Laboratory communication in dentistry involves the exchange of detailed information between clinicians and technicians for fabricating restorations, ensuring optimal patient outcomes. Effective communication includes written narratives, photographs, digital scans, and physical materials. Clinicians must understand laboratory processes, while technicians need to interpret and execute requests accurately. Certification and adherence to legal standards are essential. Effective communication impacts patient care by ensuring proper case planning, patient education, and setting realistic expectations. Clear, precise exchanges between clinicians and technicians are crucial for quality and compliance, fostering a collaborative and respectful relationship that ultimately benefits patient care outcomes.
Key points
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Importance of laboratory communication : Laboratory communication refers to the exchange of detailed information between clinicians and laboratory technicians for fabricating indirect restorations. It includes various formats such as written narratives, photographs, digital scans, and physical materials. Effective communication ensures accurate and ideal restorative outcomes.
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Roles and responsibilities : Clinicians must understand the laboratory fabrication process to provide necessary information. Technicians must comprehend the clinician’s requests and seek any additional information needed before proceeding with fabrication. This mutual responsibility is crucial for successful outcomes.
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Legal and ethical considerations : Effective communication is a legal requirement. Laboratory prescriptions must include the clinician’s signature and license number, making it a legal document. It is incumbent upon the clinician to provide necessary information to the laboratory for the proper fabrication of the requested restoration.
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Impact on patient care : Proper laboratory communication directly affects patient care outcomes. It involves case planning, patient education, and managing expectations. The clinician is responsible for coordinating the interactions between the patient, clinician, and technician to achieve optimal results.
Introduction: role of communication between clinician and technician
Definition of “Laboratory Communication”
Laboratory communication is the exchange of information between the clinician doctor and the laboratory technician for the fabrication of an indirect restoration in service of patient care. Any such communication should be in a recorded format that is relayed in an efficient and secure manner. It must include all detailed information needed by either party to facilitate the ideal execution of the requested work and may consist of a written narrative, photographs (intraoral, extraoral, shade selection), digital scans (intraoral, facial, CBCT, etc.), and physical materials.
The clinician must understand the laboratory fabrication process in order to know what information is needed for the technician for an ideal restorative outcome. It is the responsibility of the technician to understand what is being requested and to interact with the clinician to obtain all needed information before moving forward with fabrication. Honoring this mutual responsibility is the key to an effective and successful relationship and will ultimately result in optimal clinical outcomes.
Background
Laboratory technology is an integral part of dentistry and is a multi-billion-dollar industry globally. With the increased aging population and improvements in technology, this number is expected to continue to grow in the foreseeable future. Without the support of dental technicians and dental laboratories, the practice of nearly all indirect restorative dentistry would halt. Despite the indispensable standing of the dental laboratory industry, according to the Department of Labor, Bureau of Labor Statistics, there has been a nearly 35% decrease in the number of dental laboratories in the United States in the last 20 years: from 7,807 in 2003 to 5,096 in 2023. The number of accredited dental laboratory technology programs in the United States has also reduced from 49 programs in 1990 to 13 programs in 2024. It should be noted that private training programs also operate to train technicians but the need for professionally trained dental laboratory technicians remains unmet.
The National Board for Certification in dental laboratory technology, an organization recognized by the American Dental Association, offers voluntary certification in dental laboratory technology. The Certified Dental Technician (CDT) examination has multiple written parts as well as a practical component in a chosen area of specialty: ceramics, complete dentures, crown and bridge, digital workflow, implants, orthodontics, or partial dentures. Once the technician successfully completes these sections, they become a CDT and have thus demonstrated the knowledge and commitment of professional-level practice of dental technology.
The Commission on Dental Accreditation, the governing body certifies compliance and maintenance of standards for dental education programs in the United States, requires graduating dentists: “must be competent in providing oral health care within the scope of general dentistry as defined by the school, including communicating and managing dental laboratory procedures in support of patient care.” Similarly, Dental Laboratory Technology Accreditation Standards require that graduates learn “work authorization/prescription of the dentist in accordance with the state dental practice act, consistent with current procedures in dental laboratory technology in the geographic area served by the program.”
