In February, The Dental Technology Summit, a two-day conference, was held in Chicago to identify and discuss major challenges facing the dental laboratory industry. Conference attendees, who represented the various areas of activity associated with dental laboratory technology, identified the four most significant challenges as
- – dental laboratory educational programs and student recruitment;
- – dental laboratory technician certification issues;
- – offshore dental laboratories (the gray market);
- – dentist–laboratory technician interaction.
After identifying the four major challenges, conference participants divided into four groups, discussed and subdivided the various aspects of the challenges, and developed potential solutions for them. Our column in the May issue of JADA1 discussed the four areas of concern in detail.
This article reports the potential solutions drafted by conference attendees for the four major challenges facing the laboratory industry and, therefore, the dental profession. The potential solutions are divided into the four categories of challenges stated above. After the small group discussions, each of the four group chairpersons presented to the entire group the potential solutions developed by his or her respective small group. The total group of attendees of the conference discussed, amended and approved the potential solutions. Specific individual attendees are being assigned responsibilities toward implementing the suggestions made by the conference attendees.
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DENTAL LABORATORY EDUCATIONAL PROGRAMS AND RECRUITMENT
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Public awareness of dental technology should be increased.
A public relations firm should be engaged to develop methods to promote dental technology as a viable vocational area.
A public information Web site should be developed to allow patients to become educated about dental technology. Methods should be developed to inform patients about the benefits of quality dental technology, where restorations are made, what materials are used to make the restorations and how laboratory technicians are paid for their work.
Standardization in curriculum content should be developed.
A task force should be developed to determine the best curriculum for dental technology and in what sequence the education should be provided to technology students, such as a two-year program, short modules or a combination format.
Sources of educational material for laboratory technicians should be found, evaluated and used in educational programs.
Funding sources should be found to allow existing schools to provide students with the materials they need to use during their educational period.
The groups or organizations related to dental technology, having common educational needs and goals, should be identified and brought together to achieve the determined goals for the dental technology. These organizations include the American Academy of Cosmetic Dentistry, the American Academy of Esthetic Dentistry, the American College of Prosthodontists, the American Dental Association, the American Dental Education Association and the National Association of Dental Laboratories (NADL).
Education in clinical dentistry and dental technology should be integrated.
Methods should be developed to integrate teaching of dental students and dental technology students.
The individuals, schools, organizations and laboratories most likely to be influential in this area should be identified and organized to effect integration of clinical dentistry and dental technology education at the local and national levels.
Activities should be identified that encourage integration of dentists and dental technologists.
Methods should be found to encourage ongoing and continued interaction between dental technicians and dentists at all levels.
The various levels of dental technicians should be formally defined.
There should be a mechanism to differentiate between qualified technicians and those who do piece work in laboratories.
Related organizations should work together to establish postgraduate and postcertification levels of proficiency that are measurable and can be tested and validated.
Methods should be developed to identify to dentists the technicians who have achieved various levels of proficiency.
Methods should be found to encourage ongoing and continued interaction between dental technicians and dentists at all levels.
Methods should be developed to recognize technicians who excel in their respective areas.
Dental laboratory technology schools should recruit technicians known to be proficient to provide the training to their students.
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DENTAL LABORATORY TECHNICIAN CERTIFICATION ISSUES
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The value of certification should be increased.
Manufacturers should promote the importance of technician certification.
The following and other organizations should promote the importance of dental laboratory technician certification: the Academy of General Dentistry, the American Academy of Cosmetic Dentistry, the American Academy of Esthetic Dentistry, the American College of Prosthodontists, the ADA, the American Dental Education Association and the National Board for Certification in Dental Laboratory Technology.
A Master Dental Technician designation should be added to the Certified Dental Technician program.
Dental organizations should be solicited to place information about the Certified Dental Technician program on their Web sites.
Technician certification should be made mandatory.
Key states should be targeted to influence legislative action requiring employment of Certified Dental Technicians to operate a laboratory. The "Texas model" should be used as an example.
The ADA should be persuaded to allow and encourage individual states to legislate dental laboratory regulation and technician licensure. The NADL has a model bill for technician licensure and certification for use with state legislatures.
A registry list should be made of all technicians, both certified and noncertified.
From the U.S. Census Bureau or the Internal Revenue Service, or other sources, a list should be made of all dental laboratory technicians to allow communication, encourage certification and solicit for continuing education.
Laboratory owners should be educated about the desirability of allowing the names of all noncertified laboratory technicians to be placed on a national list to allow solicitation for continuing education, certification and organizational membership.
The necessity of formal education in dental technology for certification should be emphasized.
The National Board requirements for technician certification, which currently are not specific, should be changed to require two years of formal education in dental technology or its equivalent.
Currently active experienced dental technicians should be allowed to become certified by means of "grandfather" status with enough time to become certified before the two-year formal educational requirement is in effect.
