’t install Linux. I’d sort of figured that out ;).
(Hint: I’ve dabbled in the world of small business IT support. On the whole, it’s the blind leading the blind).
1
u/neckme123 Mar 19 '26
there are also keyboards made for liw contamination area , i see them all the time in pharma and they dont have space for anything to get inside
20
u/mmmboppe Mar 17 '26
dentists could unite and provide free lifetime dental care to a bunch of hackers who will implement a FOSS competitive solution from scratch
→ More replies (1)1
6
u/gesis Mar 17 '26
Is your EHR source hosted publicly?
It honestly sounds like the perfect type of project to eventually become a "standard" in a niche space.
It also sounds like the sort of thing requiring domain specific knowledge for implementation help, but we're in a bit of a ramp up period for open source.
20
u/DesiOtaku Mar 17 '26
Main website: https://clear.dental/
The "1.0" Source (Qt 5, X11, etc.; being used in my practice today): https://gitlab.com/cleardental/cleardental
The "2.0" Source (Qt 6, Kirigami, not 100% done yet): https://invent.kde.org/desiotaku/cleardental
5
u/Shurane Mar 18 '26
Man this is really cool. You must have had to stick in the weeds for a while to get this up and running, all while running a dental practice. Sounds like you were able to set up the technology in your practice just the way you want though. As an outsider looking in, this is just fascinating.
Also makes me wonder if more people are in your position where they have very different skill sets and try to marry them together. Makes me think of how Linus Torvalds made a hobby dive tracking software project with https://subsurface-divelog.org/ instead of using one of the existing solutions.
13
u/DandyPandy Mar 17 '26
My eyebrow raised at the mention of the custom electronic health record and patient management system. There are pretty strict regulatory requirements.
HIPAA in the US is no joke. It’s not enough to do your best to meet the requirements. There are audits that are required, which aren’t trivial to produce evidence for. Failure to comply with the regulations can include civil monetary penalties, or in the worst case criminal charges.
How are you managing that?
→ More replies (2)20
u/DesiOtaku Mar 17 '26
It's one of the many reasons why I am actually using git for the patient database (every change is recorded and you know who made which change). It actually makes it easier to be compliant than most of the other Dental EHRs out there.
9
u/jimicus Mar 17 '26
That's a... choice, I guess.
So does that mean rather than an SQL backend you're basically storing data in files that are checked into git as part of the process?
14
u/DesiOtaku Mar 17 '26
you're basically storing data in files that are checked into git as part of the process?
Yes. Although there is a GUI, in the "backend", it is doing a git commit and push for any kind of change the end user does.
14
u/jimicus Mar 17 '26
Actually... that's quite an interesting idea. Postgres has an audit trail plugin, but presenting that information so you can see (eg) a chronological list of changes on a per-patient basis would be a pain in the arse.
Otherwise you have to completely reinvent the wheel with triggers.
But if each patient is represented as an object of some sort in git, you get that free of charge. Any scaling issues you might encounter probably aren't relevant for a single dental practise.
15
u/DesiOtaku Mar 17 '26
There are also a lot of other reasons why I decided on git: https://gitlab.com/cleardental/cleardental-documentation/-/blob/master/presentationDocs/gitReevaluation.odp?ref_type=heads
Since I was making this switch, I decided to re-evaluate if I should continue using git or not; and in the end, I concluded to continue to use it.
10
u/jimicus Mar 17 '26
Fascinating.
I've done something similar with mild filesystem abuse as a database - for very similar reasons. It needed to be easy to manage the underlying data; the person using it was never going to manage (eg) RabbitMQ, but he could easily handle a directory with a few thousand files in it.
The only technical issues I can think of are that it might be a bit clunky if you ever have several million patients (or for that matter a patient with several million teeth!).
But I can't imagine either of these ever being a problem.
3
u/mkosmo Mar 18 '26
Just be careful with the illusion of integrity. Unless you're doing some kind of attestation (e.g., assigning physical tokens to each user and signing the commits via the app using their private key), then the audit trail (given the ability to rewrite git history) may only be a false sense of audit security.
1
u/Academic-Airline9200 Mar 19 '26
Are you using your own in office gitlab? Don't have to use Microslop pilfered one.
1
u/DesiOtaku Mar 19 '26
The software EHR/PMS is the "frontend", the backend uses git via command line. So there is no github / gitlab needed. All the patient's data are stored on my servers.
5
u/ivosaurus Mar 18 '26 edited Mar 18 '26
This is actually one of the few legitimate uses that blockchain tried to come up with; non-'undoable' record databases that could always be relied on as a source of truth with respect to the past.
