34 INSIDE DENTAL TECHNOLOGY October 2010 www.insidedentaltech.com

P utting aside the politics and rhetoric, educational programs for dental technology in the United States may be in the cross-hairs of extinction. Accredited and non-accredited programs for future dental technicians in this country face financial constraints, low enrollment, an aging faculty, and curricula

steeped in the basics but lacking modern-day relevancy. Unless they overcome these challenges, there could be long-term implications for the domestic pro-fession as well as the ability of dentistry to maintain the current high levels of oral healthcare for patients and to meet the needs of a growing population.

How will the dental technology industry endure in an education crisis?

By Pam Johnson

Learning to Survive

www.insidedentaltech.com October 2010 INSIDE DENTAL TECHNOLOGY 35

stateside for the National Association of Dental Laboratories (NADL) and an ad hoc group of industry professionals to call for changes in American Dental Association (ADA) policy and the Commission on Dental Accreditation (CODA) educational standards.

So what is being done to fix a system that is clearly in serious trouble?

Fixes from WithinElizabeth Curran, CDT, RDT, the NADL-nominated commissioner and chair of the CODA Dental Laboratory Technology committee, believes one of the solutions

While most college counselors and students are well acquainted with the services dentists provide, the dental tech-nology profession is not on their radar.

Businesses hungry to hire employ-ees with dental technician knowledge quickly snap up the few students who do complete 2-year dental technol-ogy programs though they are hardly prepared for the mass production and high-tech environment of the modern dental laboratory. Nor are they ready for the expanded roles dental techni-cians have had to assume—as advisors to clients in areas where technology and new clinical protocols have out-paced instruction in dental schools or as technical consultants to a client base underexposed to laboratory technical procedures in dental school.

The impending technician vacuum and knowledge erosion that looms on the horizon of dental technology in America has not gone unnoticed. The fact that the United States accounts for 35% of all indirect restorations fabricated in the world3 has even the most remote corners of the globe gearing up to fill the void. It has stirred enough concern

The situation is dire. In the past 3 years, the industry has lost 13,000 technicians. The total number of technicians employed in the United States currently stands at 40,480—down from 53,000 techni-cians in 2006 and 70,000 technicians in 2000, according to the US Bureau of Labor Statistics. Estimates suggest that by 2014 to 2015, the industry will lose an additional 11,000 technicians due to retirement and other reasons. What’s more, the mean age of the laboratory owners who hire those technicians is 52, with nearly four out of 10 over the age of 55.1

Now consider the number of enrollees in dental laboratory programs (see Table 1) and the number of new dental techni-cians who graduate each year (see Table 2). Collectively, the 20 accredited den-tal technology programs in the United States graduate an average of 240 to 360 students a year, a number that cannot sustain a retirement exodus. They also have an aging faculty, with nearly 50% of full-time instructors at or near retire-ment age.2 The industry is graying, with fewer entering the field than leaving.

is an educational system that supports accredited, specialized education beyond the current 2-year curriculum.

“The educational programs in place now do a very good job teaching the ba-sics, but the needs of the industry are no longer entry-level technicians,” ex-plained Curran, assistant professor, di-rector of laboratory services at A.T. Still University, Arizona School of Dentistry and Oral Health in Meza, Arizona. “Patient cases are becoming more complex, treatment planning more sophisticated, technology more ad-vanced, and patients more demanding

Setting A New Standard in the Curriculum

F or the last 30 years, the educational curriculum for pre-doc-toral dental students in the United States has had no pro-vision for laboratory procedures. On August 6, 2010 that

changed when the Commission on Dental Accreditation (CODA) revised the curriculum to read: “At a minimum, graduates must be competent in providing oral healthcare within the scope of general dentistry as defined by the school including … communicating and managing dental laboratory procedures in support of patient care.”

Anthony Ziebert, DDS, MS, director of CODA, believes the new standard provision was a direct result of the 2009 ADA Future of Dental Technology Conference last August. “At that meeting, it was clear from the NADL and the Prosthodontic Forum that pre-doctoral dental students seemed to have a lack of knowledge and that the dental schools were not teaching how to write a prescrip-tion or work with a laboratory technician,” he said. “ I think the new pre-doctoral standard will help address these concerns.”

