What is essential learning for any owner or executive from outside the profession?
Jason Mazda and Daniel Alter, MSc, MDT, CDT
Bob Savage recalls his first few days at Drake Precision Dental Laboratory. Savage is now a Past President of the National Association of Dental Laboratories (NADL) and one of the most respected figures in the industry, but 23 years ago, he was the new guy at his father-in-law's business in Charlotte, North Carolina, and he did not know what a PFM was. "It was super overwhelming at first," Savage says of coming to work at a dental laboratory when his background had previously been in engineering and construction. "It was so different from anything I had ever seen. The language and the terminology were foreign. I would have to ask people, ‘What is a PFM?' ‘What is occlusion?' ‘What is mesial-distal?' I had this vision that the profession was more artistic than science-based, and then I discovered how technical it was also. I had a lot to learn."
While the dental laboratory profession is not the only one with a learning curve for new entrants, that curve is particularly pronounced in a highly technical industry with mostly small businesses and relatively little formal education. In other words, many people start at dental laboratories with as much to learn as Savage did.
The level of that learning can vary from laboratory to laboratory, depending on the business model. Savage's father-in-law, Billy Drake, set him on a business path that included leaning on skilled technicians for their technical knowledge. "When I get into heavily technical discussions with dentists, I typically pull in a senior manager to assist," Savage says. "I know a lot more today after 23 years in the business than I did after 2 or 3 years, but I know where my lane is and when I am going to start bumping into things that I do not know deeply or well." Similarly, Dory Sartoris never planned on joining the family laboratory, DCS Dental Lab, until she unexpectedly had to take over in 2013, and while she has worked hard to expand her technical knowledge since then, she understands her limits in that regard. "Having good people who you can trust is key for any laboratory executive, but especially for someone who is not a technician," Sartoris says. Conversely, Doug Frye, CDT, has built his businesses—Functional Esthetics Dental Lab in Farmington, Missouri, and D3 Implant Solutions in St. Louis, Missouri, both of which he runs alongside his wife, Mary "Muffie" Frye—in part on every employee mastering the technical aspects, so when his stepson, Kevin Westrich Jr., came onboard, Frye was clear on what Westrich needed to learn: "Everything. Everything," he says, repeating it emphatically. "All the terminology—buccal, lingual, tooth numbers, etc. Philosophically, he needed to not only learn all of that but also apply it." Even for those who choose not to apply that knowledge by becoming a bench technician, learning as much as possible is always a positive. "It all depends on how invested the person is in the business," says Jay Collins, who purchased Cornerstone Dental Laboratory in Bristol, Pennsylvania, from his uncle in 2011 after previously owning a construction business. "If someone without dental experience is going to own a laboratory, they really need to learn about everything."
Even for those focusing more on the business side of operations, an intermediate understanding of dentistry and the language of dental laboratory technology is typically necessary. For instance, if a laboratory owner or executive plans to depend heavily on the expertise of skilled technicians, then hiring the right people for those roles is critical. "As the owner, I might be interviewing a denture technician who says they can fabricate four dentures in an hour," Collins says. "I understand enough about denture fabrication to know that making four dentures in an hour is almost impossible, so I would recognize that that person is not a good candidate."
Purchasing decisions also require a certain level of understanding. Savage says that was one of his primary responsibilities early on, and he asked as many questions as possible of the technicians to inform his decisions. "If purchasing decisions are made without considering the technical perspective, they could be detrimental to the quality and longevity of your products," Savage says. "Learning about the products and how they are used was important for me, and subsequently, has been important for other people we have hired for that role with no laboratory experience. I do not expect them to learn to be dental technicians, but it is really important that the person making the decisions and buying the product understands how it is used, because ultimately, that will make them better at their job. Having that knowledge is invaluable for any position in the laboratory." Collins emphasizes the necessity for a healthy, educated dialogue when making purchasing decisions. "I need to understand what my technicians want," Collins says. "If they say they need a certain porcelain, I ask why. Is it because they saw a fancy advertisement, or is there a more specific reason? That is just being a savvy shopper."
When the conversations are with people outside the laboratory, especially with dentists, a strong grasp of the technical elements helps to portray the laboratory in a better light. "Executives at my laboratory must talk to surgeons and dentists every day at a level where they will be respected and believed in, because the clinicians are following that lead to place implants," Frye says. Even for a non-technician owner or executive who is not the person clinicians are counting on for technical expertise, a certain level of understanding is preferable. "It is a fine line," Sartoris says of how technical she gets in these discussions. "You definitely do not want to sound like you don't know what you are talking about. You also need to understand shading, materials, margins, contacts, occlusion, etc, so you at least can translate what the dentist is saying to a technician who can figure out what is needed. However, it is also important to have the right people available to connect with the dentist if it is something really technical." Collins emphasizes that even business conversations with dentists require technical knowledge. "What I had to learn most quickly was why dentists leave their laboratories, and all the language around that," he says. "They need a custom-made product on a timeline, so when I am pitching my laboratory to them, I cannot sound clueless."
