EDUCATION dental auxiliaries Dental technician education and training — a survey P. A. Barrett,1 and W. M. Murphy,2

the results refers to these 12 respondents. As the Dental Auxiliaries Review Group report continues in the Response to some questions varied from consultation stage, the needs to keep up-to-date on all 100% because of multi-response or non- aspects of auxiliary career developments. Dental technician response. The material was sufficiently education and training has changed radically during the past small to be hand-sorted. 25 years as shown by three surveys — the latest carried out Results during 1998 and reported in this paper. As leader of the dental All colleges which responded provided den- team, the dentist needs to be aware of these changes in order to tal technician training. This was in contrast make an informed contribution to the debate. with previous surveys, particularly in 1984, when there was no up-to-date register and questionnaires were sent to colleges which In The first five years,1 the role of the den- 25 years with particular emphasis on had ceased to offer this course. All colleges tist as the leader of a team of auxiliaries removable prosthodontics. employed full-time qualified dental techni- which includes the dental technician is cians as lecturers in dental technology, 37 in emphasised. This concept is not new and Methods total (Table 1). The numbers of full-time has been developed in detail in the A postal questionnaire with a total of 22 lecturers in each college varied from one to Nuffield Foundation report, Education questions was formulated in two sections. seven, and were distributed as follows: one and training of personnel auxiliary to den- The first section referred to staffing and college — seven lecturers, two colleges — six tistry.2 All are aware of the impor- courses offered, and the second to lecturers, two colleges — three lecturers, five tance of the dental technician in oral prosthodontic materials and equipment. colleges — two lecturers, and two colleges rehabilitation. But for the busy dentist, The questions and format followed that of — one lecturer. All colleges employed part- interest in his technician may be limited the previous two surveys. Where appro- time lecturers, 31 in total (6.8 whole-time to the quality assessment of a piece of lab- priate, questions were updated to take into equivalents) who taught from 2 to 11 ses- oratory work for his patient carried out by account new materials and techniques. sions per week. A direct comparison that technician. Regardless of its impor- The questionnaire was posted to heads between staffing in the three surveys is not tance, this is only one aspect of the techni- of schools of dental technology in all 13 possible because of differences in the num- cian’s contribution to oral health. colleges of higher education in the UK ber of colleges. However, there appears to be In a review of prosthetic technology in which offered courses in dental technician a trend toward full-time staffing since the the undergraduate curriculum, Murphy education and training, the names and first survey in 1973. submitted evidence that the dentist was addresses being supplied by the Associa- In all three surveys nearly 70% of col- not carrying out duties expected of a leader tion of Teachers of Dental Technology leges employed visiting lecturers to and that the technician believed that the (fig. 1). Replies were received from 12 col- teach specialist subjects (not included in dentist had little interest in his education leges (92% response) and the baseline for Table 1). Clinical subjects were normally and training.3 Recently, personal commu- taught by local NHS consultants or GDPs, nication with dental technicians suggests and other subjects such as anatomy, phys- that this situation has not changed. In brief iology and statistics, were taught by uni- However, dental technology has G Within the past 6 years, three versity staff when available. 1,2,9 changed, and is continuing to change as reports have identified the most At the time of this survey (Spring 1998), can be seen in a comparison of three sur- cost-effective way of improving and a total of 991 dental trainees had registered 4 delivering oral healthcare veys, the first in 1973, the second 11 G for courses. This was a considerable 5 All reports agree that in the future, years later, and the third carried out in high quality will be change from 1973 (1,288 trainees) and 1998 and reported in this paper. The delivered by a team of dental 1984 (1,638 trainees). Full-time education methodology was the same in all three auxiliaries led by the dentist and training was offered by 92% of col- and this survey gives an indication of G The dentist must be conversant with leges compared with 24% in 1973 and developments in education and training all reports and developments in the 37% in 1984. All colleges offered part-time of dental technicians during a period of education and training of all and evening courses. Thirty-three per cent auxiliaries of colleges provided block courses com- G 1Senior Chief Dental Technologist, University Dental Dentists should make a constructive pared with 22% in 1984. No colleges Hospital NHS Trust 2Senior Lecturer, , contribution to the current debate on offered City and Guild courses — a major Heath Park, Cardiff CF4 4XY the consultation paper Professionals change from previous surveys (Table 2). REFEREED PAPER complementary to dentistry9 Received 19.05.98; accepted 17.11.98 In contrast (Table 3), all colleges pro- © British Dental Journal 1999; 186: 85–88 vided Business and Technology Education