Because the standard revision is so significant, dental schools will have until 2013 to demonstrate that they are in compliance. “They have to give us proof that their students know how to communi-cate with the dental laboratory and manage the dental laboratory procedures in a way that reflects what a general dentist should do,” Dr. Ziebert said.

This timeframe also provides CODA with the time to generate self-study guides to give guidance to programs on how to best meet these standards and what CODA will be looking for in terms of compliance.

“The educational programs in place now do a very good job teaching the basics, but the needs of the industry are no longer entry-level technicians.” — Elizabeth Curran, CDT, RDT

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36 INSIDE DENTAL TECHNOLOGY October 2010 www.insidedentaltech.com

www.insidedentaltech.com October 2010 INSIDE DENTAL TECHNOLOGY 37

in the expected outcome.” She supports a mandated minimum 3-year formal ed-ucation program plus an elective fourth and fifth year with a clinical interface to learn advanced prosthetics or to spe-cialize in skill areas such as dentures, implants, or technology. Graduates from these programs would have the professional skill level to compete on a global scale and immediately open their own businesses. However, Curran admits such a drastic change in dental technology education may take more time than the profession has.

“Even if we were able to recruit and fill all our existing formal 2-year edu-cation programs today, the number of graduates and the time it takes for those graduates to have the level of ex-perience they need to meet the needs of the dental industry will not be suf-ficient to fill the current void created by the technicians leaving the field,” she explained.

Jim Mahan, chief executive of-ficer of Productivity Training Corp suggests that schools could graduate more well-rounded technicians with higher earning potential if the existing 2-year programs could condense the basics into a single year and use the second year to concentrate on skills with modern relevancy such as CAD/CAM, implants, and advanced denture prosthetics. This approach would en-able schools to graduate competently trained technicians in the shortest amount of time.

“We can’t devote 2 years in our schools to teach the fundamentals,” Mahan said. “The industry is changing so rapidly, our schools can’t keep up.” If all dental technology programs adopted a standardized method of teaching the basics, then at minimum every graduate would be at the same skill level.”

“Currently, students in the 20 di!er-ent accredited programs are receiving over-the-shoulder training by 20 dif-ferent instructors, learning perhaps as many as 20 di!erent ways to wax a crown, depending on that instructor’s approach,” Mahan added. Because of the lack of standardization among the educational programs, laboratories looking to hire have no baseline for the graduate’s skill level or ability to pro-duce. Therefore, most lab owners feel the need to retrain so they can evaluate and manage performance.

“We need standardized education so that graduates can be predictably productive the minute they get hired,”

Mahan said. “This might also keep many recent graduates from being placed in lower-paying starting posi-tions, which hinders them from learn-ing advanced on-the-job skills so they can move up the ladder.”

Taking Initiative Another area that needs to be addressed is an incumbent workforce that has had no formal training. The industry needs

to find ways to tap into the 40,000+ technicians in this country to provide them with basic and advanced oppor-tunities for education.

“We need an educational platform that is able to deliver core knowledge and quality education to technicians while they maintain employment,” Curran said. “Half of those employed in this industry have no formal dental technology education, only on-the-job

training, and 75% have not obtained NBC certification status.”

The National Board of Certification (NBC) has helped address this issue in part by instituting a modulariza-tion program for incumbent work-ers that encompasses the five dental technology specialties—crown and bridge, ceramics, partial dentures, complete dentures, and orthodon-tics. It allows technicians currently

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working in the field to test their skills and knowledge in any of the 12 com-petency areas within the specialties. Technicians must pass written and practical exams administered by an independent proctor in a location of their choosing, which could even be their home lab. A dentist or certified dental technician verifies the prac-tical exam before submitting to the NBC via mail. Although successful

candidates receive a certificate of competency, passing the exams does not qualify them to receive CDT cer-tification. That is something Curran would like to see changed.

“I would like to see it structured so that a technician who has been in the field for 15 years and successfully tests out of a NBC module receives CDT sta-tus in that module,” Curran said.

