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For a number of years, dentistry and the dental laboratory technology profession have been influenced by rapidly changing factors such as emerging technologies, new materials and equipment, evolving economic conditions, shifts in demographics, new laws and regulations, innovative educational modalities, new healthcare and business models, mergers, acquisitions, consolidations, emerging disciplines, and specialties, to mention a few. Consequently, both dentistry and dental laboratory technology were faced with new responsibilities and liabilities resulting from emergent regulations elevating the knowledge and skills required to operate a dental office and a dental laboratory. States are enacting new regulations designed to safeguard the public and the workforce, including laboratory registration, materials origin and content disclosure, licensing, zoning, taxation, other changes in state dental practice acts, tariffs, HIPAA laws, and regulations from the US Food and Drug Administration (FDA), Occupational Safety and Health Administration (OSHA), and Centers for Disease Control and Prevention (CDC). Navigating between the old and new rules and regulations can be a daunting task. The already complex information required from all dental team members, knowledge shared between dentists and technicians, technology-driven dentistry, technicians becoming the new breed of digital workers, and the current pandemic crisis necessitate a far more educated and skilled workforce not only to fulfill the needs of dentistry, but also to successfully operate a competitive dental laboratory business that can survive modern-day global markets and rebuild the profession after the crisis is over. Dentistry has always been accepted as a highly skilled occupation requiring years of education; however, this is not the case with the dental laboratory technology profession.
The 1971 document Position Classification Standard for Dental Laboratory Aid and Technician Series, GS-0683, issued by the U.S. Office of Personnel Management (OMP) to facilitate a federal pay scale, included dental laboratory technology occupational classification comprising supervisory and nonsupervisory positions involving "technical work in the fabrication and repair of dental prosthetic appliances based on prescription from a dentist, and required technical knowledge of dental anatomy and skill in the use of dental laboratory materials and equipment." The factors providing the basis for this classification were the nature of the assignment (including duties, knowledge, and skills) and the level of the responsibility. This classification resulted in three categories of Dental Technology Aid and six categories of Dental Laboratory Technician:1
• Dental Laboratory Aid, GS-0683-01: Requires no previous experience; receives specific guidance and instruction in all phases of assigned tasks.
• Dental Laboratory Aid, GS-0683-02: Basic knowledge of laboratory equipment and materials; works under the supervision of a dental laboratory technician or laboratory supervisor.
• Dental Laboratory Aid, GS-0683-03:Receives intensive training in selected methods, procedures, and techniques; works under close supervision.
• Dental Laboratory Technician, GS-0683-04: Expected to carry out routine, standardized tasks with minimal supervision.
• Dental Laboratory Technician, GS-0683-05: Requires additional knowledge and added technical complexity of the procedures and techniques employed; receives training and instruction in methods, procedures, and techniques; the supervisor explains training assignments in detail.
• Dental Laboratory Technician, GS-0683-06: Receives specific training and instruction, and receives training in methods and techniques that are typical of the next higher-grade level; carries out assignments under general supervision; the supervisor explains training assignments in detail.
• Dental Laboratory Technician, GS-0683-07: Independently performs the full range of functions required to construct fixed or removable partial dentures or complete dentures for cases that do not involve acute abnormalities of the mouth; must have a thorough knowledge of dental laboratory materials, and skill in their use; must be able to visualize spatial, anatomical, functional, and esthetic relationships at all stages of the construction of the prosthesis, to produce a finished product that meets the dentist's requirements; responsible for preserving the horizontal and vertical bite relationships established by the dentist, and for matching prescribed tooth colors; receives further training in such specialized techniques as ceramic work or the construction of special dental appliances such as splints or obturators; training assignments are accompanied by detailed instructions; the supervisor provides instruction in those features of oral anatomy that are important considerations in the design and construction of dental splints or obturators; in some instances, this includes chairside instruction as the dentist points out and explains the anatomical and functional requirements of the appliance to be constructed.
• Dental Laboratory Technician, GS-0683-08: Must apply a thorough technical knowledge of both normal and abnormal oral anatomy and dentition as these affect the design, fabrication, function, and esthetics of the dental prosthesis being constructed; must be able to visualize the relationships of the parts to the whole at each step in the construction process, and remain constantly alert to those elements of design and construction that are essential to the fit and function of the finished appliance; while the supervisor is available for consultation should unusual problems arise, dental laboratory technicians at this grade level are expected to resolve the majority of problems independently.