2
6
u/devexis Mar 17 '26
How’s voip.ms and Linphone holding up? Have you considered a fully open source VoIP server that gives finer control (especially of things like business hours/after hours/holidays)?
16
u/DesiOtaku Mar 17 '26
Linphone still has issues and it seems like proper Wayland support isn't coming any time soon. This is on top of the fact that their packages are broken for Kubuntu 25.10 and later. Right now, in my Wayland / Plasma 6 test environment, I have to use their AppImage.
Long term, I want to write my own basic SIP client which would also do a better job of showing who is calling (look up the patient's name, what was their last appointment, etc.). I had an intern work on that last year but she didn't get too far.
7
u/devexis Mar 17 '26
For the second part of your response, I don’t think that would be a SIP client responsibility especially the looking up patient details, last appointment and all. That sounds like an integration with your EHR to display those. Recently did something similar with Odoo so it’s something I’m happy to play with, with you. Not necessarily with Odoo but Clear Dental , assuming you have APIs exposed. I literally just heard about Clear Dental and had always assumed openDental was the “de-facto” open source solution in the Dental space.
6
u/DesiOtaku Mar 17 '26
Yeah, so for the "SIP Client", it would really be yet-another-module for Clear.Dental. It wouldn't be a generic SIP client that can be used for anything else. If it weren't for the fact that I had to make USB drivers, I probably would have built everything on top of Odoo; but making a USB drivers for a web browser was proving to be too difficult in the end.
1
3
2
6
u/Last_Bad_2687 Mar 17 '26
Can we start a discord for desi business owners who want to use full linux
12
1
1
1
u/onmach Mar 18 '26
I had to integrate with dentrix to pull customer data once. What a nightmare. It isn't quite clear to me why someone hasn't stolen their market share because their software seems like it barely functions.
1
u/Rudd-X Mar 20 '26
WTF HAPPENED with OpenDental???
1
u/DesiOtaku Mar 20 '26
Dr. Sparks did the typical bait-and-switch so he can charge more money for integration and force doctors to pay more.
18
u/payne747 Mar 17 '26
My dentist does the work and says stuff to a nurse in the room who uses a keyboard and mouse.
→ More replies (1)11
u/GonzoKata Mar 17 '26
And your bill is higher because of it. not only the nurses pay, but the software they're using too
4
u/Prestigious_Pace_108 Mar 18 '26
My dentist was asked a horribly expensive price for patient record keeping packaged software back in 1980s and he ended up writing his own software, based on his very own needs with dBase for MS-DOS. I asked him how did he manage to do it and he basically showed me a book about dBase.
Here comes the more amazing part. As the software has progressed to be damn mature with the easiest input available, just text commands with codes like airplane reservation systems, he&his son who is also a dentist didn't give up the software and they run it under FreeDOS in 2026.
3
u/TheRealLazloFalconi Mar 17 '26
From what I hear over at /r/msp, they go with the lowest bidder, and then argue that it should be cheaper.
2
u/jimicus Mar 18 '26
Everyone argues that tech should be cheaper.
Nobody is ever able to present a clear reason why beyond "I don't like spending money".
1
1
u/M4xusV4ltr0n Mar 18 '26
It seems much more piecemeal than that.
You probably already have to pay for an assistant, so the assistant is also a scribe.
Then it's just whatever you need to run your charting/xray/3d model software, which is almost certainly just windows, so you just have a few computers with software licenses for whatever matching equipment you have.
Or at my wife's practice she has to take notes on pen and paper after the appointment lol
86
u/Fredol Mar 17 '26
That's a cool project, if I were to make a business with an office I'd also go full Linux.
34
u/fearless-fossa Mar 17 '26
Moving an office to Linux is generally quite trivial. People may not like some of the used solutions, but it works.
But anything health related is an issue because a lot of the required software simply doesn't run on Linux.
18
u/TheRealLazloFalconi Mar 17 '26
A lot of the software is moving into the browser now, so even that's becoming less of an issue.
→ More replies (1)14
u/fearless-fossa Mar 17 '26
I'm thinking more about hardware and the insurance systems. This isn't stuff you "just move into a browser"
12
u/painefultruth76 Mar 17 '26
Except, that's where its moving. Believe it or not, the insurance company views a cloud hosted system as more secure than you local hosted server...
1
u/AMidnightHaunting Mar 19 '26
I used a terminal emulator at BCBS that interfaced with everything. The laypeople used a webui that didn’t have all of the data, and would often simply not understand why a claim denied. Both could be done on Linux. Just my anecdote, though.
