Survive. Learning to. How will the dental technology industry endure in an education crisis?

Transcription

1 Learning to Survive How will the dental technology industry endure in an education crisis? P utting aside the politics and rhetoric, educational programs for dental technology in the United States may be in the crosshairs 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 profession 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. By Pam Johnson 34 INSIDE DENTAL TECHNOLOGY October

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3 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 technicians 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 Now consider the number of enrollees in dental laboratory programs (see Table 1) and the number of new dental technicians who graduate each year (see Table 2). Collectively, the 20 accredited dental 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 retirement age. 2 The industry is graying, with fewer entering the field than leaving. While most college counselors and students are well acquainted with the services dentists provide, the dental technology profession is not on their radar. Businesses hungry to hire employees with dental technician knowledge quickly snap up the few students who do complete 2-year dental technology 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 technicians have had to assume as advisors to clients in areas where technology and new clinical protocols have outpaced 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 world 3 has even the most remote corners of the globe gearing up to fill the void. It has stirred enough concern 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. 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 Within Elizabeth Curran, CDT, RDT, the NADLnominated commissioner and chair of the CODA Dental Laboratory Technology committee, believes one of the solutions Elizabeth Curran, CDT, RDT 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 basics, but the needs of the industry are no longer entry-level technicians, explained Curran, assistant professor, director 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 advanced, and patients more demanding Setting A New Standard in the Curriculum F or the last 30 years, the educational curriculum for pre-doctoral dental students in the United States has had no provision 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 predoctoral dental students seemed to have a lack of knowledge and that the dental schools were not teaching how to write a prescription 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 communicate 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. (Circle 055 on Reader Service Card) 36 INSIDE DENTAL TECHNOLOGY October

4 in the expected outcome. She supports a mandated minimum 3-year formal education program plus an elective fourth and fifth year with a clinical interface to learn advanced prosthetics or to specialize 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 education programs today, the number of graduates and the time it takes for those graduates to have the level of experience they need to meet the needs of the dental industry will not be sufficient to fill the current void created by the technicians leaving the field, she explained. Jim Mahan, chief executive officer 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 enable 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 different accredited programs are receiving over-the-shoulder training by 20 different instructors, learning perhaps as many as 20 different 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 produce. 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 positions, which hinders them from learning 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 opportunities 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 Finally, a denture liner that will perform and last long-term! Permanent resiliency over extended time Bonds chemically to acrylic denture base resins Processed, packed and cured using conventional lab processing procedures Can be trial-packed Can be molded around implant, bar and overdenture abutments Resistant to fungal growth 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 modularization program for incumbent workers that encompasses the five dental technology specialties crown and bridge, ceramics, partial dentures, complete dentures, and orthodontics. It allows technicians currently Whether it is a new denture or a reline of an existing denture, denture wearers will appreciate the long-term benefits of improved fit, function and comfort in their denture when Novus, Definitive Resilient Denture Liner is applied to their denture. NOVUS Arrives 2010! Coming Soon! Call your local dental supplies dealer, or Lang Dental directly to learn how to get started with the definitive answer to improving denture wearers comfort and function improving their lives, and the care they receive from their dental professional. Product Information: NOVUS : Definitive Resilient Denture Liner is manufactured by Lang Dental Mfg. Co., Inc. 175 Messner Drive Wheeling, IL USA (847) Fax (847) Toll free in U.S. & Canada LANG (5264) Fax: (Circle 056 on Reader Service Card) October 2010 INSIDE DENTAL TECHNOLOGY 37

