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MyView: Rethinking dental tech education

January 06, 2014

By Burney M. Croll, D.D.S.

For the past eight years I have been actively been involved in monitoring the condition of U.S. dental technology education programs and demographics of the dental technology workforce from the point of view of a practicing dentist who depends up dental technicians daily. I have been active in supporting the dental technicians who are very important members of the team that provides our patients with dental care.

I remain concerned about the availability of dental technicians in the near future as the existing workforce retires. I remain concerned about predoctoral education in prosthodontics that has suffered reduction in exposure to dental technicians and complex prosthodontic restorations for the education of new dentists entering the profession who may wish to provide prosthodontic services to their patients.

In my opinion, these issues need to be brought to the attention of the membership of the ADA on a repeated basis since this directly affects our ability to provide excellent dental service now and in the future.

The inescapable movement towards computer-based manufacturing of dental prosthetic restorations requires the same or greater attention to detail, excellent tooth preparation, soft tissue management and the ability to apply the same fundamental skills and principles by both the dentist and dental technician as in the past. This situation requires modification of predoctoral education to understand the benefits and limitations of the processes involved, continuing education for dentists who are not recent graduates, as well as rethinking the education of dental technicians that manufacture dental restorations with the new technologies.

The oral environment still has saliva, blood, tongues and gingival tissue to be managed. When intra- or extraoral digital scanners are used, the increased precision of the digital processes makes it critical to capture the tooth preparations and/or the area around one or several implants and the adjacent anatomy with accuracy. For the dentist, it is still necessary to reduce the required amount of tooth structure and provide excellent records, images and written direction to accurately produce a dental restoration.

The dental technician often has to assess these issues, be able to evaluate the adequacy of what each dentist provides and may have to advise the dentist when changes are necessary. The assumption that the dental technician designing and processing a restoration has knowledge of dental materials, oral function, occlusion and dental esthetics is not supported by the facts. If you ask manufacturing dental laboratories who they are recruiting to work in the digital processes, they will concede that most of the individuals being hired to design and produce CADCAM restorations are graphics designers and "gamers" without any dental technology education or understanding of dentistry. The underlying reasons include the demographic greying of the professionals in the dental laboratory industry, limited number of formally educated entrants into the workforce and the general lack of registration and regulation of dental technicians required by state dental practice acts. Keep in mind that the ultimate responsibility to deliver any dental restoration still rests with the providing dentist.

The number or accredited education two-year programs for individuals choosing to enter the profession of dental technology has been reduced by nearly 70 percent since 1972, according to ADA Commission on Dental Accreditation records. This is in large part due to the lack of public and industry support and awareness of the limited educational options for dental technicians. With the consolidation of military dental prosthetic service since the 1980s, the number of military trained dental technicians educated as part of professional advancement has similarly been reduced. Add to that the fact that within the United States, according to the American Dental Education Association, the voice of dental education for dental schools in the United States, there is not a single program awarding a bachelor’s degree or higher in dental technology that would include advanced experience with digital manufacturing or basic science knowledge of the new dental material available like lithium disilicate or zirconia-based materials.

The U.S. Department of Labor’s Bureau of Labor Statistics has categorized the job category of dental technician as unskilled. This makes it almost impossible to bring foreign technicians with advanced education into the U.S. to work at jobs that are supposed to be filled from the unskilled labor pool. To address these issues, the curriculum at the remaining two-year accredited programs in dental technology must be rebalanced, rebuilt or expanded. It may require additional years to create an educational program providing an understanding of biomechanics, dental materials, oral function and esthetics beyond the basic level currently taught. Applying biomechanical principles while learning to design and manufacture in the rapidly expanding digital processes and understanding new dental materials being promoted in the market place should be central to that learning experience. Although 85 percent of dental restorations manufactured are single units, a large number (in real terms), the remaining 15 percent include multiple units supported by teeth and implants. This portion of prosthetics that includes large reconstructions with multiple combinations of restorations supported by teeth, implants and edentulous ridges requires a great deal of collaboration and skill by the dental technician and dentist.

Communication skills for dental technicians must be part of any of their educational programs simply because graduating dentists with high expectations are becoming increasingly dependent upon the dental technicians to provide the education that has been omitted from predoctoral programs. With reduced predoctoral hours allotted to learn prosthodontic procedures, experience with anything but very limited prosthetic treatment, evolving manufacturing processes and the absence of direct contact with dental technicians during predoctoral education, this dependency will only increase over time if the current predoctoral educational process remains unchanged. It would be far better if predoctoral dental students learned the value of direct communication and appreciation for collaboration between the dentist and dental technician at the earliest stages of dental education as well as the benefits and limitation of the evolving digital dental process.

With the ADA House of Delegates passage of Resolution 52H-2013 in support of the registration of dental technicians in support of public safety, dentistry has the opportunity to underscore its commitment to public safety and the professionals in dental technology. "Resolved, that in order to enhance dental patient health and safety, the ADA urges all state dental boards to register U.S. dental laboratories." The document written in support of the resolution prepared by the ADA Council on Dental Practice provides excellent support that can be used to advocate the states to amend their dental practice acts. It can be distributed to local dental societies to create grass roots support for this important issue and is available from the ADA upon request. Contact Cynthia Kluck-Nygren, manager, Dental Team Activities & Publications for the ADA Council on Dental Practice at klucknygrenc@ada.org for a copy of the document.

It is my hope that members of the American Dental Association can address these issues on a local, regional and national basis by visiting, advising and supporting the existing dental technology programs in their vicinity and by addressing these issues at the predoctoral level at the dental schools where they are affiliated by petitioning ADEA for action.

Dr. Croll has a private prosthodontic practice in New York City. He is president of the Northeastern Gnathological Society, executive director of the Dental Laboratory Summit Council and directs a full in-office laboratory that includes CDT ceramists and CDT technicians. He has been a guest lecturer in postgraduate prosthodontic programs at Columbia University, New York University, the University of Pennsylvania, Montefiore Hospital and New York Hospital, Queens. He is a member of the Academy of Osseointegration, the American College of Prosthodontics and the Advisory Board to the Department of Restorative Dentistry at New York City College of Technology.