The State of Dental Laboratory Education

Grappling with worker shortages and falling program enrollment

Daniel Alter, MSc, MDT, CDT

Over the past few years, the dental laboratory profession has experienced increasing challenges with attaining knowledgeable and skilled dental talent to accommodate the growing needs of the dental patient population. We have weathered consistent challenges to the status quo that continue to impact the way we conduct our businesses and live our lives. With a plethora of variables influencing change from a macro to a micro level, there has certainly been a palpable and evident shift not just in the dental industry, but in our broader culture and society. The COVID-19 pandemic changed the workforce in so many ways and exposed differentiated ways of working. Differing styles of work ethics have emerged, and although the results are already being felt, some may argue that we have yet to settle on what will become the new norm. As dental laboratory owners and businesspeople, we also contend with geopolitical influences globally, as well as domestically, including challenges in the supply chain, cost of goods, inflation, and so much more-which all contribute to how we view our present and future opportunities. Technology has further provided us with acute and instant knowledge and communications at our fingertips, and within a moment's notice. These contributing factors all play distinct roles when strategizing and operating the business of a dental laboratory, and as dental laboratory owners, we must contemplate and produce solutions to meet the challenges so we can remain viable and thrive under these new and evolving conditions.

Formal education as a whole-in the dental field as well as other areas of study-is also experiencing a state of flux as many grapple with the perceived value that education contributes towards an employer or an individual's career trajectory. In academia, these challenges often result from financial and time constraints which decrease the perceived return on investment. This, coupled with low enrollments, have caused formal dental laboratory programs to close their doors such that there are now a mere nine accredited dental laboratory programs nationwide; a stark decline from the over sixty programs that operated just two decades ago. In addition, dental schools and dental laboratory programs are required to cover a certain curriculum, but with ever evolving technology and procedures, there is exponentially more to be covered now in the same span of time, making it exceedingly difficult for institutional academic programs to keep up. With fewer graduates from accredited programs and an increasing demand for dental prosthetics, it is clear to see the challenges that the dental laboratory industry now faces.

Establishing Solutions

Dental laboratory owners are contemplating solutions for both sides of the need: the education of dentists, and the education of dental laboratory technicians. "I am at the point in my career now that I cannot blame people for what they were never taught properly," says Kurtis Helm, CDT, owner of Helm Dental Laboratory in Wylie, Texas, "but it allows me the opportunity, at least on the prosthetic side, to pass on my more than 40 years of experience to the next generation of doctors and technicians, and that has been a big turnaround for my business. We received our PACE certification, so now we do a ton of educational events in our new education center. I look at the marketplace, see where doctors are struggling, and then we develop curriculum to cover those areas and address those struggles." This effort and shift came about after an experience Helm had with a recent dental school graduate who was working in his laboratory while waiting for acceptance into a specialty program. Having passed all his board exams and become a licensed dentist, this individual expressed to Helm that it would be great if every student from his dental program had spent at least one semester rotating through a commercial dental laboratory.

Digital technology is looked upon as the ideal opportunity to evolve the industry, both clinically and restoratively, and Helm feels that should be the focus of action for all dental schools and dental laboratory programs. Steven Pigliacelli, CDT, MDT, vice president and director of education at Marotta Dental Studio, Inc. in Farmingdale, New York, shares this sentiment. "Every program should be upgraded by 100%, digitally speaking, because they are all so far behind," Pigliacelli says. "I'm not saying the end result should be 100% digital, but it should be a 100% improvement to what is currently offered. If we continue down the current path, we will be sending out a whole generation of dental professionals who are ill prepared and cannot adapt to the changes in the industry, and that is very problematic." Similar to Helm, Pigliacelli wholeheartedly believes that the solution lies more within the scope of the dental laboratories and corporate support than in academic institutions, although both Helm and Pigliacelli are heavily involved with academic institutions and volunteer tremendous effort, time, and money to continuously elevate the profession.