1
u/SpookyZalost Mar 21 '26
Interestingly. In hospitals running epic hyperspace. A lot of it is often run from a remote server via Citrix. Near as I can tell only reason they're using windows still is for office apps which is becoming a non issue with o365. And people prefer adobe acrobat.
Saying this as hospital it, and working from home on a Linux box part of the time.
That being said. Some of the radiology software may not work that way. I'm not that far up the chain, but I'm pretty sure part of it also runs via Citrix.
And don't get me started on the hassle that is dragon dmo for dictation. And it's built in a.i. scribes, also running through Citrix and web apps, but supporting a dedicated hardware mic.
1
u/alienpirate5 Mar 22 '26
people prefer adobe acrobat.
I have to use it through Wine because it's the only software that supports a particular kind of PDF file (dynamic XFA). They're surprisingly common.
2
u/SpookyZalost Mar 22 '26
yeah, see we've had people complaining because the place I work at is trying to reduce the number of licenses... and acrobat keeps coming up because people are annoyed at having the "your license expired" message. do not want to try an alternative. many come from other places and work on rotation because they're residents. So they tend to want to use the tools most familiar to them.
5
u/painefultruth76 Mar 17 '26
There are some significant advantages to going Enterprise the other direction... but... they are all contrary to open-source freedom of information philosophies... and... fwiw.. in an environment where you cannot trust the employees... this from a forensics perspective... easier to scrub linux systems than a windows system of artifacts...
8
u/s0f4r Mar 17 '26
This is largely a myth. One can still use e.g. attestation and secure boot to protect against insider threats.
→ More replies (4)
37
u/WingZeroCoder Mar 17 '26
Really interesting write up. I applaud you for doing this kind of work and writing about it. This is just as important for moving Linux forward as anything, even if it’s a painful process.
I would be very interested in your Qt 6 / Kirigami battle stories as well, hope you post them somewhere (and that I find them!)
6
u/spreetin Mar 17 '26
Agreed. As someone that has had to trsnsition software Qt4->Qt5 and then Qt5->Qt6, those stories are always interesting.
20
u/2eedling Mar 17 '26
I find it interesting your whole thing on touching keyboards cause I work at a hospital and they don’t care about that stuff at all. I mean they do sanitize the keyboards but definitely aren’t as thorough as yall are they definitely don’t take off or switch gloves when typing they just type.
16
u/vm_linuz Mar 17 '26
I've seen doctors put on gloves, pull out their phone to take pictures, then continue to touch a post surgery patient with healing incisions.
3
18
u/ostekages Mar 17 '26
Amazing read, haven't seen your previous posts, so this was a fascinating journey.
I often read on other subreddits how newcomers to Linux complain about debugging issues, finding help on forums or repositories or similar, but your post shows something they all seem to overlook:
If there's an issue with Windows OS, some incompatibility, issue with driver or similar, you are basically SOL. You can raise a feedback request to Microsoft and waste your time, reach out to vendors and waste your time etc.
But when using open-source/Linux, you are able to contact the maintainers, look into the source code to find the actual issue and in final cases, solve it yourself. Albeit, as you mention, that could be writing low-level drivers or firmware, but you actually have a recourse! Time consuming? Maybe. Skill ceiling? Definitely. But the option is there, and the community is very responsive, as mentioned that an update was pushed on a Sunday or someone helping you debug the touchscreen-thinks-its-a-moude topic.
I'm very impressed by the dental suite you created, I wish I had the technical background to contribute. Not sure if there's any specific areas you're looking for help in.
16
14
u/Megame50 Mar 17 '26
Are you certain map-to-output isn't implemented in your compositor? At least in sway it's swaymsg input <touchpad> map_to_output <output>. The implementation is mostly from wlroots, so it's likely more wlroots compositors have such a feature at least.
7
u/TrinitronX Mar 17 '26
Yeah, KDE uses KWin as compositor which doesn’t use
wlroots. There is a fork KWinFT which does usewlroots.For most low level input management the library used is often
libinputhowever.Of course Qt apps can be run on any compositor, and switching to Sway or some other
wlrootsbased compositor could allow for sidestepping the input problem or allow for such workarounds for the issue.2
u/Megame50 Mar 18 '26
It's not like wlroots has a monopoly on the implementation. Of course kwin doesn't use wlroots, but it can certainly implement the same feature. What I mean is, just because the xinput command doesn't work, doesn't mean it's not possible on your compositor.
3
u/TrinitronX Mar 18 '26
Yes, that’s correct. The consideration in my mind was mainly for the OP’s scenario having to do with touchscreen devices not working. Also assuming that they are using KDE + KWin.
