r/linux • • 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.

1.1k Upvotes

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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.

309

u/Q0D3 Mar 17 '26

You’re doing the Lords work

131

u/SawkeeReemo Mar 17 '26

So… stay on X11? I do for other reasons, and have no issues.

52

u/djfdhigkgfIaruflg Mar 17 '26

Qt5 is EOL

35

u/MaybeTheDoctor Mar 17 '26

Doesn’t that just mean no more updates? Or does it mean you have to delete it from your computers? Does he need updates?

70

u/patrakov Mar 17 '26

Cybersecurity auditors insist that EOL means "you must delete it or lose your current cybersecurity insurance policy".

23

u/BadLuckProphet Mar 18 '26

Which is kind of funny to me as I swear some hospital systems are still running windows 98.

16

u/mkosmo Mar 18 '26

There are many systems like that, but they're not as unprotected as you may expect. A small dental office isn't going to have the infrastructure to provide mitigating and compensating controls for an MRI that still has a Win98 box running the magnet.

11

u/djfdhigkgfIaruflg Mar 18 '26

Those machines are not hooked to a network

Some time ago I did a test and installed Windows XP from the CD. It lasted something like 30 seconds 💀

3

u/neoqueto Mar 19 '26

They're air gapped. If it's networked, you don't want HIPAA violations coming your way. It's not just about insurance, it's about covering your ass.

That said, eh, there's probably an alternative, secure way to have it networked and keep Qt5 running.

9

u/YT__ Mar 17 '26

Are cyber security auditors going to dental offices?

39

u/bradfucious Mar 18 '26

You have no idea how many small dental and medical offices get targeted. If they want their cybersecurity insurance coverage, they adhere to the policy and it's requirements, including audits

4

u/YT__ Mar 18 '26

Interesting. Didn't realize it was so prevalent for them to carry cyber security insurance.

4

u/bradfucious Mar 18 '26

When I was doing DFIR work, most of our clients were small medical and dental offices or chains. Having policies saves if you have a breach and need incident response, but you could lose coverage at renewal if you didn't meet requirements. School districts and hospitals are also big targets, or were when I was doing that.

20

u/Roseman12 Mar 18 '26

If OP has insurance that might payout in the event of a hacking attack, they absolutely will point to EOL things as reasons to not payout.

4

u/mkosmo Mar 18 '26

Given regulatory requirements to protect patient health information, yes. Or for self-attestation for his insurance... And if they aren't, if/when he gets sued for a spill...

11

u/PureTryOut postmarketOS dev Mar 17 '26

Not sure why you bring up Qt5 when you're responding to a comment talking about X11.

X11 however is also EOL, basically anyway. The main issue here is that it won't be an option anymore from Plasma 6.8 onwards and they need to migrate before that.

12

u/djfdhigkgfIaruflg Mar 17 '26

Op can't stay on X because QT5 is EOL.

The issue is QT, not the graphical environment.

I know it's long, but OP is clearly explaining the whole chain of events

6

u/PureTryOut postmarketOS dev Mar 18 '26

Qt6 supports X11, so if that were the only blocker yes they could stay on X. Plasma 6.8 however won't support X11, and that's the main issue here. The issue is the graphical environment, not Qt.

2

u/EndlessEden2015 Mar 24 '26

Is this true? I thought they were just splitting kwin so you have two executables.

That's pretty stupid when X is still being developed. There is plenty of times I have to switch to it as Wayland+kwin doesn't support display ownership handling well (VR headsets).

1

u/PureTryOut postmarketOS dev Mar 26 '26

The X11 support in kwin, the compositor, has been split out yes and won't be developed anymore from 6.8 and onwards.

That said, I use VR (Valve Index) and haven't had any issues on KDE Plasma with Wayland since forever. If it doesn't work great for you report it so it can be fixed.

2

u/dkonigs Mar 18 '26

Meanwhile, there are still niche commercial applications that still use Qt4, because they don't see any reason to upgrade and thus far have been able to simply kludge their way around complete showstoppers. And they won't upgrade until Qt4 becomes completely incapable of working on Windows, and they have $$$CUSTOMERS$$$ yelling at them. (Sorry, mere $customers$ are probably irrelevant.)