• Dental Laboratory Technician, GS-683-09: Must have developed and demonstrated a degree of expertness in all aspects of the work that results in their being consulted by dentists regarding difficult design and construction problems, and in the dentist's acceptance of the value and validity of their suggestions and recommendations; is being assigned unusually novel and intricate dental prostheses, and relied upon to carry out all aspects of their fabrication independently; work under the supervision of oral surgeons, prosthodontists, or other dentists who make work assignments and discuss the requirements of the case, but who rely on the dental laboratory technician to be ingenious and creative in resolving the difficult design and construction problems involved; their advice is sought and given weight in planning and carrying out clinical or surgical procedures.
The 1971 OMP document was the most comprehensive document classifying the dental laboratory technician occupation to date. However, the classification changed when the 2010 Standard Occupational Classification (SOC) was updated by the Bureau of Labor Statistics (BLS), and the Dictionary of Occupational Titles was transferred to the Occupational Information Network (O*NET). It was then that the dental laboratory technician standing was altered and a high school diploma became the minimum requirement to enter the profession. Education for dental technicians was always voluntary as dentists and dental laboratory owners opposed educated technicians for fear of higher compensations, benefits, and additional regulations. The profession's appeal has suffered: A 2013 Yahoo! Education website reported that dental laboratory technician was the third-worst career choice with projected growth of 1%.2
Despite the efforts of countless advocates, the minimum entry to the dental technology profession remains largely unregulated at the state level. Burney M. Croll, DDS, a longtime supporter of the dentistry and dental laboratory professions, says, "I have advocated for dental technician education, certification, and registration nationally and within New York state over a long time, meeting stiff resistance from upstate New York legislative representatives as well as the New York State Dental Association, who are fierce advocates for market-driven economy over application of principles and standards. Similar resistance is apparent in most state dental practice acts. The expanding role of the CDT now goes beyond having a deep understanding of the physiology, mechanical, and production principles that are required to make a prosthetic restoration integrate into an individual patient's situation. It goes beyond quality control. It now extends to the educator of dentists throughout their careers" (email communications, February 2020).
Another passionate advocate, Elizabeth Curran, CDT, RDT, a retired associate professor at A.T. Still University, Arizona School of Dentistry and Oral Health, continues to promote recognition for formal education for technicians; she is behind developing skill standards and bringing DAMAS laboratory certification to the United States. Curran believes dental technicians should be regulated, have a required 4-year degree, and form a governing body, which can be possible with a mandate for formal education and implementation of a national curriculum. Such change likely would require grandfathering everyone in the field, or updating the skills of incumbent workers and placing them in the applicable classification (email communication, March 2020).
The National Association of Dental Laboratories' (NADL's) position in regard to the new regulations is described in the Grandfather Clause/Grace Period for Compliance, which states: "If there is a demonstrated need for regulation of dental laboratories to protect the public health and welfare, it follows that all laboratories in existence when a regulatory bill is passed should be required to comply with the standards and regulations of the bill within a reasonable period of time."3 Last year, Washington state established a "CDT certification or equivalent" requirement that will be in place by 2025, making it the fourth state to implement certification regulation after Kentucky, South Carolina, and Texas. The most stringent educational requirement is in South Carolina, where the dental technician must have a Certificate to Perform Dental Technology that includes high school or general education development (GED); 2-year dental technology degree or 3-year on-the-job training; and certification via the CDT or South Carolina State Board and South Carolina laws and rules exam.4
Despite strong resistance in the past, a growing number of dental professionals now promote dental laboratory technology training, formal education, and certification to elevate the profession.
The obvious drawback of education and certification requirements is additional regulatory burden. Further, education may indicate a theoretical understanding but not a practical skill and does not automatically guarantee a job upon completion of a time-consuming and costly process. And employers would no longer have the option to hire and train uneducated and uncertified candidates.