5 working in the field to test their skills and knowledge in any of the 12 competency 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 practical exam before submitting to the NBC via mail. Although successful Call us today to add CAD/CAM technology to your product line keatingdentalarts.com All restorations are proudly fabricated at Keating Dental Arts in Irvine, California. candidates receive a certificate of competency, passing the exams does not qualify them to receive CDT certification. 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 status 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 dental laboratory technology educational standards. And without advanced placement, Curran said, there is no way to develop relationships between UNIT $49PER $49FREE 2 nd DAY RETURN SHIPPING 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 curriculum. Without an educational mandate, 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 education 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 director of the NADL. If it were to be saved, we would have to do it ourselves. In December 2007, the NADL established the Foundation for Dental Laboratory Technology. Its mission is to address industry-driven needs and provide solutions relevant and accessible to dental technicians and other dental team members. Education is one of the major challenges facing the industry that the foundation has decided to tackle. Spearheaded by co-executive directors Braswell and Adrienne Segundo, the non-profit foundation is committed to raising awareness about the need to improve educational opportunities, develop a web-based national education curriculum, and create a grant program that would roll out in The program would offer financial 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 suppliers, laboratories, and even individuals, the foundation is also developing online outreach programs that laboratory owners, program instructors, and other involved professionals can use to raise awareness about the dental technology profession in local high schools and community colleges located near (Circle 057 on Reader Service Card)

6 accredited and non-accredited dental technology programs. Before we established the foundation, the NADL believed it was important to have a mandate from the industry 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 onthe-job training is enough. Seventyfive 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 survey. 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 develop educational curricula and materials to elevate dental technology TABLE 1 Dental Technology Programs: First-year capacity versus enrollment YEAR CAPACITY ENROLLMENT Source: ADA , Survey of Dental Education. NO. PROGRAMS TABLE 2 Graduates of Dental Technology Programs YEAR NO. GRADUATES Source: ADA , Survey of Dental Education. The choice is yours... How will you save at least $1,000 this year for your lab* See the proof. View Dimensional Stability Study: Cetylcide II used in the disinfection of dental impressions by the dental office and dental laboratory utilizing the most common classifications of dental impression materials at 1 of these or 85 of these For more information, please [email protected] or call *Based on a 24oz spray bottle of Leading Disinfectant Brand MSRP of $12.29 and Cetylcide-II MSRP of $70.00 as advertised by a major retail dental dealer (Circle 058 on Reader Service Card)

7 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. American Society of Master Dental Technicians At the New York University College of Dentistry, the ASMDT offers 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, articulators and articulation, fixed and variable determinants, functional waxing techniques, material science and behavior, plus mouth rehabilitation and partial denture design and attachments. Phone: Web: The Dawson Academy The Dawson Academy covers four areas of study: the core curriculum, advanced restorative principles and procedures, dental medicine, and practice 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 occlusion-trained technicians who are schooled by the academy. Phone: Web: 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: IDEA (4332) Web: Kois Center Technicians can participate in a series of courses working toward a recognized specialist designation 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: 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: Web: The Pankey Institute The 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 materials. Aesthetics II involves actual casework, advanced communication with the dental technician, collaborative waxup and provisional fabrication, and final fabrication and seating. Phone: 800-4PANKEY ( ) Web: Tufts University Tufts University School of Dental Medicine s Postgraduate Prosthodontics Division offers advanced education and related research in areas such as Advanced Dental Ceramics; Implantology; Attachments; and Milling Techniques. The program offers interaction with postgraduate prosthodontics residents through clinical cases and provides the opportunity to observe treatment and outcomes of clinical patients through fabricating prostheses. Phone: Web: UCLA Center for Esthetic Dentistry This 2-year, full-time graduate program places heavy emphasis on direct interaction between the technician, dentists, and patient, with the technician 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: (press 4) Web: 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 healthcare where they focus on equating the level of responsibility with the level of competency, she said. Nursing has multiple degree levels from an associate s degree as a minimum to a bachelor 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 medical technician in a clinic who takes vital signs and draws blood. And for graduates who wanted to continue their education 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 technology education must get buy-in from all of the major players, including CODA, the ADA, the American Dental Education Association (ADEA), educators, and schools, which presents huge bureaucratic and politicallycharged hurdles. Help from the Outside Clinicians who work side-by-side with technicians every day on highly complex cases witness the plight of the dental technology industry firsthand. They clearly see what the future holds if the technician workforce is further compromised. That is why the Prosthodontic Forum, which represents 17 dental organizations, 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 technology education, New York prosthodontist 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 industry leaders have been very vocal about the quality of oral health 40 INSIDE DENTAL TECHNOLOGY October

