Dental Education: Shaping of Your Clientele

In 2002, dental students were still waxing and casting their own gold crowns, says Leila Jahangiri, BDS, DMD, MMSc, Ira E. Klein Professor of Prosthodontics and Chair of the Department of Prosthodontics, Undergraduate and Laboratory Studies, New York University, College of Dentistry. "When I removed many of the laboratory processes from the curriculum, everyone thought I was insane," Jahangiri says. "My thinking was that we must be looking at products that are contemporary and modern; it was important to know the most recent developments in our profession and it is our job to educate our students so that they can be the best dentists. My philosophy has been that dental schools should be ahead of private practice and not lagging behind, which was not typically the case."

Since then, the slimming of the curriculum has continued. Significant varieties of denture setups have been eliminated; where traditionally three setups had been performed, including bilateral balanced occlusion, lingualized occlusion, and canine guidance, now only one complete setup is done. This year, NYU dental students utilized digital setups to learn the principles of occlusal schemes. "We have to teach the same proven principles, but in different ways," Jahangiri says, "and digital technology allows us to do that." Jahangiri started teaching digital denture processes 5 or 6 years ago with the purpose of jumping ahead of private practice. "Digital dentistry is the perfect example of how education can provide early access to new technology and information," she says.

As efforts at NYU College of Dentistry have advanced further, Jahangiri's conviction about the direction of dental education has only grown. When Jahangiri contacted a good friend and colleague 5 years ago to discuss the future evolution of dental technology from the time-honored techniques that are currently in use, they walked away with the realization that technology would change the typical positions in the dental laboratory, where traditionally there was a model technician, waxer, metal finisher, ceramist, etc; they believed technology and machinery would be the catalysts, allowing artistry to rise to the top of the skill hierarchy while more readily available technology performed restorative fabrication functions.

Jahangiri further comments that in dental undergraduate, laboratory, and hygiene education, she believes that each must have a common thread to be successful: constant mutual advancement and collaboration. "Dental educators should be speaking with dental laboratory educators and advancing their programs together, hand in hand," Jahangiri says. "Otherwise, they will find themselves no longer relevant and will eventually suffer the consequences; if a patient has a sophisticated prosthesis and the hygienist or dentist does not know what it is, or recognize it for being what it is, they will be adversely affected." Jahangiri continues that, "when it comes to educational support, manufacturers of technology must provide dental laboratory technology programs with the tools to train and teach, so that they can produce graduates who are well versed in technology and can push the envelope in the future. It is a very low investment that will yield enormous returns in the future. Any company that does not see that that is being very short sighted."

Laboratories that cater to the entire dental team—including dentists, hygienists, assistants, and front desk—will gain greater case acceptance and improve the oral environment for patients. Jahangiri describes this as an ecosystem in which the future dentist does not have only a dental technologist to whom he or she sends work in the mail, but rather has a much closer interaction with the technologist. "They need to be a vital part of the treatment process, where the dentist sets up a team of experts to approach treatment planning from a collaborative perspective," she says. "I envision something different from the traditional model of the dentist calling the periodontist and the technologist separately and having one-on-one conversations. In the future, I see regular meetings via digital means in which all of the team members share their respective expertise to establish what is best for the patient and come up with a uniform treatment plan that delivers the best results. The input of a dental technologist is a critical part of that."

Dental hygienists are an important factor in production and specifically generating restorative work for their dental offices, as they are the first point of contact in many cases. Patients see the hygienist for routine preventive care, which then also presents an opportunity to educate patients on various aspects of oral health, as well as managing their dentition (or lack thereof), says Joy D. Void-Holmes, RDH, BSDH, MHSc, AADH, Dental Hygiene Program Chair, Fortis College Landover. This initial information is often presented to the patient by a hygienist and in turn converted to a clinical appointment. "Technology has really infiltrated dentistry in a big way and students have an opportunity to test these technologies during various seminars, etc," Void-Holmes says. "Due to COVID, we experienced a paradigm shift in the educational setting, specifically with regard to testing for licensure. In many instances, testing agencies were forced to shift from patient-based examinations to simulations and the use of mannequins, and I believe that will continue to evolve."

When it comes to dental continuing education involving laboratory content, should dental hygiene be in the mix? Void-Holmes says yes: "Hygienists often are simply not invited," she says. "So invite us to the mix and cater to us with information on what we could do to help one another. As hygienists, we often spend the most time with patients. The patients trust us, and often when the dentist leaves, the patient turns to the hygienist for reassurance when treatment is presented that it is in fact the best treatment option for them." In today's dental hygiene curriculum, educators are teaching about types of restorations, what causes the need for the restoration, bite/occlusion issues, and how to alleviate patients' discomfort and promote oral health. Some educational programs do a better job than others at imparting this essential information. Continuing education opportunities can do much to fill in the gaps, and dental laboratories are uniquely positioned to make sure that hygienists have access to the knowledge they need.