BRITISH DENTAL JOURNAL, VOLUME 186, NO. 2, JANUARY 23 1999 85 EDUCATION dental auxiliaries

Council (BTEC) courses at Ordinary National Certificate and Diploma levels (ONC/OND). In addition, six colleges offered Higher National Certificate and Diploma levels (HNC/HND). Scottish Vocational Education Council courses (SCOTVEC) are included under the head- ing BTEC. The educational requirements for entry to BTEC courses were broadly the same as in the 1984 report apart from two colleges which asked for five GCSE subjects at grade C minimum. Eleven colleges indi- cated that either ONC or OND were mandatory for entry to HNC or HND courses. Only one college accepted City and Guilds qualifications as an alternative. Two colleges offered degree courses with entrance requirements of two A-level subjects at grades C/C in one college and grades C/D in another. Fig. 1 Distribution of colleges of higher education offering courses in dental technician All respondents emphasised that den- education and training in the UK. The uneven distribution of colleges is evident, tal technician training was incomplete particularly the scarcity in the south of England without exposure of the trainee to clini- cal dentistry. This exposure was pro- ment, splitting the second and third year All colleges taught the use of the simple vided by placements in various clinical of a full-time course. Colleges appear to hinge articulator and only one did not environments. Some trainees gained a have adapted their placements to avail of teach the use of either the average value or wide range of experiences in more than local resources. the semi-adjustable articulator. Forty-two one clinical institution. Eleven colleges per cent gave instruction in the function- had placements in undergraduate dental Prosthodontic education and training ing of the fully-adjustable articulator. schools, ten in NHS or commercial den- The three most recommended text- Acrylic resin teeth were used by all tal laboratories and one in a general den- books were: Notes on dental materials by colleges, the same usage as in 1984. In tal practitioner laboratory. These E. C. Combe, Dental technology and contrast, only 8% used porcelain com- placements took a wide range of formats, materials by H. J. Wilson, and Anderson’s pared with 17% in 1984 and 50% in the commonest being either 1 day per Applied dental materials by J. F. McCabe. 1973. Eleven brands of acrylic teeth and week or 16/17 week blocks. One respon- A further 29 titles, covering all aspects of five brands of acrylic denture base dent reported a 1-year industrial place- dentistry, were also reported. materials were used.

Table 1 Numbers of lecturers of dental technology in UK colleges of higher education 1973, 1984, 1998

Full-time Part-time

Year 1973 1984 1998 1973 1984 1998

Number of 21 18 12 21 18 12 colleges

Total number 23 51 37 63 35 31 of lecturers in all colleges

Variation in from 0 to 8 from 0 to 11 from 1 to 7 from 0 to 9 from 0 to 8 from 1 to 8 numbers of lecturers between colleges

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Table 2 Percentage of UK colleges of higher education which offered City and Guilds long way toward resolving this criticism. courses at three levels, intermediate, final and advanced. Advanced courses were A number of respondents recommended divided into general, maxillofacial, orthodontics, and and . None of the a similar system for technicians, that is, colleges offered City and Guilds courses in 1998. the registrable qualification for all techni- Year Intermediate Final Advanced Advanced Advanced Advanced cians should be BTEC at OND level, fol- general maxillofacial orthodontics crown and bridge lowed by a technician vocational training programme which would be organised on 1973 95 95 52 24 29 48 a UK basis and would be mandatory for 1984 50 78 50 11 56 56 1998 – – – – – – all technicians before being allowed to offer their services independently. There was widespread approval of Table 3 Percentage of UK colleges of higher education which offered Business and Technology Education Council (BTEC) and degree courses 1973, 1984, 1998. In 1998, degree courses and the hope was all colleges offered BTEC courses at Ordinary National Certificate (ONC) and Ordinary expressed that at some time in the future, National Diploma (OND) levels, six colleges at Higher National Certificate (HNC) and the degree would be the registrable quali- Higher National Diploma (HND) levels and two at degree level fication. The expansion of postgraduate BTEC courses Degree courses courses in more complex aspects of dental