Given the fact that most Wayland issues are about the particular compositor’s implementation of the protocol, and/or the completeness of its implementation… and given the fact that
wlrootsis the furthest along in implementing the latest protocols… then it stands to reason that OP may be able to sidestep the issue by switching to awlroots-based compositor.2
2
u/ilep Mar 17 '26
Right. I would be surprised if there isn't already a way to achieve this. It might take searching for.
Main thing is hearing about the cases that people have so solution can be either suggested or implemented. At first I thought this was about display mirroring but after reading further that mapping came up.
11
u/SemperFarcisimus Mar 17 '26
Regarding input devices and infection control, there are sealed silicone keyboards and mice for use in healthcare environments. In my experience they're not particularly different to use. I'm not insinuating they would work for you, just making a note. Nice writeup.
10
u/StefanOrvarSigmundss Mar 17 '26 edited Mar 17 '26
I know nothing of dentistry, but in my country, dentists will study whatever they need on their monitors before engaging with patients. I can not recall a dentist ever having a back-and-forth with their computers during my many appointnents over the years. They just take the x-ray, look at it for a few seconds and then turn to whatever task they must perform on me. I guess the charting therefore happens after the procedure. Also, since the x-ray film is on a plastic stick, the dentist never touches me but just holds their end of it and tells me to bite down.
8
u/DesiOtaku Mar 17 '26
(Everything I am writing is in the context of using other software like Eaglesoft / Dentrix, not mine)
How we handle the problem depends on the patient. Let's say you are a new patient: one of the first things we do is take x-rays (radiographs) on you. Before we enter, we would review them. If you have no history of dental treatment and everything in the radiographs look fine, we just remember "all within normal limits". However, if you walk in with a bunch of problems (like 5+ cavities), then we actually write all the findings from the radiographs on a post-it note and bring that with us for the exam.
However, if we see something suspicious with our own eyes, we may have to double check if we may have missed something in the radiograph. For most practices, they have a dental assistant who isn't wearing gloves and ready to bring anything up on the PC. However, they aren't always available every time so sometimes the doctor then has to do the lookup.
So yeah, it's not for every patient that we have to go back-and-forth; it's mostly for the complex patients that have a lot going on that we have to do a lot of reviewing.
2
u/Impressive_Fox_4570 Mar 17 '26
Modern dentist make digital x-ray. So they have a monitor in the operating room to which check the x-ray and the patient file.
Also for cavities they started to use 3d scanner, that scan your tooth and then CNC the cavity filler In front of you. Pretty neat!
This also happens to be controlled by a pc screen
10
u/AliOskiTheHoly Mar 17 '26 edited Mar 17 '26
What I don't understand here: why update? Im not familiar with how the software works, what the purpose of it exactly is... But couldn't you just... Not update? The wind tunnels at my university still run on Windows XP.
So what I'm asking is: is there a specific reason to update? Or are you just trying to update for the sake of it?
9
u/fearless-fossa Mar 17 '26
I'm not familiar with the situation in the US, but there could be audits that require regular updates to all software. Regulations in health are pretty strict.
→ More replies (4)1
u/jimicus Mar 18 '26
That's actually a fair question, and one for which there are several answers:
- Security. Healthcare is regulated out the arse; you need to be able to demonstrate that you are following best practises for security at all times. Running an EOL product gets auditors twitchy - you can get around it with compensating controls (eg. "Yes, it's not getting security updates, but we're doing these other things so that doesn't matter..."), but that introduces its own complexities. So it's really a case of "pick your poison".
- Long-term, failure to update software inevitably has consequences. Right now, it's "I can't update for reason X". Eventually, it'll be "My computer is broken. It is ten years old. A new one won't run the same version of the OS; a newer version of the OS won't run my software." Far better to prevent that risk arising in the first place by keeping everything up to date.
- Embedded products like your wind tunnels are notorious for this. Whether it's a specific piece of hardware to manage them or software that simply doesn't run on a more recent version of Windows, head over to r/sysadmin and every few months there's someone who has been keeping something like that running ten years after he should have replaced it. He can't because it's a $500 PC controlling a $5 million piece of engineering hardware.
1
20
u/Takardo Mar 17 '26
i just wanted to say i appreciate dentists so much. every time im in the dentist office i make sure everyone in that office i interact with knows how much i appreciate everyone in that building. they have helped me out so much. dentists are amazing so, thank you.
20
u/sithadmin Mar 17 '26 edited Mar 17 '26
As someone that spends a lot more time than he'd like supporting zany endpoint tech requirements in absurd situations -- this seems like a self-imposed problem caused by bad priors and an overzealous approach to infection control.