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OFFSHORE DENTAL LABORATORIES (THE GRAY MARKET)
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The concept of prostheses as medical devices should be enforced.
The U.S. Food and Drug Administration’s (FDA’s) view of dental laboratory prostheses as medical devices—and therefore subject to medical device regulation—should be enforced. It also should be emphasized by lecturers, professional organizations and publications aimed at both dentists and the public.
With greater awareness of the medical device designation, the government, the dental profession and the laboratory industry should conduct more observation of prostheses.
Prostheses’ manufacturers should be identified.
Enforcement of the FDA requirement to identify the location of a prosthesis’ manufacturer should be strengthened.
Dentists and technicians should be educated regarding the necessity of compliance with FDA requirements and the consequences of lack of compliance.
The NADL should define the responsibilities of laboratories in identifying the location of prostheses’ manufacture.
The ADA should address the concept of the patient’s right to know about where and of what his or her prostheses have been made, and dental organizations should be encouraged to support it also.
The use of 510(k) materials should be ensured.
It should be ensured that only materials for which manufacturers have completed a premarket notification (510[k]) of the FDA are used in prostheses.
The FDA, the dental profession and the laboratory industry should enforce the FDA requirement that offshore laboratories be registered.
The NADL should encourage laboratories using prostheses made offshore to require materials to be specified and identified.
Delivery of the dentist’s prescription should be ensured.
The dental profession and the laboratory industry should ensure that the dentist’s prescription is being delivered by the offshore laboratory.
Dentists and technicians should be educated about the necessity for accuracy in filling the practitioner’s prescription.
Barriers to offshore laboratory work should be evaluated.
It should be determined how far to attempt to increase barriers to offshore laboratory work’s entry into this country. U.S. laboratories should encourage and demand an offshore registration requirement.
Dentists and dental societies should support the establishment of technical requirements for offshore prostheses.
Offshore laboratories should not dilute U.S. resources.
It should be ensured that offshore laboratories do not dilute U.S. industry resources used to support dentists in education and research.
The ADA and state dental societies should lobby for legislative support in enforcing requirements and regulations for products made offshore.
Laboratories should have fee structures differentiating offshore and domestic prostheses.
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DENTIST–LABORATORY TECHNICIAN INTERACTION
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The perceived value of dentist-technician interaction within the ADA, dental schools and the dental technology community should be increased.
The dental profession and the laboratory industry should collaborate to publish a "white paper," including scientific data, to support the position that technicians are necessary and valuable to dentists and patients.
Laboratory technicians should be encouraged to hold membership in professional dental societies and specialty organizations.
The public should be educated about laboratory technicians through media publications and advertisements; manufacturers should share with dental organizations the responsibility for the costs of this effort.
Dental societies and local laboratory organizations should be educated regarding how to inform the public about dental technology.
Professional organizations should be combined with local technical schools to provide support for equipment purchases, internships and so forth.
The Patient’s Bill of Rights should be amended to indicate that patients can meet with technicians if needed and desired.
A viable relationship should be created between dental students, dental educators, dentists, dental technicians and patients.
The dental profession and the laboratory industry should collaborate to publish in JADA and the Journal of Dental Education a paper focusing on the desired dentist-technician relationship.
A campaign should be developed to improve the quality of the relationship between the dental profession and the laboratory industry.
Technicians should be involved in the political and educational environments in dentistry.
Dental practitioners should be trained in the best language to use in educating patients about the role of technicians in their overall oral treatment.
Dental manufacturers should be asked to contribute funds and ideas for the use of laboratories as educational locations, as dental supply houses do.
Dental manufacturers should provide externships for dental students in dental laboratories.
Speakers on dental topics should identify the laboratory technicians responsible for the technology shown in their lectures.
Dental schools should provide time in their curricula to permit dentists and technicians to teach dental students how the dentist-technician team should function in private practice.
Dentist-technician partnerships should be highlighted in mainstream professional media publications.
A "baseline" standard of care should be developed for dental technology.
A recognizable "baseline" standard of care should be developed for dental technology, relating to both competency and products.
A prototypical prescription for general laboratory use should be created and then field-tested in dental schools.
A prototype for patient management protocols should be created.
Dentists should be encouraged to fund continuing education courses attended by both dentists and laboratory technicians to foster interaction and mutual advancement of skills.
Ethical and legal responsibilities for laboratory technicians and dentists should be defined.
Standards for dentists, technicians and manufacturers should be formally defined.
A peer-review board should be created to review ethical and legal failures by dentists and technicians.
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SUMMARY
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The dental laboratory industry appears to need immediate change to face many challenges, the four most significant of which are described in this column and in our column in May JADA. The first article on this subject described the current challenges facing the laboratory industry, as determined by conference attendees representing all aspects of the dental industry and related professions. This article reports on the suggestions made by attendees of this conference to solve the identified challenges.
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