Terri Lively

Night guards serve an excellent purpose for your patients’ oral health. Not only do they protect teeth and supporting tissues, but they also can preserve your carefully delivered treatments. Well, they do when patients wear them, which is probably not as often as any clinician would like.

Why don’t patients wear their night guards, and what can you do about it? Some excellent resources explain it all and might have something to help you.

Why Don’t Patients Wear Their Night Guards?

Wearing a night guard requires a change in behavior, which is challenging for some patients. Not only do they have to stop what they were doing before, but they also have to do something new instead. This change isn’t effortless, and it requires time to achieve compliance.

Patients might leave your office with good intentions to wear their night guard. However, once their nighttime routine begins, they now must change their habitual behavior to include using the night guard. Depending on the patient’s personality, this situation might preclude some individuals from effectively wearing the night guard.

However, other patients might be ready and willing to change. They might even start strong, wearing the night guard every night. Then they suffer what the 

University of Utah’s Health Department calls 

a setback. After the setback, they revert to their old behavior—not wearing the night guard.

Clinicians need to understand that setbacks are part of the process. Overcoming setbacks is critical to lasting behavioral change.1

As health care providers, prescribing the night guard to protect the patient’s oral health is essential and 100 percent under the clinician’s control. However, getting them to wear it often falls outside a clinician’s capability. But there are a few things that you can try to help patients be successful.

Habits are automatic behavior that we learn over time. Charles Duhigg, author of 

The Power of Habit: Why We Do What We Do in Life and Business

, explains how habits work using 3 stages of habitual behavior

 Something alerts the subconscious that it’s time to initiate the usual behavior.

 This part is the usual behavior, the typical nighttime routine without wearing the night guard.

 Remuneration or prize the person enjoys for the habit; the reward can be relief from a feeling (“I’m

I did a good job taking care of that, and now I can relax

Part of changing behavior, Duhigg writes, is to disrupt the routine after the cue. Once you have successfully interrupted the regular cycle, you can insert a new routine. Then, with repetition, you can change the habit permanently. However, Duhigg says that this process might take some experimentation (and failure) to work eventually—and that sometimes it can take a long time to change. Nevertheless, identifying the habitual cycle is vital to changing behaviors.

Asking the patient a question that prompts an individual to examine their behavior closely is the best way to positively influence them, according to a study published in the 

. This approach, called the Question-Behavior Effect, involves asking a direct question about the future to accelerate a person’s readiness for change.

Direct questions have influenced people to modify their behaviors, such as to cheat less and exercise, volunteer, and recycle more. For example, researchers found that asking a question like “Are you going to set aside money for retirement?” is more effective in inspiring behavioral change than simply saying, “It’s important to invest money for retirement at a young age.”

The Question-Behavior effect is most effective when you ask a question that forces a definitive yes or no answer rather than an open-ended question. Answering a yes or no question does not leave room for clarification, which helps to promote positive behavior change. (Researchers also found that administering such questions via computer or paper-and-pencil surveys is even more effective than in-person questioning, but that won’t work with this interaction about night guards.)

One theory for why this method works is that it creates cognitive dissonance, where a person’s ideal self-image clashes with their actual behavior. By answering affirmatively to a direct question about their intentions, a person can reduce their discomfort and increase the likelihood of changing their behavior.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK

 published a helpful article to support patients with behavior change strategies. The NIDDK recommends using the 5 A’s to help patients who need to change their behavior.

 Evaluate behavioral health risks and factors affecting behavior change goals.

 Provide personalized advice on behavior change, including information on health benefits and risks.

 Collaborate to choose appropriate treatment goals and methods.

 Help the beneficiary acquire skills, confidence, and support to achieve the agreed-upon goals.

 Schedule follow-up contacts to provide ongoing support and adjust the treatment plan as needed.

Regarding night guard use, scheduling the follow-up contacts through a patient messaging system that reaches out between appointments might be helpful. However, a note in the patient’s record that nudges clinicians to revisit the first 4 A’s in discussion might also be enough to achieve the same goal for the 5th A.

Managing How You Give Feedback and When to Change It

Helping people change might require different approaches at different times, particularly in the type of feedback you provide. 

The University of California at Berkeley’s Greater Good magazine

 explains that the kind of feedback you provide on the patient’s behavioral change, positive or negative, is a powerful tool that can shape people’s mindset and motivation.

However, feedback can inadvertently reinforce an “entity mindset,” which describes accomplishments as the result of fixed traits. The positive feedback that supports an entity’s mindset can limit a person’s potential for growth and development.

For instance, if a person praises someone on a diet at a party for the dieter’s remarkable willpower for avoiding desserts and sticking to fruit, it implies that willpower is an unchangeable entity. This inflexible view of willpower can be detrimental as it limits the dieter’s potential for growth and development.