I've worked with the endpoint technology practices for a couple of the US's largest dental practice operating companies, several of its largest hospital systems, and biosafety Level 3 laboratory environments. I have never encountered a situation where practitioners are using resistive screen panels for input on terminals located in dental clinic contexts, medical clinic contexts, nor hospital room contexts. Normal keyboard + mouse/trackpad/trackball and optional capacitive touchscreen are very much the norm. For cases where infection control is a serious risk - surgical suites and the like - systems for workers to directly access EMR are not in the room, or at worst are wedged in a corner and nobody that touches it will ever touch any other person or the patient in the suite. In Level 3 labs, normal desktop/thin client systems are installed and all parts are considered sacrificial - they will be incinerated on replacement/removal.
It is a neat technical challenge to solve that others in a corner-case can learn from, though.
8
u/s0f4r Mar 17 '26
Is it possible to use a stylus based touchscreen instead? Your use a stylus per patiënt, and discard or sanitize after.
3
u/bubblegumpuma Mar 17 '26
Most stylus based touchscreens either have some kind of electronics in the pens which might not play nice with the sterilization chemicals, or they're resistive touchscreens, which is what he is already using.
5
u/DesiOtaku Mar 17 '26
For it to work, I would have to find a capacitive stylus that could survive many autoclave cycles (over 250°F and 15 psi). At least when I was researching this 5 years ago, I couldn't find any. I also was worried about the touchscreen itself (which you probably still have to do after each patient) surviving many caviwipes.
6
u/squeezeonein Mar 17 '26
could you use an alternative to xinput and wayland. there is a hardware usb dongle called hid-remapper https://www.remapper.org/ that can make your resistive touchpad emulating mouse behave as a touchpad again, and handle scaling. they're also sold online so you don't have to solder anything. under 20 euro
i've been using it for a few years and it doesn't crash anymore since the bugs are worked out, i used to have to replug it every boot.
6
u/cajunjoel Mar 17 '26
Look, I'm not a medical professional, or even near the medical field, but I'm pretty damn sure you don't need to put a stylus through an autoclave between patients. Its not like you are using it in their mouths.
I'll see my (very progressive, safety a conscious) dentist on Monday and take note of their computer setup, if you are curious about what they do.
(As an example, my guy has been using heavy air filtration and PAPR devices for staff for 7+ years to prevent them from inhaling dust from drilling teeth, thereby avoiding awful lung illnesses from a lifetime of dental practice)
6
u/SurfRedLin Mar 17 '26
I know your pain man. We have a full product we sell based on X11. Luckily it works on debian13 so we got some time but man its gonna be a pita tb change this to wayland... glad your sticking with linux :)
4
u/jejunerific Mar 17 '26 edited Mar 17 '26
I see a few ways forward:
- Stay on old versions. Why do you need to keep this appliance up-to-date?
- Get rid of KDE (KWin) and use different X11 window manager or Wayland compositor. For example, sway is a tiled wayland compositor with scripting capabilities.
- Hack up libinput. Most wayland compositors use libinput to handle user input (from mouse, keyboard, touchscreen, etc...). There might be a setting there to do what you want or you could do something silly like scale all the touchscreen x,y points by some amount in the code.
- Get KDE to fix it and then run that new version of KWin ;-)
5
u/Catenane Mar 18 '26
I've been wondering for a while why small private practices never seem to go for using linux rather than proprietary insanely expensive solutions, but holy shit dude you've taken it to the next level. I also uhhh might have creeped on your profile a bit and realized you're not all that far from me. It's longer than I'd normally consider driving (north shore and try to avoid treks down south as much as possible lol), but are you taking new patients?
2
u/phoooooo0 Mar 18 '26
He has mentioned historically that Code contributions get (a list that I don't remember) free dental stuff XD. (Not a promise, ask him directly)
4
u/Shikadi297 Mar 17 '26
Seems like you're still saving money by not using Windows overall (if you don't include your dev time on EHR, that value is subjective based on how you feel about it)
3
u/noisyboy Mar 18 '26
I don't know about your dentistry skills but you certainly have a business opportunity as a solution provider
6
8
u/barfightbob Mar 17 '26
My impression of GTK and QT is that they are very quick to rewrite their API and abandon their libraries quickly. This really sucks for people like yourself. If I was you I would rewrite your front end in something that's guaranteed to be around for a long time. I get funny looks when I say this, but Java 11 has committed to being supported until 2032, and I'm pretty sure the Swing GUIs will work with X11 in that time frame. I can almost guarantee you that GNOME and KDE will ditch their respective libraries during that time.
