I would like to thank Mr. Napier for his review of our article. I am glad it provided him the opportunity, as well as a platform, to raise several additional issues specific to the concerns of the NADL. Since many of the issues discussed by Mr. Napier are organizational in nature, and beyond our direct influence as private practitioners, my comments can only be considered as one person’s opinion.
Mr. Napier refers to a passage in the Future of Dentistry report concerning the dentist’s educational responsibility in the area of dental technology. Though it might seem a small error in transcription, the introduction of the word "all" into the following quote does create a substantial change in context. "The dentist must remain the repository of [all] laboratory skill and knowledge" is the actual quote from the Future of Dentistry report.1
Clinical Recommendation 21 in the Vision and Recommendations Section of the Future of Dentistry report speaks to the dentist being a "knowledgeable director of laboratory procedures to insure the safety of the patient."2 It speaks to the responsibility of dental professionals who are prescribing for the construction of biomedical devices and inserting them into their patients that they are intimately familiar with the materials and techniques of these devices. Since the patient does not have a direct relationship with the dental laboratory or dental technician, it is the dentist’s sole responsibility to be knowledgeable about dental technology.
If, at some point in the future, dental laboratories and technicians have a direct, professional relationship with patients independent of the treating dentist, then the need for the dentist to be as knowledgeable might be reduced. Perhaps this is a future scenario; however, the current environment dictates a technologically competent dentist. Since the dental laboratory owner and/or technician do not see the results of their efforts, the ability to adjust techniques depends on the indirect feedback of the treating dentist.
This is a crucial weakness in providing dental technology services to patients in our present delivery system. Providing patients with dental technology services is more than just a "business-to-business" relationship between dentists and dental laboratories and technicians. It should be primarily a professional relationship, with the necessary adjunctive aspects of business practices. If it is only a business relationship, then the use of off-shore laboratories will become the future standard for dental laboratory services.
Since Mr. Napier and the NADL wish to be the sole experts in dental technology, their desire for mandatory certification is commendable. However, there presently is no consensus in the dental laboratory industry itself concerning government regulation and mandatory educational requirements.
Who will bear the costs of mandatory education and regulation—the dentist and patients through higher laboratory costs, or the laboratory owners? What government agency will oversee these regulations? What will be the relationship between the patient and the laboratory owner/technician if the patient no longer relies on the dentist for dental technology knowledge? Would patients benefit from regulation of the dental laboratory industry?
Perhaps quality would increase, standards could be identified and followed, the stature of technicians might increase to a professional level and more recognition might lead to an increase in the number of technicians.
The dental laboratory industry needs educated dentists to be good customers. This requires education of the dentist to appreciate the differences in dental laboratory technology services. Just as the implant manufacturers now dedicate substantial financial resources to dentist education, the dental technology industry must expand its commitment to creating technologically savvy dentists who appreciate dental technicians and dental technology.
I am heartened by the many responses to this article that the time is near when the dental profession in all forms commits itself to partnering with the dental technology industry in all its forms to create a better future for the public.
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