To provide feedback that promotes an incremental mindset, avoid reinforcing an entity mindset. Instead, provide positive feedback acknowledging the person’s effort and inviting them to share their strategies for success. This approach promotes the idea that most abilities are skills that can be nurtured.

Also, positive and negative feedback have different influences on people, depending on their stage of change. Positive feedback is valuable when people change their behavior, reinforcing their commitment to the goal. Over time, however, people shift their thinking from overall commitment to progress. At this point, negative feedback becomes more motivating as it reminds them of the distance between where they are now and where they want to be.

Although negative feedback can be challenging, the authors posit it is essential to be willing to make people uncomfortable when working with them to change their behavior. Negative feedback can motivate people to seek improvement and development. It is essential to remind oneself that giving negative feedback to people who are already committed to behavior change can spur them to improve.

In the case of night guards and balancing ways to get patients to wear them and the patient experience you want to deliver, giving positive feedback will likely be easier for clinicians than negative feedback. But it might not require as much negativity as one might think to inspire improvement. The “negative” feedback might be not making any comment about it at all. Noting the behavior in the patient record without comment might convince many patients to increase their efforts to wear night guards more.

Magic Words: What to Say to Get Your Way,

 addresses a critical persuasion strategy in his 2020 article for 

. He also believes in questioning people and identifying the cognitive dissonance that can occur between one’s beliefs and one’s actions. However, he also suggests an essential tactic can be to ask for less.

Berger writes that asking for less initially and then gradually increasing the request can effectively achieve behavior change. This approach involves breaking a big ask into smaller, more manageable chunks.

For example, when a doctor was helping an obese trucker to quit drinking 3 liters of Mountain Dew per day cold turkey, she asked him to reduce it to 2 liters. Then, once he achieved that, she asked him to reduce it again to 1 liter a day. Finally, she had him cut it out entirely. It worked, and the truck driver lost 25 pounds from his behavior change.

Berger says this method is more effective than making a big request that falls into “the region of rejection” and gets ignored. It is a better approach to dial down the initial request and then gradually increase it to achieve better results.

Regarding night guard wear, clinicians could try reducing the ask for the patient by seeing if they can wear it twice a week to start. While 2 nights a week isn’t ideal, it is better than zero nights a week. Perhaps if the patient concentrates on wearing it only a couple of days per week, it will not feel as overwhelming as every night for the rest of your life.

Behavior change isn’t easy for anyone. However, it can be done, and in the case of your patients wearing their night guards, there are important reasons why it should be done. By leveraging these psychological principles to help them along, you can help patients achieve behavioral change that can improve their oral health, one night guard–wearing night at a time.

1. Call M. Why is behavior change so hard? Accelerate Learning Community. January 31, 2022. Accessed May 3, 2023. https://accelerate.uofuhealth.utah.edu/resilience/why-is-behavior-change-so-hard#:~:text=Behavior%20change%20is%20complicated%20and,usually%20longer%20than%20we%20prefer

2. Duhigg C. How habits work. Accessed May 3, 2023. https://charlesduhigg.com/how-habits-work

3. Morin A. Science says this is the best way to motivate other people to change their behavior. May 14, 2018. Accessed May 3, 2023. https://www.inc.com/amy-morin/science-says-this-is-best-way-to-motivate-other-people-to-change-their-behavior.html

Support your patients with behavior change strategies. National Institute of Diabetes and Digestive and Kidney Diseases

. Accessed May 3, 2023. https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/diabetes/game-plan-preventing-type-2-diabetes/how-talk-patients-about-prediabetes-diagnosis/support-your-patients-with-behavior-change-strategies

5. Markman A. Six ways to help people change. Greater Good. March 7, 2016. Accessed May 3, 2023. https://greatergood.berkeley.edu/article/item/six_ways_to_help_people_change

6. Berger J. How to persuade people to change their behavior. Harvard Business Review. April 20, 2020. Accessed May 3, 2023. https://hbr.org/2020/04/how-to-persuade-people-to-change-their-behavior

Articles

Why patient’s don’t wear their night guards as prescribed, and what can be done about it.  

Night Guards: How to Get Patients to Wear Them 

As they grow in popularity among clinicians at all stages of their careers, group practices and dental support organizations (DSOs) are offering new opportunities for dentists and their teams. We spoke to experts in the field about the effect this trend is having on the profession.

Katrina Sanders, MEd, BSDH, RDH, RF, a practicing dental hygienist, educator, and speaker, has seen a change in how practitioners view and approach patient care and hygiene. In the past, DSOs focused on maximizing patient insurance benefits by providing as many of them as possible with the meat-and-potatoes care they had come to expect. Some of today’s group practices and larger DSOs, however, are adopting new technologies and taking on such tasks as salivary diagnostic testing and the prescribing of probiotics. And, in the process, they are changing the face of hygiene education.