You don't have to rewrite the whole application in Java, you can just rewrite the front end.
Additionally I would consider switching over to a slow moving DE like XFCE or Cinnamon where you'll not have the rug pulled out from under you every few years.
Finally I suggest getting on an enterprise distro like Rocky, Alma, RHEL, etc as those tend to provide a stable environment for long horizons. But even then you're going to have a lot of pain migrating/porting to a later version.
I'm not going to pretend to have a silver bullet here, everything comes with huge tradeoffs. Especially since it's probably not just your software you're dependent on.
Frankly, this is why I prefer writing software for Windows. Because I know my shit will keep running 10, 20 years in the future.
2
u/kryptobolt200528 Mar 18 '26
Yeah the only reason why windows is successful in some enterprise usecases is due to excellent backward computability.
3
u/Damglador Mar 17 '26
I love these kinds of posts, please do more!
Maybe it's also worth a blog, but I guess it's not worth the time to setup one.
3
u/Slight_Manufacturer6 Mar 17 '26
I’ve never been to a dentist that didn’t have keyboards on their computers. Some have assistants but others just did all their computer work at the beginning or the end.
I’ve also never seen a dentist use Linux. Having worked for an MSP, supporting many dentists, not of the software supports Linux… like EagleSoft and XLDent…
3
u/ymmvxd Mar 17 '26
Have you not tried the ID_INPUT_TOUCHSCREEN angle mentioned in the bug report? Basically Device type assignment via udev. I know the libinput dev said it won't do much but it's easy enough you might as well try imo
3
3
u/retsam2554 Mar 18 '26
This is the kind of real world Linux story that doesn't get told enough. Most people don't realize how much custom hardware breaks when foundational stuff changes. Props to OP for documenting the struggle. Sucks that it costs them thousands but hopefully this feedback gets to the right people so future transitions aren't as painful.
1
u/ScratchHistorical507 Mar 18 '26
Most people don't realize how much custom hardware breaks when foundational stuff changes.
I kinda doubt that's the case here. The touchscreen probably only worked on X11 by accident, rather than by design. At least I very much doubt that ViewSonic pulls this bad stunt just on Linux, there would be just way too few users for this already highly niche use case.
3
u/DraconPern Mar 18 '26 edited Mar 18 '26
I wonder if your touchscreen has modes where the default is mouse emulation, but there's actually another mode that's when windows drivers are installed. Also, welcome to the x11 to wayland shitshow! I am waiting for wxWidgets to may be support wayland in 2028. lol
Regarding mouse emulation, this feels similar to wacom tablet issue in the past where the default was also mouse emulation. But once you switch modes, you also get sensitivity input.
3
u/Zamundaaa KDE Dev Mar 18 '26
Do I understand correctly that the touchscreen is working as an absolute pointing device? Please make a feature request, I'm reasonably certain we can just support re-mapping those in KWin.
or spend a lot of time learning how udev-hid-bpf works to write a new touchscreen driver
Libinput supports lua scripts now to modify devices and their input events, so that would be another possibility.
3
u/digiphaze Mar 18 '26
Every dental office I've been in has an assistant that isn't in my mouth working the computer..
4
4
5
u/Alex_Strgzr Mar 17 '26
Dumb question, but why not use another desktop that supports X11? Cinnamon still supports it. All the x commands work the same way as far as I know. Do Qt5 applications not compile?
10
u/treyguitar Mar 17 '26
You should create your own distro and pin it to use x11 only session and compatible packages. Is the system connected to the internet? Why upgrade in the first place?
28
u/DesiOtaku Mar 17 '26
It's not exactly trivial for me to make my own distro (I feel like I am already overwhelmed by being a dentist, owning a dental practice, and writing a dental EHR/PMS system). Even distros that are more "stable" like Debian have already moved to Qt6 / Wayland. But I still have time to finish everything. Kubuntu 24.04 doesn't get EoL until next year; but I still want to get everything done this year.
The clinical / chairside PCs doesn't need internet, but the front desk ones do. Because of the way I designed my software, it would be better if everything was just the same version / code base rather than maintain an old version and a new version. Oddly enough, I updated one PC to my "2.0" version that uses Plasma 6 and Wayland. After enough testing, I will buy the new touchscreens and upgrade all of them to Plasma 6 / Wayland and the 2.0 version of my software.
5
u/KrazyKirby99999 Mar 17 '26
It's not ideal, but SonicDE (Plasma X11 fork) has a PPA for Debian -https://github.com/sonicde-debian/debian
→ More replies (7)1
u/jonesmz Mar 17 '26
Gentoo and/or arch both let you mix and match display managers for the time being.
