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Dental lab issues on radar

The dental laboratory industry is much different for dental school graduates today than it was 20, even 10 years ago.

For starters, older alumni learned about dental laboratory techniques during dental school. With the elimination of dental lab technology programs at nearly every university dental school and subsequently, the decreased requirements for students to perform lab work for their patients, many are graduating without a clear understanding of this aspect of the profession.

At the same time, a significant decline in the number of independent accredited dental lab technology programs persists. As the trend toward offshore outsourcing puts competitive pressure on U.S. labs, concerns about domestic dental prosthetic production increase.

"It's a challenging combination of events that are all happening at the same time," said Dr. Jake DeSnyder, chair, Council on Dental Practice and a member of the Subcommittee on the Future of Dental Laboratory Technology.

Dr. DeSnyder is keenly aware of critical issues facing the dental lab industry, finishing a three-year term representing ADA members as a trustee of the National Board for Certification in Dental Laboratory Technology.

"We need to bring lab issues under our radar," said Dr. Charles D'Aiuto, chair of the SFDLT. "It's imperative that we move forward to find ways that will assist ADA members in their future needs for dental laboratory services."

The number of Commission on Dental Accreditation-accredited dental lab technology programs has decreased from 58 in the mid- 1980s to 20 today. The reason: competition for resources.

"It's really been unfortunate. The cost of operating a dental lab program at a community college or university level is expensive because of the new technology in our industry now," said Bennett Napier, co-executive director of the National Association of Dental Laboratories. It used to cost around $10,000 to open a dental lab but now can take between $150,000 and $200,000, Mr. Napier said.

From a financial standpoint, many dental schools have found it more beneficial to eliminate the labs and use the space for something else, such as research, said Dr. William Yancey, assistant dean at the University of California, Los Angeles School of Dentistry. That coupled with a lack of donations specific to keeping dental school labs alive means students have less training in what their lab counterparts do before entering the workforce.

Also looming in the near future is the large number of baby boomers who will retire as lab technicians. This group will far outweigh the decreasing number of students exiting dental lab technician programs.

"The certified dental lab technicians in the United States are an aging group. This is compounded by the fact that the training programs for the younger people are diminishing at the same time as the current group is getting more and more top heavy with the over 50 age group," Dr. DeSnyder said.

The NADL estimates that 11,000 technicians will leave the industry within the next seven years, and the current number of accredited dental laboratory technology programs has the capacity to train 1,000 DLTs between 2010 and 2015.

As the education issue continues to simmer, more and more dental labs are being moved offshore. The major companies in the lab industry have found it more financially feasible to develop labs offshore, hiring foreign labor at a cheaper cost and training them to, hopefully, meet the appropriate standards, Dr. DeSnyder said.

"The lab industry itself is getting into this game partly to reduce their costs and partly out of survival," Dr. DeSnyder said.

NADL reports that 25-30 percent of dental prostheses are either partially or totally manufactured overseas.

A lack of lab education for the dentist and a large geographic distance between the dentist and the lab have made it increasingly difficult to communicate effectively. CDP believes these issues make it even more important for dentists to learn how to work well with dental lab technicians.

In 2008, more than 87 percent of dentists reported returning dental work to a dental lab for correction, according to a 2008 ADA survey on the use of dental labs. The NADL says that percentage would be a lot lower if dentists were communicating to the lab technicians exactly what they wanted.

Communication would bolster dentists' confidence in what materials are being used, regardless of whether the work is done domestically or abroad, Dr. D'Aiuto said.

"The only way to get a good product is for the two entities to work together and to do it at a very high level and that's not being taught anywhere anymore," Dr. Yancey said.

Dr. DeSnyder thinks it’s a good idea for dentists to talk to dental lab technicians about the materials they're using. A well-trained lab tech understands the materials selection process better than the average dentist, mostly because the materials are continuously changing, he said.

"What I learned in dental school about the materials is obsolete today," Dr. DeSnyder said. "Unless you're keeping up with materials science day to day, you can really benefit from the shared expertise of your lab technician."

A high level of communication also gives the dentist a better appreciation for what can be produced in a good lab, Dr. DeSnyder said. Positive interaction will discourage the dentist from sending the work overseas if they know they can have a more personal relationship domestically, he said.