What about those who want to

move beyond CDT status and receive advanced education while employed? Currently, there are no night classes or distance-learning programs that teach accredited core or curriculum knowledge. Nor does CODA allow for advanced placement within the den-tal laboratory technology educational standards. And without advanced placement, Curran said, there is no way to develop relationships between

the workplace and formal educational programs. CODA will need to revisit the dental technology standards and revise them to better fit the way the dental technology profession operates.

“We need modernization of the cur-riculum. Without an educational man-date, this industry has always been a knowledge-on-demand profession,” Curran said. “One of the ways to help a knowledge-on-demand industry gain value and independent assessment is through developing relationships with dental education.”

Three years ago, the NADL launched a monumental initiative to bring educa-tion to the masses and help financially strapped educational programs. For years the association has been aware of the crisis facing dental technology programs and the severe shortage of qualified technicians and has voiced these concerns numerous times to the ADA Council on Dental Practice.

“We finally realized no one was going to save dental technology education,” said Ricki Braswell, co-executive direc-tor of the NADL. “If it were to be saved, we would have to do it ourselves.”

In December 2007, the NADL es-tablished the Foundation for Dental Laboratory Technology. Its mission is to address industry-driven needs and provide solutions relevant and acces-sible to dental technicians and other dental team members. Education is one of the major challenges facing the industry that the foundation has decid-ed to tackle. Spearheaded by co-exec-utive directors Braswell and Adrienne Segundo, the non-profit foundation is committed to raising awareness about the need to improve educational op-portunities, develop a web-based na-tional education curriculum, and cre-ate a grant program that would roll out in 2011. The program would o!er finan-cial assistance to existing educational facilities to buy much-needed modern equipment or to revitalize and upgrade their program curricula. It would also help individual technicians to obtain certification status through the NADL Pillar scholarship program.

Funded by donations from suppli-ers, laboratories, and even individu-als, the foundation is also developing online outreach programs that labora-tory owners, program instructors, and other involved professionals can use to raise awareness about the dental tech-nology profession in local high schools and community colleges located near

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accredited and non-accredited dental technology programs.

“Before we established the founda-tion, the NADL believed it was impor-tant to have a mandate from the indus-try we are serving,” Braswell said. “So we surveyed our CDT and non-CDT membership to determine whether they thought it is necessary to have a formally educated workforce or if on-the-job training is enough.” Seventy-five percent of both survey groups agreed that the industry needs formally educated, competent technicians.

The foundation is currently working with the NBC to assess the results of the NBC 2010 Job Task Analysis sur-vey. They will compare the results to the NADL Competency Standards and the European Federation of Dental Laboratories DOSAM Occupational Standards to identify and develop current and emerging international occupational standards for dental technology that link to the CDT and modularization program assessments. Once that is completed, they can de-velop educational curricula and ma-terials to elevate dental technology

YEAR

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

CAPACITY

627

660

537

554

469

-

ENROLLMENT

556

551

418

425

389

501

NO. PROGRAMS

24

23

22

20

20

20

TA B L E 1

Dental Technology Programs: First-year capacity versus enrollment

Source: ADA 2006-2007, 2008-2009 Survey of Dental Education.

YEAR

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

NO. GRADUATES

490

378

341

268

299

332

387

301

265

269

234

TA B L E 2

Graduates of Dental Technology Programs

Source: ADA 2006-2007, 2008-2009 Survey of Dental Education.

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40 INSIDE DENTAL TECHNOLOGY October 2010 www.insidedentaltech.com

education in the United States to an international level.

Much like Curran, Braswell would like to see a multi-tiered approach to dental technology education. “We could take a lesson from other parts of health-care where they focus on equating the level of responsibility with the level of competency,” she said. “Nursing has multiple degree levels from an associ-ate’s degree as a minimum to a bach-elor’s degree to a master’s degree for a physician assistant. Why couldn’t we consider something similar?”

For those who do not complete an associate’s degree program, Braswell suggests there could be a place in the profession for a laboratory assistant. It could be a supervised position in a single department, much like a medi-cal technician in a clinic who takes vital signs and draws blood. And for gradu-ates who wanted to continue their edu-cation after completing a basic 2-year program and externship, they could enroll in advanced 2-year programs including specialty tracks such as business, material science, implants, or technology.