Pigliacelli, who is the founder and past president of the Association of Innovative Dentistry-a brand-new dental organization dedicated to supporting the next generation of dentists, specialists, and technicians-is leading the conversation with members of the dental laboratory community on how to cultivate solutions for the current gap in education. Pigliacelli believes that through collaborative efforts, the organization will fulfill a huge need within the profession and provide a new path forward. "Setups are crucial because technicians need to understand anatomy and bites, but everything else can be learned on a computer these days," Pigliacelli says. "I honestly do not think I need to have people learn how to wax and finish metal; I do not think I would like to teach margins. Foundational concepts are important, but as far as copings for PFMs, it is just not needed anymore because it no longer exists in the market." Pigliacelli also believes there are faster ways we could be teaching, although he admits that just ten years ago, he thought about things very differently. "I wanted all of my dental technicians to learn the laboratory steps first and then work to translate all of that to the CAD approach," he says. However, Pigliacelli completely reversed his thinking after hiring a young candidate who knew nothing about the dental profession. This new hire learned everything from the digital standpoint first and filled in the laboratory functions as he went. According to Pigliacelli, this technician is now one of the most knowledgeable and skilled people in the laboratory. "Because of this experience, I believe we as laboratory owners really need to think it through right now and recognize that many things we used to prioritize are no longer relevant," he says.

Academic Challenges

Both Helm and Pigliacelli are continually active in the education and academic disciplines and feel that much of the minutia should be learned digitally, although they do suggest an analog denture setup be utilized for the tactile feel, as well as tooth form, anatomy, and function aspects. When asked about pushback from academics, Helm shares an experience and an analogy. "Unfortunately, a lot of program directors are older prosthodontists, and they believe that students today need to be taught the same way that they were taught years ago. It is just funny," he says. "I use an analogy when I speak with those who feel that way. I say, ‘Let me throw this out there. I learned how to drive back in the ‘70s with a three-speed shift on a column. Would it make sense for me to teach my children or grandchildren how to drive the same way today?'" Helm's point is that, if students are spending a full year learning how to set an upper and lower denture, wouldn't it be more efficient for them to learn how to digitally design a denture too? And this way, they will have been exposed to dozens of dentures in a semester rather than just the one. We are now in a critical mass moment that requires outside-the-box thinking and a well thought out solution. Just because we have done things a certain way for the last 30 years does not mean we need to do the same for the next 30 years.

The Value of Good Education

Whichever the method of attaining knowledge, there is a certain pride and respect that goes hand in hand with the confidence of professionalism and knowledge. Many dental professionals share a frustration with the current culture of de-valuing education and professional training. "I was meeting with a local rep recently who shared with me that there is a laboratory in Dallas that starts their pricing at $22.00 per unit for a posterior crown," Helm says. "That is ridiculous; my laboratory cannot even come close to touching that price point, but that is where some in our market unfortunately are going right now." Helm further explains that if he were a starting bench technician today, he would have to consider a different line of work. "I see what is unfortunately happening; laboratory owners and technicians can work harder, but ultimately our prices are getting driven into the ground, and how can laboratories afford to pay a competitive wage to attract talent and compete with other industries if we cannot charge our clients appropriately?" he asks.

There is always a need for good and sound education. But once again, we need to change things in dentistry in order for it to make sense for future students to seek out these programs and want to pursue dentistry as a career. According to Helm, dental laboratory work is truly a rewarding and honorable profession, but young people have to grapple with their financial realities. In addition, technicians must be committed and enthusiastic about work in the laboratory in order to find success. "If someone is unable to sleep Sunday night because they must begrudgingly go to work at the lab in the morning, then this is probably not the right career for that person," he says. Helm's goal-and what he hopes will be his legacy- is to leave the dental laboratory profession better than he found it.

Pigliacelli further expresses the need for good education and professionalism because that is what sets a profession apart from a job. According to Pigliacelli, many technicians and laboratories are operating from the vantage point of laboratory work being just a job, rather than a career or profession. Although he emphasizes that there is nothing wrong with that on an individual level, he argues that the ability to evolve and advance the field does rely on a certain level of education and professional development that goes beyond just doing a job. For Pigliacelli, this dilemma has yet to be resolved or reconciled within the dental profession. The future of dentistry and dental laboratories has the potential to truly be great as long as it is able to continue to develop true professionals. However, if all involved stakeholders-dentists, vendors, laboratories, and education programs-do not take appropriate steps to elevate education and professionalism in the field, then only time will tell what dentistry's future will look like, and good or bad, we will have to live with those ramifications.