Year ONC OND HNC HND technology was also supported. Respondents were concerned about alternative systems of training such as 1973 – – – – – 1984 39 83 – – – General National Vocational Qualifica- 1998 100 100 50 50 17 (2 colleges) tions (GNVQs) and occupational stan- dard groups which might have a divisive effect and lead to two classes of dental Not surprisingly, the construction of improved format based on European technician. customised impression trays in metal Union Regulations and Medical Device Statutory registration was given whole- alloy was no longer taught even as a Directives. hearted approval but there was some technique exercise. The use of light anxiety about the body under whose cured materials had overtaken all except General comments by respondents aegis it would take place. Technicians cold cured acrylic resin (Table 4). The Funding of courses was considered to be a recognised the role of the dentist as leader use of alloys for cast partial major issue and the majority believed that of the dental team but they wanted some showed a clear trend over the three sur- other sectors of education were better degree of autonomy. The eventual resolu- veys (Table 5) in that all colleges used resourced. Respondents were aware that tion to this matter would influence cobalt-chromium alloy and one college recent graduate technicians were criti- recruitment and career structures. used both this and student’s alloy. cised by the dental technology industry All respondents regretted the poor Developments in dentistry since the for having a great deal of theoretical standard of communication between previous survey necessitated the inclu- knowledge and inadequate practical the dentist and technician. They empha- sion of two additional questions, one on skills. This criticism is well known to clin- sised the importance of this subject and implantology and the other on veneers. ical dental teachers in relation to recent most devoted a clearly defined part of Fifty per cent of colleges provided a graduates from dental schools, and the the syllabus to inter-professional com- course on implantology, half of these introduction of vocational training dur- munication skills. The development of having both theoretical and practical ing the 2 years after graduation has gone a multi-disciplinary teaching was strongly components. The syllabus in 58% of colleges included modules on veneers Table 4 Materials generally used for customised impression and more than three-quarters of these trays (%). Metallic trays were no longer used in 1998, light-cured were practical in content. materials had superseded all except cold cured acrylic resin The final question was on inter-pro- 1973 1984 1998 fessional communication skills. All col- leges taught this subject with nearly half Acrylic cold cured 67 72 92 favouring a case study format and two Light cured – – 83 colleges had a special modular unit of Shellac 81 67 67 study. A common approach was to Acrylic heat cured 48 42 67 analyse laboratory cards provided by Thermo-forming 15 40 50 Metallic 26 6 0 trainees and to design new cards with

