Dental disease has probably been treated since the first prehistoric toothache. Primitive history recorded incantations and chemical and vegetable plaster and rinses to treat oral pain. Substitutes for natural teeth were made very early from the bones and teeth of animals, and later from other materials such as mother-of-pearl, ivory and jeweler's enamel baked on carved bone or metal tooth plates.
Until the mid-eighteenth century medical doctors concerned themselves little with the mouth; dental ailments were treated largely by laymen. Only a very small amount of medical literature dealt with dental treatment until 1728, when a Frenchman, Pierre Fauchard, published the first major text dealing with dentistry: Le Chirurgien Dentiste. By incorporating into a single book everything known about the science and art of dentistry, Fauchard established a scientific basis for a new medical specialty, and earned the title of "The Father of Modern Dentistry."
Dentistry was brought to Colonial America around 1766. George Washington was among the most famous of early dental patients for whom prosthetic teeth were made. Various forms of dental treatment as well as the techniques and materials used to replace missing teeth were continuously evolving.
The years 1839-1840 marked the foundation of the first dental school in America (The Baltimore College of Dentistry), the first dental magazine (American Journal of Dental Science), and the first national dental organization (American Society of Dental Surgeons).
The formation of dental societies was of particular significance since these societies were instrumental in encouraging state legislatures passing laws to regulate the practice of dentistry by restricting it to those prepared through education. In turn, these laws gave birth to dentistry as a recognized health profession.
First Commercial Dental Laboratory
As the art and science of dentistry continued to develop, certain dentists developed special processes and skills in fabricating prosthetic devices. Since these processes and skills were in demand by other dentists, the practice of sending out laboratory work to those possessing the processes began.
One doctor particularly noted for his prosthetic skills was Dr. W. H. Stowe who practiced in Boston. Dr. Stowe eventually found that he had little time for his own dental practice after accepting laboratory work from all the dentists who sought his services. In 1883, he began to separate his dental practice from his laboratory services, accepting laboratory work only from a limited number of dentists; however, the laboratory service was so successful that it indicated the potential need for a dental laboratory capable of serving the profession at large.
In 1887, Dr. Stowe opened a dental laboratory in Boston and was later joined by his cousin, Frank F. Eddy. The laboratory (later known as Stowe and Eddy) was generally acknowledged to be the first commercial dental laboratory in America that was separate from a private dental practice.
The establishment of the commercial dental laboratory quickly led to the training of apprentices. As the apprentices perfected skills, they opened their own laboratories and the growth of the commercial dental laboratory industry began. As more and more laboratories came under the management of dental technicians, a decreasing number of dentists went into the business and by 1910 dental technicians managed the majority of commercial dental laboratories.
The work and innovations of dental technicians became a significant influence in the development of new prosthetic techniques and materials.
As the dental laboratory craft and industry grew, it was natural that organizations should be formed. In 1950, there were two national organizations claiming to represent the dental laboratory industry, but no single unified organization. A group of dental laboratory owners from throughout the country met in Chicago that year and agreed to form a national, federated association, similar in organization to the American Dental Association, with state-level association components.National Association of Dental Laboratories (NADL), which today represents nearly 1,000 commercial laboratories nationwide. The stated purpose of NADL is to uphold and advance the dignity, honor and efficiency of those engaged as operators of dental laboratories, to advance their standards of service to the dental profession and to establish cooperation among its members.
Beginnings of Certification
Early activities of NADL were concentrated in the areas of recognition and education. In 1954, the NADL Education Committee began development of a certification program, which would set skill standards. The following year, the NADL Executive Council elected seven persons to the newly formed National Board for Certification, which adopted policies and approved examinations for the certification program. The first Certified Dental Technician (CDT) tests were administered in October of 1958, and the first CDT certificates were awarded in March of 1959.