How to Learn
One of the first things Sartoris did upon taking over her laboratory was attend a Productivity Training Corporation (PTC) introductory course—something Savage puts all of his new employees through as well. "That helped me learn the terminology and the basics," Sartoris says. Like Savage, she also attended NADL University courses, which are business-focused but address issues specific to dental laboratories. "I still use things I learned there 7 years ago," she says. Next, Sartoris spent a week or two in each department of the laboratory to learn the processes. "I wanted to observe workflows, what goes into this product vs that product, how much time each department needs, and how each department really affects the next one," she says. "I was not going to learn to sit down and do any of it myself, but I was able to understand, ‘OK, the technician trimming the die needs this before they can do their job.' There are so many great resources available now, but there is still so much value that comes with sitting one-on-one with someone who does the work every day and has experience that you can soak in and learn from." Savage says being proactive and immersing oneself in the laboratory as much as possible is important. "I just asked a lot of questions," Savage says, "and any time there were any sort of training courses in the laboratory for the technicians, I always sat in on them. That was just really important for my development. I had to take the initiative. We had a trainer in place who taught me some basic terminology, but I learned more via self-study and used my job role to try to learn the pieces and parts to it."
For Frye, that "over-the-shoulder" method has always been the best way to train his employees for any position, and he says Westrich dedicated himself to learning that way. "Kevin took it upon himself, with our guidance, to lose a lot of sleep time by learning all of these processes," Frye says. "He not only had to learn all of the processes, but also how to grow a business, which entailed hiring people who could learn the same things." In addition to the hands-on learning, Frye says CE courses are still important, even once someone has mastered the necessary technical skills. "Kevin and I still take as many courses as we possibly can," Frye says. "For example, we became a certified CHROME Lab, so dentists pay Kevin to sit chairside for open-flap, bone-reduction, guided surgery." Savage and Sartoris both suggest attending conferences, both regional and national, for CE opportunities as well as to network with other laboratories and learn from them. "If your job is client services, you should take courses in those areas but also in areas you do not know very well," Savage says. "Maybe take an implant course—something where you feel you might have a blind spot. Sitting in on those courses and hearing the questions that are asked can be so educational even for non-technicians." Online resources can be helpful as well. "YouTube, online forums, blogs—I read everything I can wrap my hands around," Collins says.
What to Learn
Understanding the fundamentals of the oral environment and how it functions will provide for the most optimal outcomes. Regardless of the type of prosthesis—fixed, removable, or hybrid—all need to work in harmony with the biological process to affect positive functional and esthetic results for the patient, dentist, and dental laboratory.
A perspective of "form follows function" is best, meaning technicians first must consider how the prosthesis will function properly in the patient's oral environment, allowing for appropriate interdental mastication, occlusion (working, balancing, and mutually protective), proper hygiene, and other similar oral benchmarks. Only then can they contemplate the esthetic aspects of the prosthesis. If you make a very esthetic and visually pleasing prosthetic, but do not follow appropriate function, it will not serve the patient any good and may in fact cause them harm. Proper oral function presents a direct correlation with a person's health and well-being, as studies have shown. Ill-functioning dental patients choose foods that are processed and softer because they are unable to appropriately masticate, so they lose out on much of the necessary nutritional value, proteins, vitamins, and other critical elements needed to maintain a healthy lifestyle.
Learning how the oral environment functions, via the many resources available, is simply the study of the human mastication/oral mechanism. Every dental technologist needs to understand keenly and intimately how the oral mechanism works, both from a micro and macro perspective; where and how all of its parts function, individually and as a whole; and their attributes. Each tooth has its purpose, and they all function as a whole to accomplish proper mastication. If any of the elements are off, it will disrupt the entire system and cause unintended consequences and perhaps even harm to the patient. When looking at occlusion and gaining knowledge on each tooth's morphology, it is critically important to examine the cusp-to-fossa relationships, working and balancing when functioning, as well as the ligaments and the height of contours, to just name a few, which are all important. For example, each tooth's height of contour is positioned to deflect food away from the gingiva on the labial surface during the mastication process, because without that, food could potentially get impacted into the gum, causing inflammation, pain, and more dire consequences. If a laboratory technician does not heed to these principles and in fact fabricates a flat or lessened profile of the tooth, it could introduce these unintended and destructive consequences and more.
‘In the Driver's Seat'
The oral environment is an incredibly impressive mechanism that functions exceptionally and intricately well. Peeling away all the layers and learning and understanding all of the individual parts and how they work together as a whole provide the dental laboratory professional with the knowledge to critically think and help problem solve patients' individual situations and restore to optimal function, thereby directly affecting their lives for the better.
"I always believe that you need to be in the driver's seat," Savage says. "You need to understand where you are at and what you need to do your job, and then look to your mentors and your leadership to find those resources. However, you need to take control of your own destiny in some regard, because in many ways, only you know what you don't know. Knowing the technical side of the business, at least at some level, is important for everybody in the laboratory. This is a great industry, and there is potential for any individual who wants to get into it to do extremely well."