However, the absence of formal education and certification has already contributed to a serious shortage of qualified dental technicians as previous generations exit the workforce. The lack of obligatory continuing education in most states allows existing workers to not update their skills, thus diminishing their value. In a presentation titled "Unskilled: Implications of the Bureau of Labor Statistics Reclassification of Dental Laboratory Technicians," Curran noted serious effects of the downgraded occupational classification on the following:2
• Education: Formal education is disappearing, and workplace training is becoming the means to learn dental technology
• Recruitment: More job changers and high school guidance counselors are not considering dental technology as a healthcare-related career option
• State funding: Lower or no economic incentives such as training grants for dental laboratory technology schools and employers
• Immigration: Retaining skilled technicians from other countries
Education and certification lead to better working conditions, higher earning potential, better career advancements, reduced need for on-the-job training, broader understanding of the profession, increased confidence, pride, and sense of accomplishment. They provide the opportunities to develop creative and critical thinking, troubleshoot, problem solve, stay informed of the latest trends, and credibly navigate and recover from crises such as the current COVID-19 pandemic. Educated employees help businesses produce superior products, develop efficiencies, and improve business models, resulting in increased profit margins. When these employees and businesses succeed, the entire profession thrives and gains notoriety.
136-Plus Years of BLS
To understand how the dental laboratory technology profession found itself at this juncture, the past and the crafting of its occupational classification should be examined.
The government entity overseeing occupational classifications in the US is the BLS. The agency was created in 1884 as part of the Department of Interior, and in 1888 it became an independent department, continuing for 15 years before being incorporated in 1903 into the Department of Commerce and Labor. In 1913, it was reassigned to the newly created Department of Labor (DOL), where it remains to this day.5 The agency employs approximately 2,500 economists, statisticians, data scientists, information technology specialists, researchers, administrative specialists, and many other professionals. The BLS maintains partnerships with state and territorial governments, coordinates with other federal statistical agencies, and contract with private vendors for data collection, information technology, and related services.6 At its helm is the Commissioner, who is nominated by the President, confirmed by the Senate, and serves a 4-year fixed term.7 The national office is located in Washington, DC, and eight regional information offices are spread across the country.7
The BLS provides statistical guidance and support for the data needs of the DOL and its agencies, and follows the DOL's mission "To foster, promote, and develop the welfare of the wage earners, job seekers, and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights." To aid in the public and private decision making, the BLS measures labor market activity, working conditions, price changes, and productivity in the US economy. To ensure that presented data and analyses are objective and free of biased influence, the BLS conducts its work independently and with confidentiality in mind.6 Today, all federal agencies that publish occupational data for statistical purposes are required to use the BLS' Standard Occupational Classification (SOC), and state and local government agencies are strongly encouraged to use this national system to promote a common language for categorizing and analyzing occupations.8
Over the years, different occupational classification systems emerged to establish clear, current, standardized, and organized occupational data for federal agencies to share. Since its inception, the SOC system developed by BLS has been updated many times. The earlier SOC classifications emphasized the industry in which one worked, while the more recent ones shifted the focus to the characteristics of the work performed.
The beginnings of occupational data collection in the US reach back to the 1850 Census of Population, which established the first classification of 322 occupations and included dentists, lawyers, carpenters, and others. As data continued to be collected into the 20th century, the complexity of the statistics increased due to a growing number of occupations creating an even greater need for a standard that would combine and classify all occupations.9 However, not until 1942 did more frequent data collection began with the monthly workforce survey when the US Employment Service needed occupational statistics and developed a Convertibility List of Occupations with Conversion Tables to serve as a bridge between its statistics and information from the 1940 Census of Population. In 1965, revisions to the census classification and publication of the third edition of the DOL's Dictionary of Occupational Titles encouraged the government to begin a comprehensive reexamination of occupational classification. Without a standard, however, analyzing and comparing similar data collected for different purposes was difficult. Thus, in 1977, the first SOC system was created to link different systems and include all occupations for which work was performed for pay or profit. The 1977 SOC was again revised and reissued in 1980, in time for the 1980 decennial census.10