A dental laboratory can be an education source for its clinicians not solely in a CE seminar situation, but also via an orientation of sorts or one-on-one workshops to help them reach success. "I believe that a lot of general dentists do not enter treatment modalities such as dental implants, esthetic/cosmetic dentistry, CAD/CAM, technology, etc, simply because they are not aware of their laboratory partner's capabilities or do not have confidence in their performance," Jahangiri says. So, rather than engage in that practice, they remain where they feel most confident and comfortable. Jahangiri says a dental laboratory technologist can offer augmented skills to meet the dentist's needs and deliver complete patient care.

Laboratories and dental technicians have become more important to clinicians and the dental industry than ever before, says Craig Moore, Director of Full Arch Technical Services with DSG Implant Experience Center. "We learned this many years ago," Moore says. "Every laboratory technician sitting at the bench knows that colleges are not teaching the prosthetic principles along with the hands-on skills with restorations like they were 20 years ago. Additionally, in the past, dentists coming out of school would work as associates with seasoned dentists and successful practices to learn how to do all things based around restorations and what was needed for the best appliance. These dentists would fill the gaps of what the young dentists did not learn in school. Now, when new dentists come out of school, they are not as knowledgeable with restorative principles as in the past. They then join larger DSOs and miss out on the mentorship of a seasoned dentist. DSOs now rely on the laboratories to fill those gaps. They call on me to help teach their young dentists how to make these cases successful and the workflows go more smoothly, especially with implants and full-arch prosthetics. We absolutely need to be involved with education now. We are really important to the educational aspect across the dental industry like never before. Even with our strategic vendor partnerships, we help with education on prosthetic principles and what is needed for success. It makes me feel really good now that we are much more important in the industry than in years past, because we were not always treated as such."

As technology continues to evolve, new tools could make continuing education and collaboration easier. "Artificial intelligence, as it develops, can help laboratories further understand their clinicians' needs and address them immediately," Jahangiri says, "because if laboratories treat everyone the same, the individual clinician may become overwhelmed and disengaged, thereby not benefiting from opportunies for further education which would allow them to enter spaces that are profitable and revenue-generating for both the laboratory and the dental office. Particularly, laboratories must ensure that every clinician is aware that they can request digital manufacturing without needing specialized equipment."

Education and knowledge transfer will make everyone on the team a critically important member, and laboratories provide essential knowledge which, if excluded, would leave a perilous gap in the restorative dental team. Dental technicians can fill the gap in positive ways to align the needs of the team and the patient, as well as grow their relationships with their clientele. Furthermore, when laboratories are pursuing opportunities to share knowledge with their dental colleagues, hygienists should not be excluded. "We do more than just clean teeth," says Void-Holmes, who adds it would be very beneficial to work with laboratories on specific courses for dental hygienists. This would build connections and help the hygienist better understand restorative modalities and materials. "The most important part of a hygiene appointment is patient education," she says. "We are going through a period of adjustment, and we will adjust; however, right now, I see a new group of hygienists coming in who understand the concepts of restorative dentistry because they want to do the best for the patient, and those hygienists will be very successful." Arming them with information to perform their jobs more skillfully and profitably will lead to generating greater revenue for the dental office and thereby the dental laboratory, while providing the best oral care for their patients. Void-Holmes suggests laboratories offer their help, with the approach of "helping me see what I am not seeing."

Hygiene, like the other specialties, is a business; hygienists need to produce, and they do. They are well aware of how to diagnose disease and how to recognize the need to restore the oral environment to normalize the patient's well-being, ensuring both profitability and quality of care for the patient. "Dental hygienists should not be afraid to offer their patients advice on maintaining their teeth," Void-Holmes says. "When you buy a car, you have insurance for it, but the insurance company does not pay for you to wash the car or change the oil. That is very similar to the mindset a dental hygienist should have, which is based on maintaining the overall health of the oral environment." In order to confidently and accurately provide such advice, the value of laboratory input cannot be overstated.

Education is not just about passing on the knowledge of the past, but also about progressing in new directions. Teledentistry is here and being utilized more than ever before, and Void-Holmes says it is a great model moving forward. Teledentistry can be instrumental in helping dental hygienists provide thorough patient education sessions when time does not permit in the office; a teledentistry appointment can be scheduled at a convenient time for the patient after the initial hygiene appointment, and the hygienist can say, "I saw that this tooth or this problem needs to be looked at." What does that mean for the patient? Members of the dental team can share screens, share x-rays, scans, pictures, etc, and provide for better patient education, engagement, and restorative conversions. In fact, when there is more time to discuss options with the patient, the dentist can join in and offer options, and then the hygienist can have an unrushed appointment with the patient, which leads to greater case acceptance and an enhanced patient experience. "It's a huge opportunity that teledentistry offers, and it's all about communication," Void-Holmes says.

There is no doubt that dental education is experiencing a paradigm shift in how it prepares the dental team to care for the patient. Dental laboratories can accommodate for this shift by engaging more closely with their clinical dental teams and offering increased education in order to help them function and best serve their patients' oral needs. This in turn provides an avenue to grow their mutual revenue streams.

Whether because of COVID-19 or the difficulties of new technology, challenges continue to arise, but many have a positive outlook for the future. Jahangiri agrees wholeheartedly: "The future for dentistry is bright," she says.