COMMUNICATION Do dentists communicate with dental well technicians?

dental degree programme. Its key principles were: • That dental students have signifi cant and appropriate opportunities to work and train together with DCPs • That they understand the principles and techniques that allow them to act as the Are dentists sufficiently ccording to the GDC leader of the dental team ‘good dental care is deliv- • That they communicate effectively with the equipped to ered by a dental team’,2 a dental technician so that indirect restorations communicate effectively team which communicates and fi xed and removable prostheses can Aeffectively and shares its be constructed with dental laboratories knowledge and skills with • That students should have a suffi cient under- other team members. Dental laboratories are standing of the clinical preparation and – and do they? Andrzej ideally placed to comment on effective com- laboratory processes so that they can appro- munication among the dental team, so Chief priately evaluate their own clinical work and Juszczyk, Robert Clark Dental Technical Instructor Andrzej Juszczyk, the work provided to and received from the and David Radford from Professor Robert Clark and Senior Lecturer dental technician. David Radford decided to investigate atti- King’s College London tudes and communication between dentist and However, dental undergraduate education in dental technician from the technician’s per- most UK dental schools is delivered independ- Dental Institute sought to spective. They invited 803 dental laboratories ently to training programmes for DCPs, even find out. to complete a postal survey covering dental/ though many of the programmes are taught in lab communication and the dentist’s under- the same establishment, within close proximity Adapted from a BDJ article.1 standing of technical procedures. This article to each other. describes their fi ndings. Technician education Learning to communicate Dental technician education is generally taught In Developing the dental team3 the GDC said in specially equipped colleges not affi liated to that dental care professionals’ (DCPs’) educa- the university dental schools. Student dental tion and training should require students to technicians take a foundation degree which understand the importance of communication covers the theoretical aspects and basic practical with other members of the dental team. In the dental technology. Practical experience is gained earlier document The fi rst fi ve years4 (second in work placement laboratories where stu- edition) the GDC laid out the requirements for dents produce appliances for patient treatments the content and delivery of the undergraduate with minimal contact with clinics or dentists.

32 vital www.nature.com/vital COMMUNICATION

Currently there seems to be little provision to were laboratory owners and 13% were 78% said that it was encouraged and 87% integrate education with dental undergraduates. employed technicians. confi rmed that their suggestions were acted The laboratories divided themselves into: on (Fig. 2). However, there was a degree of Understanding roles 42% specialist crown contradiction with a signifi cant minority (39%) Up until quite recently undergraduate dental and bridge saying that they were expected to just get on students produced the technical work for a laboratories; with it. Sixty-two percent had received blank number of their own patient treatments. How- 31% special- prescriptions but the majority (64%) would ever, the requirement of The Medical Devices ist removable seek guidance from the dentist before produc- Directive (MDD)5 for custom made dental prosthesis ing any appliance. devices to be manufac- laboratories; tured by suitably qualifi ed 37% general Newly qualified dentists personnel, regis- dental laborato- Respondents were asked how well they thought tered with the ries. Nine percent newly qualifi ed dentists (1-3 years qualifi ed) identifi ed themselves communicated with them, on a rising scale of competent as orthodontic labs. Sixteen percent of techni- ‘poor’ (0) to ‘very good’ (5). Over 50% gave a authority, has been interpreted cians were attached to dental practices and 82% score of 3 and above. However, only 8% had in a way which prevents this. were working in remote dental laboratories. very good communication and 44% gave scores Therefore, dental students send Six percent acknowledged doing solely NHS of 2 and below. Respondents were also asked if their technical work to dental work; 21% solely private work and 61% - the communication with newly qualifi ed dentists laboratories, exactly mirroring much larger percentage – a mixture of NHS was worse or better than with established dental the practice followed by qualifi ed and private work. practitioners (qualifi ed for over fi ve years) on dentists. This process is consequently a rising scale from ‘worse’ (0) to ‘better’ (5). a necessary part of dental students’ learning Communication Fifty-percent of respondents gave a score of 3 experience. One study stated that ‘it is essential Most commonly, 87% of technicians commu- and above; 50% with a score of 2 and below that the dentist and the dental technician work nicated directly with the clinician conducting but only 5% gave a maximum score. Only together effectively as a team. Each should the treatment; 6% communicated via the lab 2% of newly qualifi ed dentists were scored as have a sound understanding of the role of the manager and 9% with a practice manager. Sev- having a very good understanding of dental other so that they can collaborate in an enty-nine percent communicated by telephone; technical procedures. effective fashion’.6 46% by laboratory prescription card and 35% Developments in dental undergraduate by personal visit. Ten percent of technicians Individual views education in the UK have seen a signifi cant used email and other methods including fax Fifty-four percent of dental technicians working decrease in the amount of hands-on dental and text messages. These results are shown in in a commercial laboratory did feel an integral technology. Students spend less time carrying Figure 1. Ninety-two percent of respondents part of the dental team, and provided positive out technical tasks and more time being told said their communication was welcomed; comments such as: how to. If future dental education provides a reduced laboratory element for dentists then it Fig. 1 Percentage of respondents using different methods is critical for the dental profession to create and of communication maintain relations with dental technologists. The views and attitudes of dental technicians 100 are directly relevant as they are stakeholders in the provision of dental care.