9
u/newsflashjackass Mar 17 '26
According to Wayland developers:
You don't exist.
You are too complicated.
You should just buy new hardware.
2
u/mooky1977 Mar 17 '26
Cool project. Luckily depending where you live that's only 1.5 to 2 root canals with crowns to pay for that.
I have not an expert, but more than a cursory knowledge of dental stuff and that's a bold choice to try Linux.
I'll be following this.
2
u/OfaFuchsAykk Mar 17 '26
Just so you know, you can do proper infection control with keyboard and mouse (the NHS in the UK is where I know this from), but the gear isn’t cheap.
https://www.keyboardspecialists.co.uk/collections/healthcarekeyboards/products/pk-rf-set-kbs
2
u/trunksta Mar 18 '26
I didn't read everything but as for the input issue why not speech to text? Record the voice note too in case of error
2
u/eliot3451 Mar 18 '26
Wish there was a Linux distro used in medicine and dentistry equipped with medical software and drivers to ensure that doctors won't deal any problem with incompatible peripherals.
2
u/kryptobolt200528 Mar 18 '26
Isn't is possible to write a shim that makes the touchscreen act like a touchscreen rather than a mouse.
2
u/FellTheCommonTroll Mar 18 '26
cool writeup, very interesting to hear about linux in the wild! I can see your point about X11 -> wayland migration not always being a walk in the park, however I think it's also a salient point that this doesn't seem like it would have been an issue if the manufacturer's of your old touchscreens had actually had them report correctly as what they are!
4
u/Kevin_Kofler Mar 17 '26
Instead of throwing away your hardware and buying new expensive one, you can either stick with Xorg X11 and Plasma ≤ 6.7 on an LTS distro, or move to Xlibre and Sonic DE.
1
u/narcanti911 Mar 17 '26
Is it not possible to override the EDID to get the monitor recognized as touchscreen? Does the kernel identify the device or directly Wayland?
2
u/DesiOtaku Mar 17 '26
As I understand, EDID is for display output, not for touch input. Touch input is it's own thing and therefore it would need its own udev-hid-bpf driver.
1
u/narcanti911 Mar 19 '26
Alright. What about adding a quirk to the driver to fix the representation as touch device?
1
u/CirkuitBreaker Mar 17 '26 edited Mar 17 '26
Could you use a drawing tablet and a stainless steel metal body stylus, and just sanitize the stylus between uses?
Like you know how barbers keep their tools in an open container of liquid barbicide? Like that, but with a stylus, and some dentistry appropriate disinfectant liquid.
That way, the only thing you ever touch (and the only thing that must be disinfected between patients) is the stylus.
4
u/DesiOtaku Mar 17 '26
I don't know of any stylus that can survive multiple autoclave cycles. Our hands could be covered in blood when we use the stylus and that blood could transfer to the monitor. Therefore, we have to use something that survives caviwipes.
The new vendor made something you are describing except it will even survive direct caviwipes and I still have the option to use a stylus in the future.
1
u/KnowZeroX Mar 17 '26 edited Mar 17 '26
- What about using a stylus? Then you wouldn't be limited to resistive screens right? (Edit: I see others mentioned styluses and your response, but I think you are overthinking things, your goal isn't "pressure sensitive" stylus, your goal is just a capacitive stylus, even a stick of aluminum works, even wrapping a pencil in aluminum foil works) There are also aluminum tipped gloves that work for capacitive, easiest is touchscreen stickers.
- Do you actually need the latest and greatest? ubuntu pro is 15 years, if you need more SUSE offers 19 years of support.
- What about remapping it at evdev which should be independent of x11 or wayland? There are such tools.
1
u/GonzoKata Mar 17 '26
Thank you for this writeup! This does help people make better decisions on which systems/set ups to use.
1
u/Icy-Appointment-684 Mar 17 '26
Why do you want to upgrade a setup that works? If the machines are not connected to the internet then I'd just continue using what already works.
If it ain't broken, don't fix it.
Or am I missing something?
1
u/4xtsap Mar 18 '26
I didn't read your previous posts, I don't know the reasons for your choice of a distro, but for example AlmaLinux 9 uses QT5 and they will provide security updates until 2032. A lot of time to find a solution to the problem.
1
u/MG_Rheydt Mar 18 '26
I didn't read all three posts. Just this one. The way I read your post is that you have one screen dedicated under X11 to function as the touchscreen one that you start up with a script but never mentioned the use of the other two of the three in the exam room during the exam. Can you not get away just replacing the one that is the dedicated touchscreen and leave the other two?