Importance of Effective Communication in Dentistry
Effective communication fosters collegiality and a relationship of mutual respect, creating an environment for better outcomes for all parties. Not only is there an ethical obligation, but also a legal one. All laboratory prescriptions require the clinician’s signature and license number per the Dental Practice Act that establishes legal requirements for dental practice for each state, protecting the public from inept clinicians. The signature and license number render the laboratory prescription a legal document between the clinician and the technician.
Collaboration Between Dentists and Dental Technicians
Appropriate laboratory communication ultimately impacts patient care outcomes and additionally involves proper case planning, patient education, and setting realistic patient expectations. Management of the triad of the patient, clinician, and technician ultimately rests on the clinician ( Fig. 1 ).
Best practices for communication
Methods of Communication
At the very core of the clinician–technician relationship is the need for clear and effective communication that starts at the introductory conversation. A well-written, detailed prescription that details the case plan for the patient must be determined by the dentist and not the technician. A dental prosthesis may take many visits and steps. Each prescription will reaffirm the final case design with the details as to which step is being requested at this time and the desired materials. This prescription must adhere to Health Insurance Portability and Accountability Act (HIPAA) rules and guidelines.
Typically, the clinician’s office staff reaches out to the dental laboratory staff to initiate a relationship, often with an introductory letter ( Fig. 2 ). Procedures, turnaround times, fees, and other details are discussed, and clinician preferences are noted, often by completing a form from the laboratory ( Fig. 3 ). Prescription pads are shipped, and/or digital connections are made for the first submission to the laboratory. This relationship of mutual trust and respect hinges on both parties’ understanding of what the other needs for the patient. The first prescription will determine the quality, and possible longevity, of the relationship.
Standard Operating Procedures
Most dental offices and commercial dental laboratories have defined workflows and standard operating procedures (SOPs). SOPs provide detailed instructions on the clinical and technical processes and steps needed for each type of dental prosthesis being manufactured. SOPs ensure consistency, efficiency, and quality of both the clinical and manufacturing processes.
Quality control and design review should be performed throughout the clinical and manufacturing processes. Personnel should be trained to perform at competent levels in all areas of these workflows. Additionally, instructions for use should be provided by the laboratory to the clinician and by the clinician to the patient.
Materials used in the fabrication of dental restorations and appliances in the dental laboratory are identified by control numbers, such as lot or batch numbers, and are documented in a Device History Record. Material Safety Data Sheets information must be available and organized for easy access in the laboratory. IdentAlloy and IdentCeram certificates document the composition, brand, and source of dental materials and should be included with the finished restorations sent from the laboratory to the dentist. The dentist can then add the certificates to the patient’s record.
It should be noted that laboratories fabricating sleep and snoring devices, and certain maxillofacial prosthetic devices require registration with the Food and Drug Administration (FDA) for oversight as they are considered medical devices. These laboratories are subject to audit at any time by the FDA. It is a legal requirement for the dental laboratory to be in compliance with the US Code of Federal Regulations, Title 21, Chapter I, Subchapter H, Part 820: FDA Quality System/Good Manufacturing Practices that governs the methods used in, and the facilities and controls used for the design, manufacture, packaging, labeling, storage, installation, and servicing of these devices (Code of Federal Regulations Title 21). Additionally, as mentioned previously, Occupational Safety and Health Act (OSHA) infection control and exposure control protocols should also be followed as defined in Federal Regulations 29 CFR 1910.1200 and Hazard Communication as defined in 29 CFR 1910.1030.