Still, even after a 1980 revision, the original SOC system was not universally adopted and many agencies continued collecting occupational data using other systems.9 The occupational data and underlying classification structures became fragmented, incompatible, outdated, and lacking information on occupational skills that continued to develop. Despite assurances of maintaining historical continuity and updating the SOC on a regular basis, the lack of federal funding and the absence of a clear directive to enforce comparability allowed 15 years to pass before the validity and usefulness of the 1980 SOC was evaluated. In 1993, the BLS held an international conference to revise the SOC. Subsequently, the Office of Management and Budget (OMB), part of the Executive Office of the President, requested that federal agencies with occupational classification systems different from the SOC work together on SOC revisions. In 1994, the Standard Occupational Classification Revision Policy Committee (SOCPC) was established to spearhead the revisions that would meet the needs of the 21st century. The Committee was chaired by the BLS and the Bureau of Census with representatives from those two bureaus, the DOL's Employment and Training Administration, the Office of Personnel Management, the Defense Manpower Data Center, and ex officio the National Science Foundation, National Occupational Information Coordinating Committee, and Office of Management and Budget.9,10
The SOCPC initiated the notice in the Federal Registerto call for comments on the uses of occupational data, the purpose and scope of occupational classification, the principles underlying the 1980 SOC, conceptual options for the new SOC, and the SOC revision process. Based on the public comments, the new revision criteria were established to cover "all occupations in which work is performed for pay or profit, including work performed in family-operated enterprises by family members who are not directly compensated, excluding occupations unique to volunteers." The revised system was to reflect existing occupational structure in the US and to be flexible enough to integrate new occupations classified based on work performed, and required skills, education, training, or credentials. This time, the SOCPC followed practical methods with key classification principles focused on work performed with "skills-based considerations." The SOCPC then requested public participation in the next part of the process and formed six workgroups to build the revised SOC: 1) management, administrative, and clerical; 2) natural science, law, health, education, and arts; 3) sales and service; 4) construction, extraction, agricultural, and transportation; 5) mechanical and production; and 6) military. The workgroups invited experts from many areas to testify and provide written recommendations to develop a proposed structure plus a title, a definition, and a list of associated job titles. Each proposed occupation was thoroughly reviewed, defined, and accepted by SOCPC, and handed to another workgroup to discuss and recommend a hierarchy-a key characteristic of the 1998 SOC that became one of the more challenging aspects. In July 1997, the SOCPC published the new structure, and after considering more than 200 comments, a revised structure was submitted to the OMB and issued in August l998.9 Ultimately, the final 1998 SOC was distributed in a two-volume manual including more than 30,000 job titles commonly used by individuals and establishments.11 This became recognized as the 2000 SOC. In 2006, the OMB and SOCPC started new revisions by publishing notices in the Federal Registerto solicit public comments, questions, and suggestions for the 2010 SOC. The notices resulted in hundreds of comments that provided bases for changes to codes, titles, and underlying classification principles to finalize the revision process for statistical agencies to start using the new system in 2010. Although the 2010 SOC retained the 2000 SOC structure, its major and minor changes increased clarity, corrected errors, and accounted for significant updates in technology, healthcare, human resource occupations, and the nature and organization of work in the US economy. These revisions involved editing (grammatical edits, improvements to definitions, descriptions of performed work), content (addition or deletion of occupational titles), titles, and codes (related to the analysis of the types of skills needed to perform the work).9
The last and final revision of the SOC system to date took place in 2018 and is considered to be the most current federal statistical standard. The 2018 SOC is used by more than 16 federal agencies and 100 other federal programs to classify workers into occupational categories to collect, calculate, and disseminate data.12 Implementation of the 2018 SOC was similar to that of the 2010 SOC.13 It began with the first Federal Registernotice in May 2014, followed by the SOCPC reviewing public input and federal agency input, and conducting its research to develop recommendations for OMB. After the second Federal Registernotice requesting public comments on SOCPC recommendations in July 2016, final recommendations were sent to OMB throughout 2016. In November 2017, the third Federal Registernotice announced the final 2018 SOC structure, occupation codes, and titles to be implemented by the federal statistical agencies at the beginning of 2018. The reference date of May 2021 reflects the full implementation of the 2018 SOC data.12 To facilitate historical comparisons, the BLS developed "crosswalks" showing the relationship between occupations listed in all SOC classifications.11