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Table 5 Materials generally used for technician training, so that the decrease in devices for patients, and these records metallic removable partial dentures (%) in trainees may not have been accompanied must be retained for at least 5 years. A writ- 1998, all colleges had changed to Co-Cr alloy, and one (8%) also used student’s by an equivalent decrease in qualified ten prescription from a dentist to a techni- technique alloy technicians.3 This is being closely moni- cian may be included in these directives. tored by The Dental Technician Education Since the publication of the Nuffield Year and Training Advisory Board (DTETAB), report, dental technicians have been dis- Materials 1973 1984 1998 whose own survey between 1982 and 1987 cussing its recommendations, and the showed a similar trend of decreasing num- effect of implementing them on their Student’s alloy 86 39 8 bers with a shift from part-time to full- careers. As the Dental Auxiliaries Review time education. It is interesting to Group report9 goes out to consultation, Co-Cr 10 72 100 compare developments in technician edu- discussions will continue and the part cation in Poland6 and The Netherlands.7 played by the dental technician in deliver- At the present time, two colleges offer ing oral healthcare will be clarified. supported, with a preference for closer degree courses in dental technology and The dental technician of the future may links with undergraduate dental schools most of the other respondents in this survey be a university graduate with postgraduate and, ideally, some form of integration into indicated that they were actively engaged in qualifications, seeking due recognition for the curriculum, a system already being developing similar courses. There was also his level of expertise and registered with an implemented in the School of Clinical widespread interest in developing addi- appropriate authority as a professional Dentistry, Sheffield. This was seen as an tional postgraduate courses in specialised complementary to dentistry. essential way forward toward a better subjects. One undergraduate dental school If the dentist is to maintain credibility understanding between the dentist and recently started a degree course in dental as leader of the dental team, he must be technician. technology, independent of a college of fur- familiar with the latest developments in ther education. The contentious question all aspects of education and training of all Discussion of finding a balance between theoretical auxiliaries, so that he can coordinate the A comparison between the three surveys and practical aspects of the course might be highest level of care for his patients. showed the profound changes that have resolved by a vocational training period taken place in dental technician education after graduation. The authors acknowledge with gratitude the cooperation of all those who responded, and to The and training during the past 25 years. The A common theme running through the Association of Teachers in Dental Technology for number of centres which provided train- three surveys was the lack of communica- supplying the addresses of colleges. ing increased between the first and second tion between the dentist and technician. As surveys and decreased to the present num- described in the Nuffield report, this was 1 The first five years. The undergraduate dental ber of 13. The cause for this reduction may mainly because of the switch by the dentist curriculum. London: General Dental Council, 1997. be because of rationalisation, as financial from on-the-premises technical support to 2 Education and training of personnel auxiliary to viability is a major factor in maintaining large commercial laboratories. A serious dentistry. Oxford: The Nuffield Foundation, 1993. courses. Dental technician courses are commitment to improving technician 3 Murphy W M. Prosthetic Technology in the Undergraduate Curriculum. Br Dent J 1978; expensive to run as they require a large communication was evident in the latest 145: 139-141. capital investment in equipment and survey but doubt was expressed by respon- 4 Murphy W M, Huggett R. Dental technician materials and staff/student ratios must be dents about the dentists’ willingness to training in colleges and faculties of technology high to maintain close supervision. change. The view was put forward that the and further education in UK — a survey. Dent Tech 1973; 26: 107-110. If this is the explanation for the reduc- best hope for better communication was 5 Murphy W M, Huggett R. Dental technician tion in the number of centres, it is not sur- the development of closer links with training in colleges and faculties of technology prising that there is not an even undergraduate dental schools with com- and further education in UK — a survey. Dent distribution of training centres particu- mon core programmes for dental under- Tech 1984; 37:5-10. 6 Thomas G D. Teaching and training dental larly as there is no UK strategy on dental graduates and trainee technicians — a technicians in Poland. J Br Inst Surg Technol technician education. The paucity of cen- similar view expressed in the USA.8 1996; 6: 28-34. tres in the south of England is particularly A more powerful impetus for change is 7 Skinner C J. Comparison between the training and education of dental technicians in England noticeable (fig. 1). at the discussion stage in the form of Euro- and Wales and the Netherlands. J Br Inst Surg Although the number of trainee techni- pean Union Medical Devices Directives. Technol 1995; 5: 3-7. cians has dropped during the 25 years of These are being developed at the present 8 Christensen G J. A Needed remarriage — these surveys, there does not appear to be time by the Medical Devices Agency of the dentists and dental technicians. J Am Dent Assoc 1995; 126: 115-116. undue concern about a shortage of trained Department of Health. Part of these direc- 9 Professionals complementary to dentistry. A technicians in the industry. This may be tives will make it a legal requirement to fol- consultation paper. Report of the GDC Dental explained by the high level of wastage in low defined guidelines in prescribing Auxiliaries Review Group, May 1998.

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