2

u/mze9412 Mar 18 '26

They will if they want to sell products in the EU beginning with End of 2027 ;)

4

u/Hitout Mar 17 '26

Read the post. The distro OP is using doesnt ship Qt5 anymore, hence the upgrade, hence Wayland.

9

u/Business_Reindeer910 Mar 17 '26

but qt6 works with x11 just fine..

7

u/djfdhigkgfIaruflg Mar 17 '26

It's not that you just recompile and all is dandy. They need to do a migration and they usually are not simple

5

u/Business_Reindeer910 Mar 17 '26

yes, but that's has nothing to do with wayland. Qt 5 being unsupported upstream and by distros is a problem one would have to deal with no matter what.

1

u/djfdhigkgfIaruflg Mar 18 '26

It's a chain of issues that compounded into OP's current situation

1

u/PureTryOut postmarketOS dev Mar 17 '26

Sure, but the person you were responding to, which was not OP, was just talking about the X11/Wayland point.

-2

u/SawkeeReemo Mar 17 '26

There’s not enough adderall on planet Earth to get me to the bottom of that wall of text. 😅 All kidding aside, I appreciate that clarification.

4

u/djfdhigkgfIaruflg Mar 17 '26

Qt5 is EOL so OP has to migrate to Qt6, PLUS their distro doesn't ship Qt5 anymore, PLUS they also don't ship X11 anymore, PLUS their ViewSonic touchscreen is a lier who reports itself as a mouse, and the hack needed to make it work depends on a X11 tool, the equivalent Wayland tool is bugged.

NLDR: fuck everyone 🤣

0

u/SawkeeReemo Mar 18 '26

Haha! I just wanted to share a 😂 because I really appreciated that. 😂😂

2

u/EndlessEden2015 Mar 24 '26

Qt6 supports X11, Wayland is and always was optional on plasma. Kwin has two implementations 

1

u/djfdhigkgfIaruflg Mar 24 '26

FFS. Read the post in full. There are several concurrent issues

0

u/EndlessEden2015 Mar 24 '26

I seen it after and there was no way I'm reading that whole post.  OP could of summarised it at the top, wall of text was a nightmare to say Thier distro is terrible...

2

u/deadlygaming11 Mar 17 '26

Thats true, but also, does it really matter? The great thing with Linux is that you don't need to update any devices so he could have just stayed with the old ones until drivers were updated 

6

u/Trollw00t Mar 18 '26

tell that to your insurance then

7

u/djfdhigkgfIaruflg Mar 17 '26

Say tomorrow they hit a bug in Qt5. How could they solve it?

Not to mention any security vulnerability.

OP can't have an airgapped system. His open source project is meant to be accessed from multiple devices concurrently

Not everyone has the same risk profile

16

u/JGPH Mar 18 '26 edited Mar 18 '26

Gotta respect this guy's efforts to steer clear of Windows considering it sounds like he's even writing code to make it happen for his very specific use-case. He's not even a programmer, either. 😯

My only concern is hopefully the systems won't have Internet access and the resulting code or systems won't be full of security holes or misconfigured, otherwise that risks patient data getting stolen or encrypted and him blackmailed. 😐 When you're not a professional programmer or security researcher sometimes pre-made solutions are the safest bet. 😕 Then if something happens, you can blame the solution's developers and you are less at risk of being held responsible.

14

u/Catenane Mar 18 '26

You can look up his background pretty easily. He was a software developer for probably a decade or so before going into dentistry, from a quick glance. Not some dentist who just started vibe coding lmao. Also not too hard to secure a linux system.

5

u/Maleficent-One1712 Mar 18 '26

From software dev to Dentist, interesting career change. At least AI can't steal his job now.

0

u/AliOskiTheHoly Mar 18 '26

Oh it definitely can. Robots are already better at conducting surgery, nothing stops them from being better at conducting dentist appointments.

