Uplifting Higher Education
The state of the college system, how it is impacting the profession, and what those both within and outside it can do to help
From gold crowns fabricated in the 1700s to the opening of the first commercially successful dental laboratory in 18871, from the analog laboratories of the 1900s to the digital revolution of the 2000s, the dental laboratory profession is no stranger to change. The materials, the equipment, and the workflows have been continually improved and refined over the years, and the challenge of dental technicians has been to keep their knowledge current and educate the next generation. In the earliest days, fabrication methods were often kept secret, proprietary to the dentist or technician who developed them, but by 1947, the first college-based program for dental laboratory technology opened its doors in Brooklyn, New York. In 1950, the National Association for Dental Laboratories (NADL) was formed, and by 1959 it had begun administering Certified Dental Technician (CDT) testing and certification. Only a couple years later, there were three 2-year college-level dental technology programs that had met the standards of the Commission on Dental Accreditation (CODA).2
By 2010, there were 20 CODA-accredited dental technology programs in the US.2 However, in recent years, the options have begun to shrink, down to only 13 today.3 While much education can take place on the job, these educational programs represent repositories of knowledge and teaching skill that would be challenging—if not impossible—to reproduce with training received in a single laboratory. So why has the number of programs declined when the demand for qualified technicians is so high? Employment in the field is projected to grow 12% between 2020 and 2030, which is higher than the overall national average growth of 7.7%.4
According to Arax Cohen, CDT, MS, Dental Prosthetic Technology Department Chair at Los Angeles City College, the job market is booming. "I get calls weekly requesting recommendations for students and alumni to fill positions. Often students get hired from internships and may have multiple jobs offered to them. If you get this education under your belt, you set yourself up with a strong foundation for a successful career."
Despite this, one of the challenges facing these institutions is attracting students. In 2019, Durham Technical Community College reported the highest number of graduates from an accredited dental technology program—a grand total of 53. Some reported as few as four or five graduates.5
"They have closed six or seven schools in the last 10 years. It is hard to even find students to come to the school," says Domenico Cascione, MDT, CDT, President of OPERART LLC Dental Laboratory and Lead Faculty for the Restorative Dental Laboratory Technology Program-Division of Health Sciences at Pasadena City College in Pasadena, California. "We need to let people know that education is important."
Looking for Answers
One aspect of the problem is visibility. "Most people do not even know we exist," Cohen says. "This particular segment of dentistry needs to be understood for its real value."
When the average person doesn't know what a dental laboratory technician is or does, it is hard to inspire them to pursue it as a career. And yet, Cohen observes that most of the students at her courses have heard about the profession by word of mouth. "Some of my college students say their dentist said they should go to school to become a technician, or friends of the family who own a laboratory suggested pursuing it."
The only way to combat the low profile of the profession and its educational programs is to speak up. "Members of the dental community could add links on their websites for educational programs and opportunities," Cohen suggests. "Dentists with in-house laboratories, which often seek to employ our students and graduates, could increase visibility by talking with patients; they may be interested in the technology, artistry, and science blend in this career choice."
However, it isn't just lack of knowledge that prevents students from choosing this path. Other factors have combined to reduce the appeal of a career in the dental laboratory, including low earning potential after graduation. According to the US Bureau of Labor Statistics, the median pay that can be expected by a laboratory technician is $38,620 per year.4
"The hourly salary is very low," Cascione says. "My students come back to me after they graduate and tell me they have been offered $15 per hour to work in a laboratory, when before they had been making more working elsewhere. Working on the bench can be very stressful, and $15 per hour is not fair to them."
In part, this issue can be traced back to the 2010 update to the Standard Occupational Classification (SOC) by the Bureau of Labor Statistics, which made the minimum educational requirement for the field a high school diploma. Further educational requirements have been left in the hands of individual states, and only four states require technicians to be certified.6
To combat this, Cascione advocates for national education and certification requirements. This, he says, would elevate the profession, increase pay and benefits, and fill the schools with new students. "Anyone can be a technician today," Cascione says. "But this is a medical field, and we need to have educated people. Dental technicians make teeth that go into the human body, and they should not be doing so without education."
With low applicants, numerous job openings, and no post-secondary education requirements, those who do enter the profession might be tempted to skip the 2-year educational program and go straight into the laboratory. However, that leaves the burden of education on the laboratory, and once employed, budding technicians may find it difficult to attend outside educational events to further their knowledge and careers.