“We have seen a powerful influence in education and…[in] the expectations…within our profession to move patients away from the standard model [and toward]…looking at patients individually and developing unique care plans,” Sanders explains. “Sometimes, we need to integrate new products, procedures, technologies, and modalities to achieve that. So…born out of that is an interesting new wave of group practices.”

Sanders also sees these practices’ granting more autonomy to providers and making more resources available to them so that they can offer tailored, patient-centric care.

The attitude “used to be, ‘If we don’t have the product here in this office, or if corporate hasn’t thumbed up this new product/device/technology, then you don’t get to use it,” she observes, but “now they are starting to say, ‘if somebody wants a custom-made experience, let’s create that and empower our providers.’ So that’s been a neat shift.”

Belangie Perez-Torres, RDH, director of Hygiene Strategy & Operations at Aspen Dental Management, says that strong relationships with patients make collaborative care possible and that group organizations recognize that hygienists are instrumental in building the kind of relationships that motivate patients to get the care they need. “Collaborative care goes beyond…the…relationship between the doctor and hygienist,” she stresses. “It involves the patient in the co-assessment and codesign of their treatment plan to achieve oral health and overall health goals.”

Moreover, hygienists are more intentional in their questions. They are moving away from low-value inquiries about brushing and flossing frequency and asking about family history of gum disease and edentulism to fashion patient-appropriate plans. “If their parents had dentures before they were 50, that’s a concern,” she points out, because such a patient may be healthy today but at higher risk for future problems.

And technology facilitates fruitful conversations. For instance, she adds, patient management software improves the collection and organization of data, and having the information at hand helps patients and providers make the right decisions. “That’s where DSOs can be a differentiator because they recognize technology as a great investment, not just operationally but also clinically.”

Lori Hall, CDA, LDH, senior director of Hygiene Operations at Heartland Dental, says her company views hygienists as patient advocates as well as providers. At practices supported by Heartland Dental, the hygienist is the first clinician that patients see and the one who discusses medical history with them and relays that information to the dentist. “If they can make sure the doctor understands the things going on with the patient from the get-go, then the clinical team is going to take better care of their patients,” she says.

Technology is also essential to the changing role of hygienists. Many Heartland practices offer better patient care with lasers and intraoral scanners like the VELscope® Enhanced Oral Cancer Assessment System, which identifies areas of the mouth clinicians should examine more closely. “That’s a great thing” about this system, she adds, it “could save someone’s life.”

And yet, some of the basic skills hygienists learned in school, like measuring blood pressure, are coming back because hygienists know that the symptoms of hypertension and diabetes show up early in the mouth, so there is a renewed interest in detecting these conditions as soon as possible.

“Over the years, I’ve seen us start looking at patients…more holistic[ally],” Hall says. “We are on the front lines, catching these things and…help[ing] patients by referring them to their physicians.” She attributes some of these developments to a changing patient population, one that is more aware of the importance of oral health and familiar with the things being discussed in the operatory. And technology only enhances communication: “You might think that scanning would be just for Invisalign or ortho, but we can show patients so much with that, like malocclusion and the connection to perio. You can show someone the plaque,” she says. “From a patient-education standpoint, it’s amazing what it can do.”

Brandi Hooker Evans, MHE, RDH-ER, owner and president of Stellar Outcomes, thinks that group practices have allowed hygienists to shape their own careers as dental health providers. She isn’t sure whether that is because group practices have influenced the profession or because hygienists have begun to realize the significance of their role, but that realization, she believes, is crucial to today’s hygienists. Moreover, large organizations can afford to offer excellent benefits and give hygienists access to specialty dentistry, thus enriching their experience. Having that knowledge and those tools is very exciting: “If you are willing to be a team player and own your career by providing quality assessment and diagnosis, the level of disease in the population is such that you will…[earn] double, if not triple, [what] a typical hygienist [earns]. And if you are working with a bonus system, which many big corporate groups…[offer], you make considerably more money than [by] just clocking in and out.”

There is a caveat, however. If you only “pick and scratch” teeth in 40-minute, back-to-back appointments, or sometimes in a double-column model, that’s a quick path to burnout. Instead, Hooker Evans encourages hygienists to seek out the sweet spot where they can earn more while seeing fewer patients, delivering better care, and providing the comprehensive treatment each of them needs.