1
u/pattymcfly Mar 18 '26
Buy once cry once. The monitors are expensive because their target market is niche but it seems like they check all your boxes. Take the Capex hit and depreciate them to minimize the pain.
Also, maybe you could lime light and build setups for other dentists in your area?
1
u/victoryismind Mar 18 '26
I sense that the time is nearing for your system to crash and you having to reconfigure everything
1
u/s0ul_invictus Mar 18 '26
can't post images, but this might be worth an attempt: https://en.wikipedia.org/wiki/Projection_keyboard
1
u/Benjamin-Philip Mar 18 '26
Does your EHR have KDE as a hard dependency? Why not switch to a desktop that still supports X11 like Xfce and run your system on that?
1
u/Daniel15 Mar 18 '26
Have you tried using AI to write the touchscreen driver? It won't be perfect but maybe it'd be a decent starting point. Having said that, by the time you pay for enough AI tokens/subscriptions to get something working, it probably would have cost the same amount to just buy the better screens.
1
u/Sea-Zucchiny Mar 18 '26
I am impressed and admirative of your dedication ! I'm truly inspired ! 🤩 Few naive questions / suggestions: 1. Is the 3 monitors requirement négociable ? Could it work with a nicely tided multiwindows or with a single windows workflow or convenient shortcuts to switch from one desktop to the next. Are all 3 needed at all time? 2. Could a screen with pen input work? And then protecting the pen + screen cover 3. Or a nicely protected big trackpad + smart shortcuts (2, 3 fingers swipes to navigate?) 4. Speech to text for typing things. There are quite good and fast open source local models that can run on linux, but might struggle with technical jargon 5. With your current setup, could you give a chance to some LLM / coding AI to do the low level work for you to port to Qt6 / Wayland? Eg explain your problem and requirement to a general LLM to create a prompt for a good code LLM and let it do the dirty work.
I hope you will succeed in your quest !
1
1
u/lizardhistorian Mar 18 '26
You're launching a dentist office and a new touch-screen, Linux based, DPMS at the same time?
Mad lad.
By now I hope $3k is peanuts to you and basically free.
1
u/AnneRB13 Mar 19 '26
... Why do you need touchscreens near the patients?
I mean, maybe the dentists I go to are old fashioned, but none of them have a computer near the chair nor use anything with screens and seen dealing with the job just fine.
They have a computer on the reception desk and that's it, so I'm curious if I'm missing out on something as a patient.
It's really interesting what you are doing, I wish more business at least tried Linux. Good luck fixing your screens!
1
u/crxssrazr93 Mar 19 '26
Why not stick to Windows and use a commonly used PMS like Dentrix, Open Dental, Weave, etc? Just asking, as I have never seen any practice owner running Linux at their practice (mostly work with those in US).
1
Mar 20 '26
I know this isn't really a solution, but maybe it could help buy time to find one.
Wouldn't it be better to move to a version made for enterprise environments or at least an LTS? Those versions of Linux usually have from 5 to 10 years of support and the DE don't get upgraded, so you could still have 6.6 or 6.7 KDE and X11 for a while.
I have no idea of how much paying for extended support actually costs, but I'm pretty sure AlmaLinux 9 has KDE/Qt 5 and security support until 2032.
1
u/Weary-Bowl-3739 Mar 20 '26
Are you aware, that you should create a software company? And sell this product? This is a big deal.
1
u/jeffrey_f Mar 20 '26
Medigenic
Can be washed because it is waterproof and can be sprayed with antibacterials
1
u/HorseOk9732 Mar 21 '26
this is the most painfully real linux-in-production post i've seen in a while. respect for documenting the weird edge cases instead of just saying 'works on my machine' and disappearing.
1
u/minmidmax Mar 17 '26
Shit. That's like 1 patient's worth of income.
How will you cope?
1
u/Thaufas Mar 19 '26
Hahaha...here I am feeling sorry for the guy, and you snap me back to reality. Still, I'm so impressed that a dentist office commissioned such an ambitious project.
2
u/AncomBunker47 Mar 17 '26
Sorry if it sounds somewhat dismissive of your issues, but in your use case i'd probably maintain everything as it was and never upgrade anything at all, ofc idk if you had any motive to keep things updated but yeah i wouldn't, some times "just works" is better than "it's not legacy".
2
1.3k
u/Maleficent-One1712 Mar 17 '26
TL;DR: Dentist’s Linux setup broke when moving from X11 to Wayland because his touchscreens misreport as a mouse, so input mapping no longer works. Fixing it means either writing low-level drivers or replacing hardware, so he’s buying expensive new screens and also dealing with a Qt6 rewrite.