In February, we were privileged to lead The Dental Technology Summit, a two-day conference in Chicago on the status of the dental laboratory industry. The conference aimed to accomplish these goals:
- – identification and discussion of the major challenges facing dental laboratory technology;
- – development of potential solutions for the challenges facing the industry;
- – assignment of potential solutions to conference participants;
- – report to the dental profession and the dental laboratory industry regarding progress by June 30;
- – development of future conferences as solutions begin to mature.
The conference participants represented most of the constituents related to laboratory technology: dentists, prosthodontists, technicians from both small and large laboratories, educators from dental technology and clinical dentistry, representatives of several organizations (the American College of Prosthodontists, the American Dental Association, the National Association of Dental Laboratories, the Prosthodontic Forum), private education providers, representatives of the National Board for Certification in Dental Laboratory Technology, editors of national dental publications, and numerous dental manufacturers and retailers.
For those needing financial assistance, participation was partially reimbursed by major dental manufacturers.
We will report on the findings of the conference in this and next month’s columns relative to the challenges facing dental laboratory technology and the potential solutions. (Note that we plan to continue to hold these conferences until positive results are achieved.) This month’s column offers an overview of the dental laboratory industry and concentrates on the challenges facing dental technology as expressed by the conference participants.
 |
THE LABORATORY INDUSTRY TODAY
|
|---|
Much of the data on which we have based the following overview of laboratory technology has been compiled by Marketdata Enterprises, a market research and consulting firm in Tampa, Fla.1(pp1–23),2
There are about 12,000 dental laboratories in the United States, which employ about 46,000 technicians. About 40 percent, or 5,000, of these laboratories, have only one technician, while others have as many as 200. The largest laboratories produce about 8 percent of the gross U.S. receipts. The smaller laboratories account for the remainder of the receipts.
As estimated in numerous and varied writings, the laboratory industry is responsible for about $6 billion to $8 billion of productivity annually. Procedures such as veneers and crowns placed for reasons of improving esthetics represent an estimated 15 to 30 percent of the industry activity. Growth of dental products is expected to increase about 6 percent per year for the next several years.
|
CHALLENGES FACING DENTAL LABORATORY TECHNOLOGY
|
|---|
Four major challenges, as identified by conference attendees both in small groups and as a collective body, face the dental laboratory industry. The challenges were identified, discussed and critiqued until they were felt to be representative of the state of the industry at this time.
Dental laboratory educational programs and recruitment.
American Dental Association–accredited programs in dental laboratory technology have decreased by more than one-half since 1990 (T. Berger, manager, Education Information Services, American Dental Association Division of Education, written communication, March 30, 2005). Conference participants stated that the process of accreditation is difficult and expensive, but not the sole reason for the decrease in accredited programs.
Dental technology is not a visible vocational option. Many laypeople do not know that it exists. Dental patients do not know who makes their crowns, veneers, fixed prostheses and dentures; when they report for their seating appointments, the restorations simply appear from somewhere.
The income of typical laboratory technicians is not attractive. Of course, there are some exceptions to that statement. However, if a person is to spend two years in a program, it seems only logical that his or her salary on completion of the course would be significantly higher than minimum wage. That is not the case.
Few technology programs are located in dental schools, and technology students must seek programs in nondental environments. This separation does not encourage interaction of technicians and dentists.
Few technology programs are located in dental schools, and technology students must seek programs in nondental environments. This separation does not encourage interaction of technicians and dentists.
The cost of starting and operating a dental technology program is high, and the rewards for running the program are minimal.
Most large laboratories would rather train and educate their technicians themselves than recruit graduates of a technology program.
Dental laboratory technician certification issues.
As stated by the attendees, the perceived value of certification is low. Most people do not know that dental technology exists or that there is a certification board.
There is no mandate for technician certification. Only a few states recognize the presence of a certifying board, and only two—Kentucky and South Carolina—require certification.
It appears to be nearly impossible to identify all of the non-certified technicians. There is not a target list. Soliciting non-certified technicians to become certified is difficult.
Technicians are not required to complete specific education to become certified, so interested technicians can become certified relatively easily.
Offshore dental laboratories.
Unknown to most U.S. dentists, there is major use of laboratory work accomplished outside the U.S. borders by laboratories in this country. Dentists may not know that they are using laboratory work from China, the Philippines, Mexico, Costa Rica and other countries, because their U.S. laboratories may not inform them that the laboratory work is being accomplished out of the country. Although the quality of much of the offshore laboratory work is acceptable, there is little information relative to what alloys, ceramics or polymers are used in the prostheses. Patients do not know where their laboratory work was done. Although this would not be a problem for some patients, others would object to this lack of disclosure.
Dentists cannot easily communicate with technicians thousands of miles away from their dental practices and do not know if their laboratory prescriptions were interpreted correctly by the offshore technicians. Often, corrections in restoration color, contour, anatomy and occlusion cannot be completed rapidly.
U.S. laboratories offer services, including educational programs, to the dental profession. Significant use of offshore laboratories—a so-called "gray market"—could dilute the ability of domestic laboratories to offer these services.
Dentist/laboratory technician interaction.
Conference attendees stated that dental educators and administrators in dentistry, as well as leaders in the ADA and the American Dental Education Association (ADEA), appear not to recognize the necessity of the need for more interaction between dental technology and clinical dentistry. Many students in both technology and clinical dentistry have no interaction with those in their counterpart profession during their educational period. Although there are exceptions, there is no formal relationship fostering interaction between dental technology and clinical dentistry at any of several levels: student, educator, professional organization, or state or national dental political body.
No professional organization has endorsed baselines for standard competency of care for dentists and technicians. Each clinical situation appears to have its own goals, objectives and standard of care as described and interpreted by individual dentists or technicians. Ethical and legal responsibilities between technicians and dentists are defined poorly.
|
SUMMARY
|
|---|
Undoubtedly, the four challenges facing dental technology we have described in this article are not the only ones, but they are the major ones as identified by the participants in the Dental Technology Summit. The attendees conducted active discussion on all of these points and developed potential solutions. It was gratifying to see the various political and organizational factions agree on the challenges, and the participants felt at the conclusion of the conference that the described challenges are, in fact, those that need immediate attention. We will discuss suggested potential solutions in a column in the June issue of JADA.
TOP
THE LABORATORY INDUSTRY TODAY
CHALLENGES FACING DENTAL...