Revising the SOC is a multi-year process. The 2010 and 2018 revisions each took approximately 5 years to complete. Over the 43 years since the SOC was first introduced, it has remained a four-level hierarchy with the number of major occupation groups increasing from 21 in 1977 to 23 in 2010 and 2018, and the number of detailed occupations growing from 662 in 1977, to 840 in 2010 and 867 in 2018.12,14
SOC Revision Process
Balancing the need for continuity against the importance of staying current, the OMB and SOCPC expect the revisions to continue approximately every 10 years, with input from the public being a key component.9Therefore, the next SOC can be expected to take place in 2028. The OMB will likely publish an initial Federal Registernotice soliciting public comment around 2024, until which time no comments will be accepted regarding SOC changes. Those interested in submitting changes when the time comes can sign up for email notifications on the SOC website at bls.gov/soc (email communication, February 2020). The information that will be particularly important to the SOCPC will include the nature of work performed; accurate and updated existing SOC definitions and information; the difference between work performed and other detailed occupations, job titles, employment size and expected growth; types of employers, industry information, education, and training; licensing, tools and technologies used by workers; and professional or trade associations and unions.14 The OMB will publish three solicitations for public comment in the Federal Register. The first notice will solicit comments on any proposed changes to the Classification Principles, Coding Guidelines, and major occupation group structure, and request input on changes to existing occupations or the addition of new occupations. The second will ask for comments on the proposed SOC structure related to the list of revised occupation codes and titles. The third will issue the final SOC structure and summarize the comments received in response to the second notice.14
The SOC does not classify or identify workers using the term "professional" or other similar terms such as "skilled" or "unskilled." The SOC was created solely for statistical purposes and the classification structure is not intended to rank or group occupations by education, credentials, earnings, or any other similar user-defined indicator of status. However, government agencies or private users may define and use various terms to suit their purposes. For example, O*NET classifies occupations into five job zones, based on data concerning the levels of education, experience, and training needed for work in an occupation, ranging from "little or no" to "extensive" preparation.15 The Occupational Outlook Handbook, a BLS publication, was first published in 1948, with the last print edition offered in 2010/2011. Because then the handbook continues to be offered online and it includes information about the nature of work, working conditions, training and education, earnings, and job outlook for 568 occupations in 325 occupational profiles, covering approximately 80% of the jobs in today's economy. It is released biennially with a companion publication, the Career Guide to Industries, and is available on the BLS website.16,17 Ultimately, the SOC revisions helped to shape O*NET and the Occupational Outlook Handbook.
Dictionary of Occupational Titles and O*NET
The Dictionary of Occupational Titles was first published in 1938 and was updated periodically. It provided useful occupational information for 70 years before being replaced with the O*NET online database, which to this day remains controversial.18 The change started in the 1980s, when the DOL, instead of publishing a revised edition, waited until 1990 to create the Advisory Panel for the Dictionary of Occupational Titles, which in turn recommended against updating the resource. The Advisory Panel proposed developing O*NET to provide the most comprehensive online standard source of occupational information in the US, for use by a wide range of audiences, from individuals making career decisions, to public agencies and schools making training investment decisions, to employers making job structure and hiring decisions, to administration of federal programs.19 O*NET was developed in the 1990s under the sponsorship of the DOL/Employment and Training Administration, replacing the Dictionary of Occupational Titles, and can be easily accessed online today.20 Current O*NET-SOC 2019 structure has been revised based on the 2018 SOC and contains 1,016 occupational titles, 923 of which represent O*NET data-level occupations (Figure 1).21
Specific Vocational Preparation