"Unfortunately, I have seen the decline of educational programs," says Josef Kolbeck, CDT, of Kolbeck Dental, who is known for his work as an independent educator. "There is a lack of people with knowledge in our field, as well as a lack of time to properly train new people. I have started seeing more and more difficulties in attending courses because of the cost of traveling and the cases that pile up when technicians leave for a couple of days."
Attracting potential students isn't the only problem. College administrators can also be unaware of the specifics of the profession, and a small, technology-heavy program may find itself overlooked when the time comes to distribute the necessary money and class space.
"Real estate on college campuses is very premium, and so obtaining classrooms is a hard thing," says Anita Bobich, CDT, BA, Professor and former Program Administrator for the Restorative Dental Technology Program at Pasadena City College. "You are competing with larger programs such as computer technology, music, mathematics, etc. But you have to advocate for your students. It can be tough to do when you are up against a difficult set of administrators who do not understand your profession. They may they think you are part of dental hygiene or confuse you with dental assisting."
One solution? "If you are an educator, you need to have a presence on your campus. I have had five presidents and at least five or six deans over the course of my teaching career, and I have made it my business for them to understand what we do. From day one, I was in their faces," Bobich says.
For those who aren't educators themselves, there are still ways to speak up. "Laboratory owners can talk to the board of trustees at college campuses," Bobich says. "We have had so many people speak for us. They made time after a busy day to come out and tell the trustees and all of the members exactly what was going on and why they needed to support our program. And they came multiple times to make the case for us. So speak to the trustees, speak to the deans, and ask to join the advisory boards for the programs in your community."
The Digital Transition
When the majority of laboratories began to shift toward digital workflows, there was a corresponding upheaval in education.
"The revolution hit our industry in lots of ways, and it hit education particularly strongly," Bobich says. "You had to relearn everything you thought you knew because the profession changed, almost overnight. The equipment changed, the materials changed, the understanding of compatibilities and incompatibilities changed, and what was possible and impossible changed."
In the face of that dramatic shift, many factors played into whether an educational program could make the transition and stay relevant. Would administrators understand the need to invest in new digital equipment? Would they grant the space necessary for it? Would the faculty be up to the task of entirely restructuring the curriculum?
"When I started many years ago in 1985, we used all analog techniques. Everything was only on the bench. Even the invoices were just carbon copies. And all the professors are the old generation like me," Cascione says. He has kept his skills up to date by also running his own dental laboratory, but not all educators are able to do the same, and it can be a challenge to keep up.
"It is the nature of this particular field," Cohen says. "It is constantly changing, so you have to reflect that in what you deliver in the classroom."
For some schools, the cards all fell into place. For others, it was more challenging—or impossible.
"It was a lot of work to get all the pieces together, and it did not happen overnight," Bobich says. During her time as Program Administrator at Pasadena City College, she spearheaded their transition to a more digital curriculum. She began by revamping the whole curriculum with the intention of creating a program that was 60% digital, 40% analog. That way, the student could fulfill both needs in the profession upon graduation and fit into any workflow. The goal was to educate a student body that would be familiar with all the technologies that were current in laboratories, from 3D printing systems to milling machines.
"It is something that we started thinking about in 2011 and it took about 5 years to get all the parts together," Bobich says. "We went about writing the curriculum, going through our approval process with the state of California and with our chancellor's office, and running everything through our curriculum and instruction committee. We went from 16 courses to 24 in 2016."
Bobich praises all the support she received during the process. "The partnerships were the key," she says. "I have to give my college credit; when they saw what we were doing, they tripled our space because we have so much equipment. We have a standalone digital laboratory. It is set up so that when you walk in, everything is where it needs to be, in the order that it needs to be used, organized in a way that makes sense for the industry—like setting up a simulation in school. That is where support from companies came in because they helped us put the equipment in, and they helped with in-service training for faculty. The industry came through for us in such a big way. And the members of our advisory board keep us current and apprised of what is going on all across the industry."
Clearly not all the programs have had this level of support, considering the dwindling numbers over the last 10 years.