The survey 80 A postal questionnaire was compiled covering areas including registration of dental techni- cians and type of laboratory. Respondents were 60 asked to gauge the effectiveness of communi- cation and the understanding that their clients had of technical procedures. The questionnaire with a covering letter was sent to the 803 dental 40 laboratories that make up the UK Dental Labo-

ratories Association database. of responses Percentage 20 The results Forty percent of the laboratories responded to the survey. Fifty-two percent of respondents were registered with the GDC as of the end of 0 January 2008. The remaining 48% needed to card Email Other register before July 2008 in order to continue Via lab clinician manager manager practising dental technology legally within Prescription Directly with Via practice the UK. Eighty-four percent of respondents By telephone Personal visit www.nature.com/vital vital 33 COMMUNICATION

Fig. 2 Status of and response to communication cards to record what has been agreed offers a permanent, signed and traceable record of the 100 patient’s prescription as well as a method of Yes auditing work being carried out. The use of a No telephone in isolation without laboratory cards may lead to a breakdown in communication or 80 even a degree of abuse. Parts of the survey were very positive with a large majority saying that their communication was welcomed, encour- 60 aged and that their suggestions were acted on. However, when assessing how effective dentists were at communicating technical instructions the dental technician’s opinions 40 changed markedly. Not all of the returned questionnaires car-

Percentage of responses Percentage ried comments, however, there were in excess 20 of 156 that did. The comments ranged from very laconic, less than ten words, to an expan- sive 500 words; from enthusiastic and positive, 0 to depressingly negative and even paranoid. The majority gave a negative view of the dentist- laboratory interaction with the most common cards theme being that the laboratory is undervalued on with it welcomed You just get and a lack of dentist recognition of the labora- encouraged Clinician acts on suggestion tory’s knowledge, experience and skill. Is communication Is communication Blank prescription Conclusion • ‘As time moves on, I feel that dentists value will be the only members of the dental team Within the limits of this work reported in the dental technicians more and as the range with educational backgrounds in all facets of British Dental Journal1 and based on the views of available products expands we need to both clinical and technical skills.’ of responding dental technicians, it can be con- know more to be able to give advice. Newly • ‘Do any newly qualifi ed dentists visit a cluded that the aims of the GDC as expressed qualifi ed surgeons are far more aware of commercial laboratory as part of the year of in the second edition of The fi rst fi ve years have newer products for them and the patients.’ VT? Perhaps they should.’ not been met with regard to: • ‘Things are improving. I feel like the status • Effective communication between dentist of the dental technician has risen but still has and dental technician some way to go. All surgeries carry out staff • Newly qualifi ed dentists do not have an training meetings now. Maybe the dental lab ‘Good communication appropriate understanding of dental should be invited bi-monthly.’ technical techniques betweenb clinicianli i ian • Dental schools do not suffi ciently Comments on communication included: prepare dental undergraduate students to • ‘Good communication between clinician communicate with the dental laboratory. and dental technician is vital if a good h i i end result is to be achieved. This must and dental technician 1.1 Juszczyk A, Clark R K F, Radford D R. UK continue to be taught and reinforced to dental laboratory technicians’ views on the undergraduate dentists.’ isi vitall ffor a goodd effi cacy and teaching of clinical-laboratory • ‘All of my clients welcome communication communication. Br Dent J advance online and try to include me. This has improved ’ publication 15 May 2009 (doi:10.1038/ over the years.’ end result.’l sj.bdj.2009.434). 2. General Dental Council. The principles of However, other respondents commented that: dental team working.2006. • ‘The newly qualifi ed dental graduates appear An unquestionable need 3. General Dental Council. Developing the to have little or no knowledge of even the The need for effective communication between dental team. 2004. most basic laboratory procedures. The last dentist and dental technician seems unques- 4. General Dental Council. The fi rst fi ve years fi ve years have seen a noticeable decline. They tionable. This is made even more important – a framework for undergraduate dental are happy and willing to communicate, but by the development of new and exciting tech- education, 2nd ed. 2002. that is often because they want guidance.’ niques and materials for patient treatment and 5. The Medical Devices Directive. www.mhra. • ‘Much of technical dentistry is too complex appliance construction. The communication gov.uk. 2008. for newly qualifi ed practitioners to effectively referred to in this questionnaire is when 6. Davenport J C, Basker R M, Heath J R, Ralph team lead.’ further information is required by the dental J P et al. Communication between the dentist • ‘In the future the so caller team leaders will technician, after the initial use of a patient and the dental technician. Br Dent J 2000; probably be clinical dental technicians as they prescription form. The use of prescription 189: 471-474.

34 vital www.nature.com/vital