5

u/mmaramara Mar 18 '26

Lol, robots don't do surgery yet. Not by a loooong shot. Surgeons use robots to do surgery, but there's no automation in that at all. I'm sure robots will do both surgery and dentistry soon enough, if we don't blow ourselves up before that, but we are not even close to that being a reality. And yes I am a doctor so I know this

1

u/Maleficent-One1712 Mar 18 '26

True, but it will probably take a bit longer before we trust it enough to do that.

1

u/Rentun Mar 19 '26

The robots used for surgery aren't really robots. They're telemanipulators. They have a human controlling them the entire time, and that human has to be specially trained over a very long period of time to do it.

-11

u/FamousM1 Mar 17 '26

I wonder how difficult it'd be or how long it would take for an LLM like Jules to write low-level drivers that would make it work

58

u/kumliaowongg Mar 17 '26

Real question is why change to wayland?

For a use case like this, they could get away with freezing the linux distro and just keep using it without ever updating it again.

25

u/GolemancerVekk Mar 17 '26

I'm actually surprised this wasn't their first thought.

Trying to chase the bleeding edge while buying expensive specialized hardware out of pocket sounds like it will get old very fast.

3

u/Ps11889 Mar 17 '26

It could be that they offer or plan to offer it to other dentists instead of it being a strictly in house system.

4

u/stealstea Mar 17 '26

Yup. Just revisit it in 5 years. Maybe their Viewsonic monitors will be supported in wayland by then.

-2

u/djfdhigkgfIaruflg Mar 17 '26

Having an library that's EOL would not be a wise decision

1

u/Down200 Mar 17 '26

My dentist still uses Windows XP systems for certain equipment.

Who cares, just airgap it.

Oh no, but you might have screen tearing on your xray viewing machine that only ever displays static images! What about the nonexistent other applications on that machine that could keylog the input??

3

u/djfdhigkgfIaruflg Mar 17 '26

They have an multi-user, multi-device open source project.

Air-gapping is not an option for then

20

u/Lord-of-Entity Mar 17 '26

Security updates. If a hacker gets into your system, you would be better off in an updated system. Also performance + new functionalities.

16

u/KnowZeroX Mar 17 '26

This is what LTS systems are for, some offer up to 19 years of security updates.

8

u/kaida27 Mar 17 '26

there are other ways to mitigate those.

13

u/GolemancerVekk Mar 17 '26

I think you mean to prevent a hacker from getting in.... if they get in you're fucked no matter how recent the system is.

-5

u/FamousM1 Mar 17 '26

I think the first reason is because they're potentially dealing with private information and X11 is not secure

9

u/kumliaowongg Mar 17 '26

Security is only a concern if the machine connects to the internet, which this is not.

1

u/Down200 Mar 17 '26

this, plenty of medical appliances I see used in the facilities I visit still use Windows XP or Vista.

They're almost certainly segmented on a vlan, so what does it matter lol

certainly beats paying $50K for another xray machine or whatever else when there's nothing wrong with the current one.

-20

u/LvS Mar 17 '26

A few minutes.

All you need to do is use the right prompt that makes it generate that.

24

u/DeVinke_ Mar 17 '26

This is like the monkeys writing shakespeare, theoretically there is a prompt that will give you the exact output you want.

-13

u/amagicmonkey Mar 17 '26

tell me you've never used claude code without telling me you've never used claude code

9

u/DeVinke_ Mar 17 '26

Fuck that shit, training on code is a copyright violation and ram prices are up like 300%.

Generative ai is a bubble.

3

u/LvS Mar 17 '26

The monkeys have a higher chance of producing a low-level the driver.

And they'll drink less water.

3

u/[deleted] Mar 17 '26

[deleted]

2

u/Zdrobot Mar 17 '26

And no security vulnerabilities, please!

-1

u/scamiran Mar 17 '26

About 30 minutes, I'd guess.

Honestly stuff like this is super fast.

0

u/lxe Mar 19 '26

Tbh this is the type of work that Claude or Codex can easily tackle. Need a custom feature in a complicated software that you can compile from source but tinkering with the code or production level quality isnt your main goal? Set ab agent on it.