The 1991 Dictionary of Occupational Titles revision included 12,000 occupational titles, referred to as DOT codes. Information for each was obtained by trained occupational analysts visiting each worksite, interviewing job incumbents, and observing them at work; it included a written description, aptitude rating, temperament requirements, interests, physical demands, job environments, specific vocational preparation (SVP), general educational development, and complexity.22 The SVP was a component of Worker Characteristics information defined as the amount of elapsed time required by a typical worker to learn the techniques, acquire the information, and develop the facility needed for average performance in a specific job-worker situation. Training may have been acquired in a school, work, military, institutional, or vocational environment. It did not include the orientation time required of a fully qualified worker to become accustomed to the special conditions of any new job. SVP included vocational education, apprenticeship training, in-plant training, on-the-job training, and essential experience in other jobs. The various levels of SVP were mutually exclusive and did not overlap.23,24The nine-point scale ranged from 1 (receiving a short demonstration only) to 9 (more than 10 years of specific preparation).22
O*NET Specific Vocational Preparation
Under the current O*NET model, numerous jobs would exceed the Dictionary of Occupational Titles SVP codes. When the National Center for O*Net Development was looking for the best way to connect occupations with people, it determined that the SVP is the best and simplest approach. However, O*Net used the SVP codes to fit the more than 11,000 Dictionary of Occupational Titles jobs into 1,122 O*NET occupational units (OU) and classified them into five Job Zones. When O*Net collapsed various jobs into occupational units, it averaged the SVP codes from the different jobs, but if the SVP of a specific occupational unit had a fractional amount, O*Net eliminated the fractional amount and retained the whole number only; eg, an average SVP 7.89 resulted in SVP 7. As a result, many jobs' SVPs were downgraded.25
Findings reported by Robert J. Harvey of Virginia Polytechnic Institute and State University raised serious concerns regarding the level of ratings quality, reliability, validity, and applied utility of the O*NET database because it did not seek to describe occupations in the traditional definition even though the occupation was the unit of analysis for the Dictionary of Occupational Titles and O*NET evolved from that. Further, O*NET developers stated that they "favored a dramatic decrease in the number of occupations to be detailed…and saw this position as consistent with the future direction of the American economy.… The contemporary workplace is becoming transformed. Global competition is increasing the pressure for high performance. Businesses are reorganizing to develop more flexible and adaptive workforce structures. Organizations are flattening. Midlevel managers are disappearing. Jobs are increasingly being performed by self-managed teams, with groups making decisions that were previously in management's domain." As a result, O*NET's five-category Job Zone system was designed to parallel the Dictionary of Occupational Titles' nine-point SVP ratings but actively ignored the full range of Dictionary-level diversity, causing misleading results in practice and substantial disagreement.
In 2010, the Committee on National Statistics, Division of Behavioral and Social Sciences and Education, National Research Council of the National Academies, recommended that the DOL direct research to improve the model, beginning with the skills and knowledge classifications; start a series of studies to develop occupational profiles at each hierarchical level of each classification; and establish and support an external advisory board composed of senior scientists to develop suggestions from its members, the department, the O*NET Center, the user advisory board, and other sources.22
Occupation Classification Changes
At the time of the transition to O*Net, the dental laboratory technician occupation became downgraded from an SVP 7 to an O*NET Job Zone 2 with SVP 4.0<6.0. SVP 1 and SVP 2 generally were considered unskilled, SVP 3 and SVP 4 semiskilled, and SVP 5 through SVP 9 skilled. The new O*NET Job Zone 2 required only high school education and occupation-specific training, more than 3 months and not more than 1 year, whereas the SVP 7 status had incorporated more than 2 years up to and including 4 years. Effectively, the re-classification has downgraded the dental laboratory technician profession by two slots2 (Table 1). A letter to Teri Morisi, Branch Chief Division of Occupational Outlook, Employment Projections Program, Bureau of Labor Statistics, provided by the NADL supports this claim (email communication, February 2020).
What followed was advocacy for reclassification for the dental laboratory technician occupation to at least Job Zone 3 (Table 2).
When comparing the 2000 SOC, 2010 SOC, and 2018 SOC classification revisions, no significant dental laboratory technician occupation differences exist. The profession is classified in Major Group 51-0000 (Production Occupations), Minor Group 51-9000 (Other Production Occupations), Broad Occupation 51-9080 (Dental and Ophthalmic Laboratory Technicians and Medical Appliance Technicians), and Detailed Occupation 51-9081 (Dental Laboratory Technicians).
The Major Group for the dental laboratory technician occupation in all three classifications remained Major Group 51-0000 Production Occupations, Minor Group is 51-9000 - Other Production Occupations, Broad Occupation is 51-9080 - Dental and Ophthalmic Laboratory Technicians and Medical Appliance Technicians, and Detailed Occupation is 51-9081 - Dental Laboratory Technicians.