Regardless of which direction these various initiatives take, dental tech-nology education must get buy-in from all of the major players, including CODA, the ADA, the American Dental Education Association (ADEA), edu-cators, and schools, which presents huge bureaucratic and politically-charged hurdles.

Help from the Outside Clinicians who work side-by-side with technicians every day on highly com-plex cases witness the plight of the den-tal technology industry firsthand. They clearly see what the future holds if the technician workforce is further compro-mised. That is why the Prosthodontic Forum, which represents 17 dental or-ganizations, and the Dental Technology Summit, an ad hoc group of concerned industry professionals, have been so persistent in expressing their concerns to the ADA.

A strong advocate for dental tech-nology education, New York prosth-odontist Burney Croll, DDS, is a member of the Prosthodontic Forum and executive director of the Dental Technology Summit.

“Over the past five years, we—along with the NADL and other in-dustry leaders—have been very vo-cal about the quality of oral health

American Society of Master Dental TechniciansAt the New York University College of Dentistry, the ASMDT o!ers a comprehensive educational program designed to earn students the master dental technologist designation. The curriculum includes but is not limited to lectures and hands-on courses in tooth anatomy and physiology, articu-lators and articulation, fixed and variable deter-minants, functional waxing techniques, material science and behavior, plus mouth rehabilitation and partial denture design and attachments.Phone: 718-746-8355Web: www.asmdt.com

The Dawson AcademyThe Dawson Academy covers four areas of study: the core curriculum, advanced restorative prin-ciples and procedures, dental medicine, and prac-tice and professional growth. Courses include Functional Occlusion—from TMJ to Smile Design or Occlusion and Function; Achieving Predictable Esthetic Results; and Advanced Problem Solving. The Dawson Academy Lab Association gives their dentists access to laboratories with qualified oc-clusion-trained technicians who are schooled by the academy. Phone: 800-952-2178Web: www.thedawsonacademy.com

Interdisciplinary Dental Education Academy At IDEA’s training facility in Foster City, California, top technicians teach intense hands-on training and advanced courses including Replicating Nature with Implants; Functions and Dysfunctions of the Masticatory Organ; and Fascination of All-Ceramics.Phone: 866-700-IDEA (4332)Web: www.ideausa.net

Kois CenterTechnicians can participate in a series of courses working toward a recognized specialist designa-tion at the Kois Center. Located in the heart of Seattle, Washington, their dental training center provides a rich environment for advancing the use of implants, periodontics, and restorative and esthetic dentistry. Coursework includes Treatment Planning I; Functional Occlusion I; Biomechanics; Fixed Retained; Removable Retained; and Functional Occlusion. Phone: 206-621-5310www.koiscenter.com

Las Vegas Institute (LVI)Technicians can achieve master esthetic technician status by completing a series of LVI courses, including Core 1: Advanced Functional Dentistry; Neuromuscular Tech; Full Mouth Waxing; Smile Design and LVI Smile Design II. They can also take the LVI technician exam to earn the distinction of LVI fellow.Phone: 888-584-3237Web: www.lviglobal.com

The Pankey InstituteThe Pankey Institute added a new series of dentist/ceramist courses to its lineup. Aesthetics I and II are designed to give the dental team in-class instruction and live patient experience. In the Aesthetics I class, students learn about smile analysis and design, function and esthetics, photography, “trial smile” direct composite case mockup, and restorative ma-terials. Aesthetics II involves actual casework, ad-vanced communication with the dental technician, collaborative waxup and provisional fabrication, and final fabrication and seating. Phone: 800-4PANKEY (472-6539)Web: www.pankey.org

Tufts UniversityTufts University School of Dental Medicine’s Postgraduate Prosthodontics Division o!ers ad-vanced education and related research in areas such as Advanced Dental Ceramics; Implantology; Attachments; and Milling Techniques. The program o!ers interaction with postgraduate prosthodontics residents through clinical cases and provides the opportunity to observe treatment and outcomes of clinical patients through fabricating prostheses.Phone: 617-636-6629Web: http://dental.tufts.edu

