Stretching Educational Boundaries

The Need
Technology is progressing so fast that it is difficult to keep track of all the de-velopments. Dental technology has grown exponentially and so has the demand for faster services along with natural aesthetics and excellent function. To this end, it becomes imperative that the dental health team optimize a team approach when treating the patient. Furthermore, it is even more important to understand what each team member can contribute and in what way(s) they may be limited.
During the past 10 years, a good number of formal dental technology training programs have been shut down. On the other hand, the number of dental schools has recently increased, with several slated for construction, while others are opening soon across the country. This will increase the number of dentists, but the projections show that the number of dental technicians is actually on the decrease. There is no question that dentistry will soon experience a shortage of trained and experienced dental technicians in the very near future. Additionally, as technology expands, so does the need for “team” training to understand the ramifications for our mutual patients, especially with the significant decrease in the curriculum for dental students related to dental technology concepts and laboratory techniques.

A Solution
In 1998, I (Dr. Schneider) had the foresight to see the value in putting dental technology (laboratory) students together with dental students in a didactic and clinical setting that would serve to maximize their mutual experiences. I invited a group of dental technology students from Kirkwood Community College to observe and participate in an occlusion class (including both lecture and laboratory experiences) that I directed for the dental students during their freshman year.
This was a weekly course that included making impressions on mannequins, the fabrication of accurate diagnostic casts, taking interocclusal records and face-bow transfers, and programming semi-adjustable articulators. This would allow the students to observe, evaluate, and then record an occlusal analysis to facilitate equilibration of the casts for an optimal occlusal scheme. This initial exposure gave the students from both schools the opportunity to see the value and importance of dental materials, dental anatomy, and the use and proper programming of an articulator as it relates to occlusion and the need for accurate techniques.
Both groups of students were also exposed to the need for the un-derstanding and accurate use of dental materials and how this knowledge (or lack thereof) can affect the final treatment outcome for the patient. Communication with each other, as a team, about occlusion and the desired outcome is the initial step in developing a definitive prosthesis for a patient. Beginning with this initial exposure, the program has expanded and grown significantly to what it is today; it now includes clinical exposure for the dental technology students working with the dental students in patient treatment facilities.

The Results
The initial program was so successful that the administration team at the University of Iowa endorsed the suggestion of matching sophomore and junior dental students with second-year dental technology students. Obviously, up until that point in time, this was an opportunity that a majority of dental technicians never had during their formal technology training. At Kirkwood Community College, this opportunity is now called the DLT Clinic I.
In Clinic I, dental technology students have their first opportunity to see what happens to the dental patient, from the initial appointment to making the final impression for the fixed or removable prosthesis. The dental technology students work side by side with the dental students, assisting chairside and also helping to do procedures with the dental students in the dental laboratory. They are also able to observe what happens to the patients in preparation for interim or definitive prostheses. Then, they can evaluate the prostheses in preparation for insertion and see the process for delivery and follow-up of the various prostheses. This creates a much better mutual understanding of (1) how paramount technical precision is in the fabrication of every restoration and/or prosthesis and (2) the possible hurdles that may present along the way.
Clinic I provides understanding for the dental technology students about the challenges the clinician encounters when trying to capture that “perfect” impression. Seeing the clinical work being done, either in a preclinical setting or in the dental clinic, allows the dental technology students to be very aware that there is a body attached to the mouth. From this realistic perspective, they can better understand that it is sometimes difficult for a clinician to get the “perfect” impression when tongues, cheeks, lips, saliva, blood, and other tissue management challenges can play a significant role in the quality of the impression and, of course, the final prosthetic outcome. Because of their experiences in Clinic I, the dental students and the dental technology students can see why it is imperative that attention be centered on dental anatomy, occlusion, and the all-important margins of fixed restorations. They begin to have a clear understanding of why each clinical step is equally important and how it can affect the work/outcome of the dental laboratory team and the clinician alike. For example, they soon learn that preliminary impressions are just as important as final impressions.
It is unfortunate, but many dental technology students go on to work in settings where they rarely (or never) meet the clinicians for whom they are completing cases. In addition, the decrease in emphasis on dental technology in the dental schools’ curricula is also lending itself, in part, to the disconnect between doctors and dental technicians. It is vital to allow dental students more time with dental laboratory technicians and/or dental technology students to learn and appreciate one another’s work, and to begin the journey of building better professional relationships. In Clinic I, they learn together that communication between the dentist and the dental technician is always critical and, though it is made easier through the use of digital photography and the Internet, it is still important to establish meaningful face-to-face team relationships. In this program, the dental students are able to see the dental technology student as a “real person,” and together, they can communicate their concerns about a case or even discuss treatment options from both clinical and technical perspectives. In the end, they learn that everyone benefits from this team relationship.
Dental technology students are required to keep a running journal of their observational experience (strictly adhering to HIPPA guidelines). At the end of each journal entry, dental technology students are asked, “What considerations did you experience when working with a dental student (dentist)?” The answer given back most often is, “communication.” Doctor-patient and doctor-technician communication is paramount to success; if these lines of communication are not open and healthy, we truly believe that the patient may suffer the consequences.