Since that time, the National Board for Certification in Dental Laboratory Technology (NBC) has offered the CDT examinations more than a dozen times each year at locations throughout the country. The examinations have undergone continual upgrading and revision. Currently, there are approximately 5,500 technicians with active CDT certificates.
The Certification Program
In order to retain their certification, CDTs are required to apply to the NBC every year for renewal. To qualify for renewal, the CDT must attest that he or she has complied with the laws governing the practice of dental technology and dentistry in the applicable state, must submit proof of continuing technical education (including Regulatory Standards) and must pay a renewal fee. Continuing education requirements may be met through attendance at approved clinics, reading of accepted technical publications, completion of college level credit courses, or the development of original technical clinics or papers.
The authority of state governments to regulate health professions is well established. Every state in the nation has exercised its authority over dental health services by enacting a dental practice act, which establishes the basic relation between the dentist and the dental technician or commercial dental laboratory. In general, these acts state that the fabrication and repair of dental prosthetic appliances are included in the definition of the practice of dentistry, and that no unlicensed person may engage in any phase of such fabrication or repair unless it is at the direction of a licensed dentist. The required direction normally means the written dental prescription or work authorization of the dentist. The nature and format of the prescription is spelled out in varying degrees of detail by the different state dental practice acts.
All state dental practice laws specify the functions that the dentist may perform and the conditions under which he or she may perform them. Any unlicensed person found to perform these functions directly to the public is considered to be engaged in the illegal practice of dentistry.
During the past two decades additional regulation has been imposed on dental laboratories in the form of occupational health and safety laws. These laws deal with the requirement for employers to provide safe and healthy workplaces for their employees, and they are promulgated and administered both by Federal (the Occupational Safety and Health Administration or OSHA) and state agencies.
While there are fewer than half a dozen states having more specific regulatory legislation governing the operation of a commercial dental laboratory, there has long been a segment of the laboratory industry desiring the enactment of registration or licensing laws. This is a state-level issue and the decision to seek or oppose such legislation must remain in the hands of the respective states.
The National Board for Certification cannot participate in the influencing of legislation; however, it does encourage the protection of public health and welfare by maintaining the nationally recognized certification standards, which form a solid foundation for either statutory or voluntary regulation of dental technology.
Dental laboratory owners and managers must also be aware of applicable state and local laws (Zoning, taxation, etc.), which apply to all businesses.
In addition to those obligations on the dental profession and the dental technician or laboratory, which are set by law, there are also groups concerned with the maintenance of proper ethical and technical relationships between the dentist and the dental technician. These include dental schools, schools of dental technology, the dental societies and dental laboratory associations.
The role of the dental school goes beyond imparting scientific information and skill to the dental student; it extends to giving students an understanding of the many intangible factors, which contribute to the making of a professional person. Included in these factors are the fundamentals of ethics, which govern the graduate's conduct in practice and the relationship that must be maintained with auxiliary personnel and commercial dental laboratories.
Dental technology schools have similar responsibilities in the educating and training of dental technicians. Formal education in dental technology has grown from three accredited two-year programs in 1961 to more than 19 today. The Commission on Dental Accreditation issues accreditation for educational programs relating to the dental industry. The dental laboratory industry is represented in the accreditation process by having a representative on the Commission, membership on its dental technology education committee, and numerous consultants who take part in the onsite inspections that are required for program accreditation.
The roles of the American Dental Association, the National Association of Dental Laboratories, and their affiliated state-level associations include the establishment and maintenance of professional ethics and standards of conduct for their members. They are also active in promoting programs of continuing education for their members. Further, these organizations are primary sources of legislative initiatives in regard to the laws governing the practice of dentistry and dental technology.
As with most professions and industries, there are both technicians and dental laboratory owner/managers who desire to achieve and be recognized for their advanced levels of professionalism.
The NBC also administers the Certified Dental Laboratory (CDL) program, which addresses personnel skill standards, laboratory facility and maintenance, and training and practice in infection control. Information on this program is here.