On behalf of the National Association of Dental Laboratories, or NADL, I would like to respond to the February JADA article by Drs. Thomas McGarry and Theodore Jacobson, "The Professions of Dentistry and Dental Laboratory Technology: Improving the Interface."
It is appreciated that the authors tackled such an important issue, and raised the awareness of the current environment. I know Dr. McGarry to be well-intentioned on the partnership of the dental profession and dental technology, having seen several of his presentations, and thus do not question the intent of the authors. Their article provides a springboard to address the "real issue at hand" and some of the effects caused by previous posturing taken by the dental profession that have facilitated some of the problems raised in the article.
Organized dentistry and organized dental technology should be equal players in the process of solving the issues of restorative dentistry. For far too long, it has been David and Goliath. The dental laboratory industry is a business employing dental technicians who provide a valuable service to dentists. The respect afforded to technicians and the industry should be one of a business-to-business relationship, not an employer-employee relationship.
Dental technicians work for commercial dental laboratories (except in those cases where a technician works in-house within a dental office setting). With that said, the political actions, the words and the mindset of organized dentistry continue to look upon dental technology as the "wild card" of the dental team. This attitude in some ways is understandable, given that dental technicians and the laboratories that employ them are for the most part independent businesses, not in the direct control of the dentist.
This independent attribute of dental technology is its greatest strength. The dentist does not need to provide management of the laboratory or technician, and can safely entrust the ever-changing knowledge of dental technology to the independent laboratory professionals. Likewise, dental technicians entrust the realm of clinical dentistry to those professionals in the operatory.
Dental laboratories lack a key element that other members of the dental team (assistants and hygienists) possess. State government does not license dental technology and/or dental laboratories, except in a handful of states. This lack of government "recognition" results in a lack of public awareness that the occupation even exists, oversight of continuing education and mandatory adherence to standards.
Given the dental profession’s historic and present aversion to the regulation of dental laboratories as well as technicians in the individual states, today’s dental technology environment has been caused in part by the dental profession’s stated political position.
NADL has a model bill for statutory regulation of laboratories and technicians that provides for appropriate continuing education and minimum standards that can be advocated by state dental laboratory associations seeking such integration. Unfortunately, at nearly every juncture, when efforts have been made in the individual states, such legislation is dead on arrival. The dental profession cannot complain about the lack of education for dental technicians, while consistently advocating against a minimum mandatory education for technicians. You can’t have it both ways.
With that said, let’s address the actions taken by the dental laboratory industry and the solutions we see for ourselves as a business partner with the dental profession. Our industry has had a voluntary certification program for both dental technicians and dental laboratories for 47 years; the certification program of technicians is recognized by the ADA and is in the final stages of applying for third-party accreditation by the American National Standards Institute.
The industry has voluntary comprehensive competency standards that took five years to complete; these have yet to be formally acknowledged by the ADA. The industry has a voluntary quality assurance process to ensure consistency in case development. This program is currently under review by the U.S. Food and Drug Administration to see if it meets the quality systems/good manufacturing practices requirements that must be met by all dental laboratories.
None of the issues raised by the authors will ever be solved, regardless of what the dental laboratory industry does, or the dental profession professes that it can do, as "the repository of all knowledge on dental technology." The reality of all situations in life, business or politics comes down to money. On the front end, dental technicians do not make a lot of money; the learning curve to become a productive technician in today’s environment is significant and expensive. However, the opportunities for a dedicated individual to make a nice living as a dental technician, dental laboratory manager or laboratory owner do exist, and will continue to increase in the future.
Until organized dentistry treats dental technology as a true partner, and allows a win-win relationship, the complaints about the decline of dental technology educational programs, the low entry wages of dental technicians compared with starting salaries of other dental team members and the customer service issues that may arise from off-shore options will be on the table 10 years from now.
Here’s what the NADL recommends to move forward from the current holding pattern:
- The politics need to be removed from the equation. Dental laboratories and technicians are partners; they are not subservient to the dental profession. In the day-to-day world of technicians and dentists, we have reached this milestone. We have not yet reached that sacred ground politically.
- The dental profession needs to recognize and value quality, while at the same time respecting the need for dental laboratories to earn a profit as an independent business. This will allow the industry to attract the best and brightest individuals to enter the dental technology field.
- It is agreed that the cross-training of dentists and dental technicians has to happen in the educational institution environment. Our industry takes its role seriously as the expert in dental technology. In this regard, NADL disagrees with the Future of Dentistry report, and feels that dental laboratories have been, and should continue to be, the repository of all knowledge and skill on restorative dentistry. Nonetheless, to return to the day when the dental client had more extensive knowledge and exposure to laboratory procedures certainly makes the long-term outlook rosier for both the dental profession and the laboratory industry and, ultimately, for the dental patient.
- Joint continuing education is crucial. The Chicago Dental Society took a bold step this year in launching a partnership with the National Association of Dental Laboratories to hold synergistic programming at its 2004 Midwinter Meeting. This partnership will continue, and will hopefully pay off in bringing these two groups of dental professionals together to seal a better tomorrow for both.
Let’s face it, the joint problems we face are not about the dental profession or the laboratory industry. They are about creating an environment that ensures the quality of oral health care for the dental patient. That’s why the dental profession and the laboratory industry exist.