Faculty and Administration Made This Happen
Clinic I, for dental and dental technology students, has expanded from the initial preclinical occlusion class to a valuable experience in 5 different areas within the University of Iowa College of Dentistry, the University of Iowa Dental Clinics, and the University of Iowa Hospitals and Clinics (Hospital Dentistry). This diversity offers an exceptional opportunity for dental technology students to see an even wider variety of clinical situations. We are very fortunate that, within these 5 areas, the administrations and faculties had the insight and wisdom to place their full support behind this observational clinical experience. Because of the different clinical settings, the dental technology students’ exposure to clinical dentistry is quite varied and very unique. They are able to minimally assist at the chair (clinically) with the dental students and work in the dental laboratories at the dental school and hospital dentistry clinic alongside experienced dental technicians. A broad exposure to general dentistry, basic prosthodontics, periodontics, and geriatric dentistry is provided. Additionally, at the maxillofacial prosthodontic clinic in the hospital, the students are also exposed to patient cases involving such complex clinical challenges as craniofacial defects, facial trauma, extraoral prosthetics, obturators, extensive implant restorations, and other atypical types of prosthetic rehabilitations.

Is This Model for Mutual Learning Just the Beginning?
It is opportunities such as this that provide the initial seed for the growth of better working relationships between dentists and dental technicians. Most likely, because of their face-to-face experiences in the program, these students will go beyond the typical doctor-technician relationship (ie, someone you occasionally speak to on the phone and write messages to on a prescription) to a meaningful and rewarding professional team relationship. This exposure will help lead to the establishment of lifelong professional friendships and will likely increase the desire to seek out continuous learning opportunities together. Clinical courses presented by technicians and dentists are generally well attended and lead to the expansion of team-based knowledge. This, in turn, benefits all of those in-volved, especially the patients.
I have asked, “Why aren’t all dental technology programs affiliated with dental schools?” Of course, there are multiple reasons, such as location, availability of schools, and so on. However, with the recent growth in new dental schools, the opportunities should increase for this kind of mutual training and team experience. In the authors’ opinion, there is a growing need, and it will continue for many years to come. As the technology base expands, it would be beneficial for schools to pool their resources. This would allow for the mutual use of advanced technology from digital impressions and treatment planning to the laboratory scanning/milling of prostheses. The list is expanding daily.
Dental schools need to bring their focus closer to home, thus discovering the great wealth of learning opportunities that will enhance their students’ educational learning objectives.


Dr. Schneider practices full time at the University of Iowa Hospitals and Clinics, Hospital Dentistry Institute, is the director of the division of maxillofacial prosthodontics, and is a professor. He earned his DDS from the University of Southern California and practiced general dentistry in Arizona for 5 years before earning his MS and certificate in prosthodontics from the University of Iowa in 1983. He is a Diplomate of the American Board of Prosthodontics, Fellow in the American College of Prosthodontists, past president and past executive director of the American Prosthodontic Society, and has more than 40 years’ experience as a dental technician. He is a Fellow in the International Team for Implantology, the Academy of Osseointegration, and the American Academy of Maxillofacial Prosthodontics. He lectures for the Kirkwood Community College Dental Technology program in Cedar Rapids, Iowa, and has been on the Kirkwood Dental Technology Advisory Committee for more than 20 years. He has been a Trustee of the National Board for Certification (NADL) in dental laboratory technology and been involved with NADL activities for many years. He can be reached at robert-schneider@uiowa.edu.

Disclosure: Dr. Schneider reports no disclosures.

Ms. Mitchell is currently the director of the dental technology program and is a professor at Kirkwood Community College in Cedar Rapids, Iowa. Ms. Mitchell earned her AAS from Kirkwood Community College in Dental Technology and earned a BS from the University of Iowa in health occupation education. She has been an educator at Kirkwood Community College for 23 years. Prior to this, she was the owner and operator of a Fixed Dental Laboratory in Kansas City, Mo, and in Iowa City, Iowa. She serves as the curriculum consultant for the Commission on Dental Accreditation and serves on the Accreditation Review Board. She served as a board member for the National Association of Dental Laboratories (NADL) as the educator representative from 2008 until 2012. She is also an active member of the Iowa Dental Laboratory Association and has been serving as the immediate past president since 2012. She was awarded Educator of the Year by the NADL in January of 2013. In September of 2012, she was chosen by Dental Products Report as one of the “Top 25 Women in Dentistry.” She can be reached at (319) 398-5400 or at betty.mitchell@kirkwood.edu.

Disclosure: Ms. Mitchell reports no disclosures.



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