The current Occupational Outlook Handbook defines it as: "Dental laboratory technicians use traditional or digital impressions or molds of a patient's teeth to create crowns, bridges, dentures, and other dental appliances. They work closely with dentists, but have limited contact with patients. Dental laboratory technicians work with small hand tools, such as files and polishers. They work with many different materials, including wax, alloy, ceramic, plastic, and porcelain, to make prosthetic appliances. In some cases, technicians use computer programs or three-dimensional printers to create appliances or to get impressions sent from a dentist's office. Dental laboratory technicians can specialize in one or more of the following: orthodontic appliances, crowns and bridges, complete dentures, partial dentures, implants, or ceramics. Technicians may have different job titles, depending on their specialty. For example, technicians who make ceramic restorations such as veneers and bridges, are called dental ceramists." According to the handbook, dental laboratory technicians held close to 36,500 jobs in 2018, earning a median annual wage of $40,440. Because of demands from an aging population, employment growth for 2018 to 2028 was projected at 11%, which would be an increase of 3,900 jobs-much faster than the average for all occupations, and comparable to the 7% growth rate for dentists, which are listed as the first similar occupation.26
O*NET replicates the SOC in defining the dental laboratory technician occupation as "51-9081.00 Dental Laboratory Technicians - Construct and repair full or partial dentures or dental appliances" in Job Zone 2.27 It lists 43% of dental laboratory technician respondents as having a high school diploma or equivalent, and 39% have a post-secondary certificate or associate degree. Technology is frequently required in job postings for dental laboratory technicians. Similar to the Occupational Outlook Handbook, O*NET lists the 2018 median hourly wage at $19.44 and annual wage at $40,440, with much-faster-than-average projected growth at 11% and 5,100 job openings for 2018 to 2028.28
It is no surprise, then, that potential entrants turn away from pursuing the dental technology profession. Dental professionals across the world are baffled about why dental technicians in the US are not required to have formal education in dental technology fundamentals to fabricate dental prostheses for the public. In the 1970s, there were about 60 formal education programs for dental technology accredited by the Commission on Dental Accreditation (CODA); a decade ago, that number dropped to 20, and today only 14 programs offer training in all six dental technology specialties and a certificate, diploma, or degree (associate or bachelor).29,30 In 2018 and 2019 these remaining programs admitted 319 students and graduated 211. Meanwhile, 327 dental hygiene college-level programs enrolled 8,288 and graduated 7,377 students in 2018, and 66 dental schools with an applicant pool of 11,298 enrolled 6,250 and graduated 6,305. The number of dental technology graduates is nowhere near what is needed to serve the growing population of patients and dentists alike. Dental laboratory technology education is coming to a halt at a time when the BLS predicts 11% job growth, bringing an even higher demand for knowledgeable dental technicians.29,31
NADL and Classifications
The NADL continues to receive questions on how dental laboratory technicians are classified by the federal government and how the association is attempting to clear the common misconceptions relative to these classifications, according to NADL Executive Director Bennett Napier. No government agency, including the BLS, uses "skilled" or "unskilled" terminology or classifications. However, when the occupation was downgraded, the NADL made a substantial investment in research, correspondence, and work with allied organizations-the DOL, O*NET, and the OMB-pursuing a change from Job Zone 2 to Job Zone 3. These efforts generated some success; for example, O*NET has changed the way education data is reflected and has added an education category that now shows the percent of dental laboratory technicians who earned a "post-secondary certificate," which currently is at 43% high school diploma or equivalent, 22% post-secondary certificate, and 17% associate's degree.28
Many Job Zone 3 occupations require licensure and/or have a formal education requirement. For example, dental hygienists are required to be licensed, whereas dental laboratory technicians are not. The key points used by the NADL to reevaluate the classification of dental technicians under the O*NET system from Job Zone 2 to at least Job Zone 3 included the manufacture of medical devices and their regulation by the FDA; independent market research indicating that the majority of practicing dental technicians hold education of at least the community college level; the requirement by some state dental practice associations of a CDT designation to operate a dental laboratory; CAD/CAM technology necessitating unique skills and knowledge such as computer science and/or an engineering background; and dentists becoming reliant on dental technicians as material and technique experts as well as valuable team members during patient treatment (email communication, February 2020) (Table 3).
Because the next revision of the SOC is anticipated for 2028, and the first Federal Register notice is not expected to be posted till 2024, the NADL's discussion for the next round of comments has not yet started. Nonetheless, NADL In-House Counsel Eric Thorn says, "Conversations regarding potential 2028 comments will turn on the level of progress made toward broader state adoption of basic minimum standards and basic education requirements for dental laboratory technicians over the next 5 years. While the NADL has consistently provided substantial assistance and support, making progress on this front requires active leadership, involvement, and support from laboratories and laboratory professionals in the currently unregulated states, and at least minimal cooperation from state dental societies" (email communication, February 2020).
Occupational Classification Proposals
Even though the dental laboratory technician occupation was not advanced during the 2010 SOC and 2018 SOC revisions, numerous proposals were submitted to BLS.