Evolution of the Prescription
The laboratory prescription is a legal document, much like a prescription to the pharmacy for medication, and must be completed accurately and thoroughly (Leeper). In a survey of state regulatory agencies, St. Arnault and Evans found a wide range of legal requirements for the laboratory work authorization form. As this mandate varies from state to state, it is the responsibility of the clinician to know and be in compliance with their state’s requirements. Most state regulatory agencies require at the minimum the following for the work authorization form:
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Completed, signed, and dated by a licensed dentist
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Include a detailed description of the work to be done, and if necessary, provide diagrams
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Include the patient’s name or other form of patient identifier
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Specify the dentist’s name, address, and license number
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Specify the laboratory’s name and address
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Include the date of work authorization and desired completion date of the request
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Both the dentist and the dental laboratory must retain a copy of the prescription for a specified amount of time following the work’s completion. The time of retention of this record varies by state and can be as long as 10 years or as short as 1 year
Laboratory prescriptions are most commonly completed on paper (or printed from a Web portal) and included in the laboratory package with the physical models, impressions, etc. The laboratory either provides the clinician with a paper form with areas to complete ( Fig. 4 ) or a Web portal in which case details can be completed. If the case is fully digital, depending on the digital platform being used, the software will have a laboratory connection that must be connected in advance. Third-party providers have developed software to interconnect the scanning technology, the clinician, and the technician.
The full details of case design should always be present at each stage of the case. The clinician should use standard and professional language in their requests, jargon should be avoided. The American College of Prosthodontists has published a glossary of accepted terminology, and the American Dental Association provides codes that are helpful in creating precise work authorization forms. Too often, the clinician omits important information without paying full attention to the required information that necessitates communication from the laboratory to the office, often causing delays in case completion.
As the use of digital dentistry has become more pervasive, digital prescription platforms have made it easier for laboratories to capture pertinent information by making certain information fields mandatory. Incomplete forms cannot be submitted due to software restrictions. As such, the delays inherent in inquiring about missing data are minimized on electronic prescription platforms.
Ethical, Regulatory, and Legal Considerations
HIPAA compliance is a mandatory aspect of software development for dental practices that send prescriptions to dental laboratories. Protection of patient privacy applies to all aspects of dental health care including communication with the laboratories. As such both the dental practice and the dental laboratory must comply with the applicable standards of the privacy, security, and breach notification rules. To ensure HIPAA compliance, the software must have the following features.
Encryption
The software must ensure encryption of all protected health information sent electronically to the dental laboratory. No patient name or personal information should ever be sent to the dental laboratory.
Access control
The software must provide security login protocol that allows only authorized personnel and denies non-authorized personal access to the patients’ protected health information.
User authentication
The software must provide user authentication mechanisms to ensure that only authorized personnel can access the software.
Secure communication
The software must ensure secure communication between the dentist and dental laboratory.
Audit trail
The software must maintain an audit trail of all protected health information (PHI) access and modification.
Data backup
The software must provide a mechanism for regular data backup to prevent data loss.
As the landscape of data security is ever-changing, additional and updated requirements may be necessary depending on the specific needs of the dental practice. It is recommended to consult with a HIPAA compliance expert to ensure that the software meets all the necessary requirements for the particular area of practice.
From the legal perspective, the work authorization form is a prescription for work requested by the clinician doctor and requires all information to be communicated thoroughly and precisely to the technician. Ethical lines may be crossed if the clinician expects the technician to make crucial decisions about restorative and material designs without their guidance. For example, in a recent survey of technicians in Oregon, only 11% of respondents reported that they regularly receive clear instructions on prescriptions from clinicians for removable partial dentures. , Although this is a report of a small sample of work by a small sample of laboratories, it still points to a pervasive issue with lack of quality communication in the clinician–technician relationship. Multiple other studies have demonstrated similar results of technicians reporting suboptimal communication from the clinician on case details needed for restoration fabrication. ,
Respectful Exchange of Information
Respectful exchange of information and materials between the clinician and the technician should include legible, concise, and precise language as well as supportive documents and physical models.
Any materials (physical or digital) being sent on behalf of the clinician to the laboratory must be inspected for quality by the clinician prior to exiting the dental office. The following basic parameters for appropriate communication are recommended.
Clear and comprehensive
The prescription should be legible and comprehensive in that it includes all pertinent case information with details required for proper execution. For example, when requesting a framework for a removable partial denture, the design elements must be thoroughly and clearly delineated. , Fig. 5 provides examples of appropriately completed prescriptions with clear instructions. Commonly overlooked items on the laboratory prescription include shade information, implant size and manufacturer information, and restorative material needed. Fig. 6 provides examples of inappropriate work authorization forms.