UCLA Center for Esthetic DentistryThis 2-year, full-time graduate program places heavy emphasis on direct interaction between the technician, dentists, and patient, with the techni-cian working closely with the treating dentist from diagnosis to case completion. There is extensive training in natural tooth morphology, esthetic tooth arrangement, smile design, diagnostic waxing, and acrylic prototype (provisional) fabrication. Material science and selection for various clinical situations and dental photography are also covered.Phone: 310-206-8388 (press 4)Web: www.edmclaren.com

Opportunities for Advanced Education For technicians who want to take their skills and knowledge to the next level, there are a myriad of institutes and education centers from which to choose. Below is a sampling of comprehensive training courses available.

services dentistry will be able to de-liver if changes in dental and dental technology education are not insti-tuted,” Dr. Croll said. “The majority of dentists in this country rely now more than ever before on the dental technologist’s expertise to collaborate and advise on complex casework.”

Heeding their call to action, the ADA called a special conference on August 7, 2009 to address the issues raised by the NADL, Forum, and Summit groups. The ADA Future of Dental Technology Conference centered on the reduced dental technology work-force, dental technology education, o!-shore and regulatory concerns, certification of dental technicians, and general prosthodontic competence of pre-doctoral graduates.

The issues raised at the conference were passed through a subcommit-tee to the Council on Dental Practice, where the subcommittee’s recommen-dations, new resolutions, and actions were approved for submission to the ADA House of Delegates. The House will meet this month during the asso-ciation’s annual session to vote on in-stituting the recommendations.

While not every issue raised at the conference made it to the Council on Dental Practice, Dr. Croll believes it is a great starting point for increasing den-tist/technician interaction and educa-tion and curbing the use of o!-shore laboratories by universities.

The recommendations, resolutions, and actions approved include: • Encouraging component dental so-

cieties to recognize the continuing education needs of certified dental technicians by inviting them to at-tend continuing education seminars.

• Encouraging dental programs to collaborate with dental technol-ogy programs in dental schools.

• Encouraging dental schools to use US laboratories for the fabrica-tion of undergraduate and gradu-ate prostheses in lieu of sending them abroad.

• Encouraging US dental schools to use in-house laboratories when-ever possible to facilitate dentist/technician interaction.

It may be a start but is it enough?

Global PerspectiveManufacturers may be betting that it is not enough. What has not been ad-dressed—and may never be—is the manufacturer’s involvement in the

dentist/technician equation of pa-tient care. Lily T. Garcia, DDS, MS, FACP, vice president of the American College of Prosthodontists and a mem-ber of the ADEA Board of Directors recently participated in a key opin-ion leader meeting held by a major manufacturer that services the den-tal technology industry. She was in-trigued to hear di!ering perspectives on the future and the greater need for a

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“We finally realized no one was going to save dental technology education. If it were to be saved, we would have to do it ourselves.”

—Ricki Braswell

42 INSIDE DENTAL TECHNOLOGY October 2010 www.insidedentaltech.com

broad-based involvement to develop solutions. The meeting left her con-cerned about the e!ect that having fewer highly educated technicians will have on her ability to provide specialty-level patient care and about who will deliver the millions of restorations and complex prosthetic cases the US mar-ket demands now and in the future.

“If we lose our technician base here in this country, where is dentistry left?” asked Dr. Garcia, a professor in the Department of Prosthodontics at the University of Texas Health Science Center San Antonio. “Will we be sitting in front of a computer screen prescrib-ing and interacting virtually on a case and sending that case digitally to other parts of the world?”

That is not such a far-fetched concept. Mahan’s company receives requests from all over the globe for their PTC technician-training program. “There is an emerging market and awareness of dental technology throughout the world,” Mahan said. “We are in a world economy, and the US currently has the highest demand for dental procedures in the world.”

In most of the rest of the world, the dental technology profession is regulat-ed, with education as the central com-ponent of that qualification, Curran said. In other countries, it is viewed as a patient-safety issue—something that has not been addressed in this country yet because the dentist is seen as the prescriber and safety net between the

patient and the dental technologist. But, Curran says the truth is, most dentists in this country leave material selection up the laboratory and have no idea if the proper material science was applied in the fabrication or if the res-toration was manufactured properly.