In 2010, the NADL proposed that dental laboratory technicians should fall under the Major Occupation Group A Technical classification, which required educational preparation and included technical occupations involved in carrying out technical and technological functions in health, engineering, science, and other disciplines. Further, the NADL advocated that the DOL re-evaluate the classification of dental technicians under the O*Net system from Job Zone 2 to at least Job Zone 3 (email communication, February 2020).
In 2014, the NADL submitted comments to the SOCPC, recommending the addition of Certified Dental Technician, Dental Laboratory Professional, and Dental Laboratory Technology Professional to the list of job titles, as well as reclassification of Dental Laboratory Technician (SOC 51-9081) in Major Occupational Group: Dental Laboratory Technicians to be included in Major Group 29-0000 - Health Care Practitioners and Technical Occupations or Major Group 31-0000 - Health Care Support Occupations.32
In 2017, Anita M. Bobich, BA, CDT, Program Administrator of the Department of Restorative Dentistry at Pasadena City College, and Betty L. Mitchell, BS, CDT, TE, former Program Director of Dental Laboratory Technology at Kirkwood Community College, published an article titled, "Transforming Dental Technology Education: Skills, Knowledge, and Curricular Reform" in the Journal of Dental Education proposing a distinction between dental technicians and restorative dental technologists. Dental technicians were described as having been trained on-the-job, and dental technologists as having graduated from CODA-accredited programs, acquiring a knowledge base similar to those required by dentists and dental hygienists. The authors further recognized that "restorative dental technologists (RDTs) are employed in a dental laboratory or dental office and work on a daily basis with many dental materials, dental instruments, and sophisticated laboratory equipment, such as CAD/CAM scanning, design, milling units, and 3D generative or additive printing technologies. RDTs have extensive knowledge of material science, biomechanics, tooth anatomy, supporting structures, and the physiologic functions of the orofacial system. RDTs are prosthetic designers, engineers, scientists, metallurgists, and artists due to the scientific, biomechanical, technical, and esthetic nature of their work. In their managerial roles, RDTs supervise and train dental technicians and support staff to ensure the dental laboratory is compliant with state regulations (Dental Practice Act, state registration requirements, materials and point of origin disclosures, continuing education compliance, etc) and federal regulations (FDA, OSHA, EPA, CDC, etc). Similar to dental practitioners, RDTs ensure the safety and well-being of their employees and compliance with HIPAA and state laws related to the privacy of dental patients and their records. RDTs and dental technicians work in independent dental laboratories, hospital settings, research laboratories, military laboratories, and dental practices."33
Subsequently, the author of this article along with Bobich and Mitchell submitted comments to the SOCPC in response to Federal Register Vol. 81, No. 141 to propose changes to the 2018 SOC. The comments and recommendations included placement of modified Broad Occupation and Detailed Occupations as detailed in Table 4.
The narrative and rationale provided in the comments concurred that of the two possible placements, the first provides the best fit within the 2018 SOC Classification Principles and 2018 SOC Coding Guidelines for dental laboratory technicians. The proposed position captured the degree and scope of duties that restorative dental technologists and dental technicians are responsible for concerning patients and dental practitioners, required levels of knowledge, skill and expertise to perform the work, as well as managerial and supervisory duties, continuous training of staff, and use of sophisticated materials and technologies.34
Presently, there is a high demand to attract young entrepreneurs, researchers, technical and regulatory experts, as well as other talented individuals to this profession. With emerging needs, as well as innovations in materials/equipment/techniques, rising regulations, and more liabilities exerted on dental laboratories, the profession no longer can sustain itself solely on a minimum requirement of high school diploma or on-the-job training.
To elevate the future of the dental technology profession, dental technicians must have a voice in the matter. They need to promote their worth, embrace accountability and liability for completed work, urge state dental associations to influence state dental practice acts, and support dental laboratory technology associations in promoting legislation to raise the standards for the entire profession. With the changing industry landscape, a significant segment of technicians aspiring to enact new laws, and the next SOC revision potentially in 2028, dental laboratory professionals have another chance to make a difference. By distinguishing between the educated technologists and on-the-job-trained technicians, we can promote our very rewarding profession for what it truly is: a highly-skilled career that necessitates education, training, certification, and lifelong learning.
About the Author
Renata Budny, MBA, MDT, CDT, FNGS
Associate Professor, Chair
New York City College of Technology, City University of New York
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