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In Part III of his ongoing column, Eric Nunnally, CDT, finds that technicians and dentists have more parallels than he thought, and that his technician background is finally giving him a leg up.
We dental lab people love to worry. Offshore competition, lab school closures, increased FDA involvement, lack of workforce, denturists and the cost of CAD/CAM systems keep many of us up at night, sweating.
Rest assured that dentists also have their fair share of threats and worries. Labs and dental practices have a lot more in common than I realized--both are minimally regulated businesses with great potential to be lucrative, and both technicians and dentists want to protect the future of their professions. Here are two other commonalities I've discovered:
In LMT, I read the prediction that by 2020 we may lose 2,240 laboratories due to retirement. Similarly, 6,500 U.S. dentists retire every year and only 5,000 students graduate from dental school. The number of dentists leaving the profession will likely increase even more as the baby boomers retire, especially when the stock markets rally and their retirement funds rebound to previous levels.
Just as the word "offshore" makes lab folks worry about the amount of work going offshore and our future, the words "S. Mutan vaccine" have the same effect on dentists. A vaccine for Streptococcus Mutans, the primary bacteria that causes tooth decay, is in development and could be on the market within 20 years. The potential of this vaccine makes a lot of dentists worry that eventually they won't be treating caries. However, the reality is that if it comes to fruition, the vaccine will not eliminate caries, but could lessen the amount, similar to the result of fluoridated water. And, the vaccine could help if a shortage of dentists becomes a reality.
One thing I've come to realize in dental school is that as a technician, I had severely underestimated the level of knowledge and expertise a dentist has to have. This point really hit home when I heard a presentation about the University of Minnesota Dental School offering a bachelor's degree in "dental therapy" with the ultimate goal of providing care to remote, underserved areas of the U.S.
During the four-year program, the dental therapist learns basic dental procedures--restoring primary and permanent teeth, extractions of primary teeth, placement of sealants, screenings, etc.--and must work under the supervision of a dentist, similar to what's required of dental hygienists. The speaker argued that these therapists will offer an equal quality of care for these procedures. Really? I've learned that diagnosis of even a simple case requires a thorough knowledge of physiology, pathology, occlusion, possible dental abnormalities, modern materials, pharmacology and proper treatment planning. Even what seems like a routine extraction can result in major complications like partial facial paralysis, loss of function or chronic pain if a nerve is damaged. While I believe there is a great need for treating the underserved, I also believe patients need the expertise of a dentist--not a dental therapist--to minimize those risks.
My Second Semester
Head and Neck Anatomy is the 800-pound gorilla of this semester. It means we're back in the gross anatomy lab dissecting a cadaver from the neck up. You wouldn't believe what's involved: nerves, muscles, veins, arteries--and lots of them, from where they originate, where they cross, what they supply, nervous system pathways and functions and on and on. It's one of the courses that relates to almost everything we'll do as practicing dentists--from extractions to endodontics to dentures.
In my last column (LMT February 2010), I said our class should be waxing more, but I've since reconsidered. The waxing we're doing is meant to reinforce our understanding of dental anatomy and I think we're accomplishing that goal. Besides proper indications/contraindications, needed preparation designs, limitations and basic waxing procedures, I don't think the dentist needs to know any more. I understand waxing more than anything else and I don't see how it's going to make me a better practitioner.
Plus, how much longer will manual waxing be standard procedure in the lab? It's just a middle step in a manual process that's rapidly transitioning to CAD/CAM. Dentists should also have an appreciation for what the lab needs in order to fabricate a quality denture and the school is doing a good job of exposing us to the laboratory side of this specialty. In our Complete Dentures course, we're covering edentulous anatomical landmarks; denture procedures like angles and measurements; and fabricating custom trays, occlusion rims and setting posterior teeth. Next year we'll complete the same projects, but for an actual patient--our first patient!
And I'm happy to report that my lab background has finally given me an advantage over other students. The Dentures course is almost identical to the course I took during lab school at Bluegrass Community and Technical College.
Editor's Note: If you have a question or concern you'd like Eric to address in a future column, please e-mail Kim Molinaro
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