Forging AheadMandated, degreed education is the foundation and future of any industry. When education su!ers, so do all other aspects of a profession. Curran, Braswell, Mahan, Dr. Croll, and others will con-tinue to keep the momentum going, pounding away at the ruling bodies of the profession to wake up and take action.

If you want your voice to be heard on this issue, write or e-mail the ADA,

ADEA, CODA, and the NADL. Help those who are already committed to working toward a solution.

References1. National Association of Dental Laboratories. 2010 Costs of Doing Business Survey. June 2010.2. American Dental Association. 2006-07 Survey of Dental Education Curriculum. 2007. American Dental Association (ADA) Survey Center.3. iData Research Inc. 2009 Dental Market Survey. 4. Bureau of Labor Statistics, US Department of Labor. Occupational Outlook Handbook, 2010-11 Edition: medical, dental, and oph-thalmic laboratory technicians. Available at: http://www.bls.gov/oco/ocos238.htm.

T he success that many manufacturers are having with continuing education hands-on, online, and lecture series courses given by global opinion leaders attests to the demand for educational

opportunities in dental technology. Educational opportunities such as online webinars and podcasts have proven to be a popular alterna-tive to traditional courses for customers who are challenged by the economy and reluctant to travel. Below is a list of manufacturers pro-viding valuable and well-attended CE programs throughout the year.

Dentsply ProstheticsDentsply o!ers 1- to 3-day continuing education courses throughout the year at their facility in York, Pennsylvania and their new Technical Education Center (TEC) in Burlington, New Jersey. The three-level cur-riculum covers a broad range of topics, including some basics for tech-nicians new to the business in addition to advanced and master’s level courses on topics such as metal-free restorations and creative ceramics.Phone: 800-487-0100 Ext. 56040Web: http://prosthetics.dentsply.com

GC AmericaHolding courses at their Alsip, Illinois training center and in cities through-out the US, GC America o!ers a variety of product-specific education as well as courses on infection control, esthetics, and fit and function.Phone: 800-323-3386Web: www.gcamerica.com

Ivoclar VivadentIvoclar Vivadent o!ers an extensive lineup of fundamental and ad-vanced CE courses held throughout the year at the ICDE center in Amherst, New York or the Implant Esthetics Center of Excellence in Sarasota, Florida. Course topics include the IPS e.max brand, fun-damental and advanced complete denture techniques, CAD/CAM technology, and implants. Phone: 800-533-6825Web: www.ivoclarvivadent.com

Jensen DentalJensen provides an extensive lineup of online webinars on numerous topics, including infection control, alloys, and refining as well as hands-on courses for the Creation, Authentic, and Pulse Interface brands. The company also o!ers an online virtual study club for interacting with col-leagues and key opinion leaders. Hundreds of technicians come from all over the country to learn from master dental technicians at the Jensen Days tradeshow held each year during the Chicago Midwinter meeting.Phone: 800-243-2000Web: www.jensendental.com

StraumannFor users of the Straumann CAD/CAM system, the company o!ers a series of hands-on courses to teach customers how to create simple and complex CAD-designed restorations, including single copings, three-unit and long-span bridges with bite registration, Maryland bridges and inlay/onlay bridges with bite registration, provisional restorations, full-mouth rehabilitations, and custom abutments. Phone: 800-448-8168Web: www.straumann.us

VidentThis year Vident launched VITA University, a nationwide educational initiative reaching 10 major cities in the US and taught by leading technicians. A wide variety of topics are covered, including profitability of titanium-milled copings, shade layering using a foil technique for veneers, the latest CAD/CAM material advancements, Sirona inLab training, pressable ceramics, basic principles of setting denture teeth, and digital dentistry summit panel discussions. Phone: 800-828-3839 Ext. 238Web: www.vident.com

Whip MixThrough a series of interactive webinars, Whip Mix o!ers training and education on a variety of topics including LEAN, phosphate investments, the Pro Series furnaces, the Vericore virtually designed implant abutment, implant-supported milled implant bars, and func-tion and occlusion.Phone: 800-626-5651Web: www.whipmix.com

Dental Technology CE Thrives