"The faculty have had a hard time making this happen on some of the campuses," Bobich says. "Some of the programs are in transition but have not quite gotten there yet. And other schools have just not funded the necessary expansion to the program at all." Still, she remains positive. "I believe it will happen," she says. "It is a difficult, uncomfortable transition we are in right now. Some programs are going to struggle through it, others may not make it, and some have not made it because the task was just insurmountable for them. But not because they did not try."
Creativity in Education
In a changing professional landscape and a challenging transition to digital, educators have continued to find creative ways to pass along their knowledge. At the onset of the COVID-19 pandemic, the digital revolution was joined by the online education revolution.
"We had to jump into online learning overnight," Cohen says. "The program's classroom instruction has changed to a hybrid format with online lectures and hands-on laboratory work. In addition, we were fortunate to have the support of the college administration, which enabled allocation of funds to purchase laptop computers and CAD software for students to take home on loan. The digital technology instruction can be conducted online via Zoom as well as hands-on in the classroom. I believe this is just the beginning for online education in dental laboratory technology. COVID has pushed us into a different era and inspired us to think outside the box."
Another problem is being addressed through these new online options. With only 13 accredited programs, what about the student who would like to further their education, but can't take time away from family or work, or doesn't have the resources to relocate? Cascione offers one solution: "We created a series of continuing education courses online for different levels of CAD/CAM technology. Whether you are a graduate of this particular school or not, you can apply for those courses and receive the training to become a digital dental technology technician, along with a certificate for continuing education. We provide every participant with a software dongle, so they are not just observing me as I design a crown but can also do the project themselves."
And during this difficult time, it's not just traditional educators who are stepping up to make sure that knowledge gets passed to the next generation. Independent educators are joining in to make continuing education more accessible.
"The ‘Webinar in a Box' is a box full of materials that I send to everyone interested in growing and learning the basics and fundamentals of complete dentures through virtual hands-on training. They can obtain CE credits and new hands-on knowledge without leaving their laboratory," Kolbeck says. "I also offer on-site trainings using their current work in production, rather than bringing ideal models along. This way, the work continues while I'm training them."
How Can You Help?
Educational programs for dental technology have continued to push forward, through the digital transition, through the restrictions of the COVID-19 pandemic, and through the bureaucratic and regulatory challenges in both education and the laboratory industry. Now, there are a number of ways that the average member of the dental technology community can step up and help them not only survive, but also thrive.
The simplest way to help is just to spread the word about both the importance of educational programs and the offerings that are available.
"Any exposure the programs can get, for either potential future students or faculty, will be a help," Cohen says.
Cascione agrees. "The problem is that people do not know what we can offer. We need to have help to get the word out," he says.
Another way to increase exposure might be to tie laboratory programs more closely to dental schools—which would have additional benefits, as well.
"I think that all dental technology programs should be on the premises of dental schools, and students in both disciplines should learn how to evaluate, design, construct, and restore side-by-side, thus improving the outcome for both dentists and technicians. Personally, combining technical knowledge and clinical experience from working side-by-side with dentists marked the moment in my career when I became a better dental technician," Cohen says.
When it comes to the challenge of academic bureaucracy and funding, it might seem like there's nothing to be done from the outside, but even here, there's a way to assist.
"Educators need to go after every grant," Bobich says. "If members of the industry want to help, they can learn about grant writing. The grants are there to help, and there is money out there, but the process of applying for grants is challenging and competitive."
Cohen proposes industry partnerships to both increase accessibility to digital technology and offset costs to schools. Milling centers could assist in the manufacturing component of the students' designed restorations. Sponsored events, workshops, and seminars could be held at schools, thereby minimizing facility cost to sponsors while increasing exposure for both the sponsors and the educational program.
And it's not just about supporting the educational programs; it's also about supporting the students who enter them.
"Host an intern in your laboratory. Volunteer for lectures and to do demonstrations in the classroom, or bring small groups of students through the laboratory to observe," Bobich suggests. "Meet face-to-face with students, or host a forum between the students and the laboratory owners where they can meet one another—where the industry could be a little nurturing, a little welcoming. Let students know that you are here to help so that they feel like there is a great industry waiting for them."
And to support those who aren't students but still want to learn, Kolbeck encourages those who can to become educators and ensure that their knowledge is passed on to the next generation. "Dedicated programs where experienced trainers and educators can travel to other laboratories to train and do workshops are highly needed. If you can give back to this beautiful field, do it by giving new generations the option to learn and improve their skills."
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