8 services dentistry will be able to deliver if changes in dental and dental technology education are not instituted, 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 workforce, dental technology education, off-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 subcommittee to the Council on Dental Practice, where the subcommittee s recommendations, new resolutions, and actions were approved for submission to the ADA House of Delegates. The House will meet this month during the association s annual session to vote on instituting 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 dentist/technician interaction and education and curbing the use of off-shore laboratories by universities. The recommendations, resolutions, and actions approved include: Encouraging component dental societies to recognize the continuing education needs of certified dental technicians by inviting them to attend continuing education seminars. Encouraging dental programs to collaborate with dental technology programs in dental schools. Encouraging dental schools to use US laboratories for the fabrication of undergraduate and graduate prostheses in lieu of sending them abroad. Encouraging US dental schools to use in-house laboratories whenever possible to facilitate dentist/ technician interaction. It may be a start but is it enough? Global Perspective Manufacturers may be betting that it is not enough. What has not been addressed and may never be is the manufacturer s involvement in the dentist/technician equation of patient care. Lily T. Garcia, DDS, MS, FACP, vice president of the American College of Prosthodontists and a member of the ADEA Board of Directors recently participated in a key opinion leader meeting held by a major manufacturer that services the dental technology industry. She was intrigued to hear differing perspectives on the future and the greater need for a 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 (Circle 059 on Reader Service Card)

9 Dental Technology CE Thrives 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 alternative to traditional courses for customers who are challenged by the economy and reluctant to travel. Below is a list of manufacturers providing valuable and well-attended CE programs throughout the year. Dentsply Prosthetics Dentsply offers 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 curriculum covers a broad range of topics, including some basics for technicians new to the business in addition to advanced and master s level courses on topics such as metal-free restorations and creative ceramics. Phone: Ext Web: GC America Holding courses at their Alsip, Illinois training center and in cities throughout the US, GC America offers a variety of product-specific education as well as courses on infection control, esthetics, and fit and function. Phone: Web: Ivoclar Vivadent Ivoclar Vivadent offers an extensive lineup of fundamental and advanced 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, fundamental and advanced complete denture techniques, CAD/CAM technology, and implants. Phone: Web: Jensen Dental Jensen provides an extensive lineup of online webinars on numerous topics, including infection control, alloys, and refining as well as handson courses for the Creation, Authentic, and Pulse Interface brands. The company also offers an online virtual study club for interacting with colleagues 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: Web: Straumann For users of the Straumann CAD/CAM system, the company offers 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: Web: Vident This 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: Ext. 238 Web: Whip Mix Through a series of interactive webinars, Whip Mix offers 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 function and occlusion. Phone: Web: broad-based involvement to develop solutions. The meeting left her concerned about the effect that having fewer highly educated technicians will have on her ability to provide specialtylevel patient care and about who will deliver the millions of restorations and complex prosthetic cases the US market 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 prescribing 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 regulated, with education as the central component 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 restoration was manufactured properly. Forging Ahead Mandated, degreed education is the foundation and future of any industry. When education suffers, so do all other aspects of a profession. Curran, Braswell, Mahan, Dr. Croll, and others will continue 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 the ADA, ADEA, CODA, and the NADL. Help those who are already committed to working toward a solution. References 1. National Association of Dental Laboratories Costs of Doing Business Survey. June American Dental Association Survey of Dental Education Curriculum American Dental Association (ADA) Survey Center. 3. idata Research Inc Dental Market Survey. 4. Bureau of Labor Statistics, US Department of Labor. Occupational Outlook Handbook, Edition: medical, dental, and ophthalmic laboratory technicians. Available at: 42 INSIDE DENTAL TECHNOLOGY October