“You are less stressed, enjoying more one-on-one time with your patients, providing higher quality care—which is more profitable—and…liv[ing] a more comfortable life,” she says. Another aspect of working in a corporate setting is that you can provide pro bono care to those patients who cannot afford what they need because when overhead is lower, there is more room for philanthropy. “Most of us in the dental profession showed up hoping to help people. So, if we can help people in a more profound way day-to-day…become more profitable, and…have the capacity to donate service…the emotional satisfaction of that career increases exponentially.”

Of course, there are also disadvantages to working in a group. Hooker Evans acknowledges that some have a culture of low-quality, high-volume care. However, she would encourage hygienists to “just say no” under such circumstances. Although she doesn’t judge hygienists who submit in those situations, she stresses that in 20 years as a hygienist, she hasn’t known anyone who feels happy, healthy, or whole in such a scenario.

“In our heart of hearts, as a hygiene community, we know that type of practice is not using our skills, knowledge, and license to the best of its ability,” Hooker Evans says, adding that adopting a whole-health approach to hygiene often outproduces high-volume patient rosters. “Having a quality conversation with the practice owners about our vision for the future and what we want to be as providers and what we want to see for our patients is critical to moving away from that corporate burnout.

Overall, Change Has Been Good for Hygienists

According to Sanders, many large group practices and DSOs have had a positive impact on the profession. Some host all-team meetings and annual educational sessions. A leadership mentality at the top fosters mentorship and the opportunity to elevate the level of care team members provide, often outside traditional hygiene. Without this, 2 hygienists at the same practice could be delivering vastly different patient experiences. By focusing on core values and recognizing “rock star” staff whose critical thinking and daily actions improve care, this kind of leader fosters excellence.

Sanders also appreciates that group practices tend to make a greater effort to treat periodontitis, which affects nearly half (47.2%)of adults between the ages of 30 and 79.

 By contrast, the number of gum disease treatments are much lower at private practices. Unfortunately, some misinterpret this difference as overdiagnosis on the part of groups that are pushing hygienists to deliver more care than patients need. The irony, she says, is that group practices’ periodontal treatment percentages align more with what dental professionals know to be true about the prevalence of gum disease.

Perez-Torres believes that hygienists should champion new technology and patient care initiatives. Those who do, “at least in the group practice, tend to have more growth opportunities…. For example, they might become a trainer or grow into a clinical support role for hygienists, like a hygiene manager or director. We even have hygiene recruiters,” she points out.

Perez-Torres says that our greater understanding of the connection between oral and overall health and the rapid growth of artificial intelligence will prove synergistic in terms of patient outcomes and, therefore, that the industry will seek hygienists who can train others in the use of new technology. Hygienists are often involved in product development, she notes, because their clinical experience bridges the gap between engineering and patient experience. And these trends allow for different career paths outside the operatory. “I’m seeing many more hygienists in DSOs in VP roles.… [At] Aspen Dental, we have two, and I’ve seen other DSOs promote many hygienists into leadership roles,” Perez-Torres says. “And I love that.”

Looking ahead, Sanders sees 3 critical developments:

The shortage of hygienists could push providers into a no-hygienist model.

 As hygienists leave the profession and clinicians try to fill empty roles with new graduates, Sanders envisions a future in which dentists clean their patients’ teeth or move hygienists to a double-column scenario, in which they treat 2 patients simultaneously and an assistant picks up the slack.

 Sanders has seen many hygienists’ learning to provide myofunctional therapy, perform A1C and airway screenings, collect samples for salivary testing, and deliver nutritional diagnostics services. They want to become certified in Botox and dermal fillers, which she considers a viable option. Some are becoming anesthesiologists, numbing all patients at large group practices, while others are assisting periodontists during surgery. Some pursue mobile dentistry and administering care in nursing homes, rural areas, and Native American reservations. And still others may embrace telehealth and work independently.

Group practices will offer different services. 

Sanders thinks some will adopt a boutique-style or spa-like approach. Instead of serving everyone, they will see patients who want a particular type of care. These niche, branded practices can develop a standard operating procedure they can duplicate and franchise as demand dictates.

Sanders has been involved with group practices throughout her career, including working in one when she was just out of school. She learned a lot and enjoyed her time there and thus encourages clinicians to consider their options and remember that there is always a spectrum in terms of autonomy and benefits between a large group and a private practice and that the latter will always have its own culture and will focus on certain aspects of care.

“We are starting to see some really neat trends, with…these group practices…working to empower their providers and elevate patient health,” she says. “I’m excited to see what happens—as long as we keep our sights and our minds on elevating the health of our community first and foremost.”

Hall, too, is optimistic about the future of technology-driven roles but thinks that as long as hygienists are coming into the profession, there will be demand for them at dental practices. Hooker Evans is likewise enthusiastic. Among her coaching and continuing-education clients, she senses a hunger for more. The oral-systemic health connection, she says, has ignited interest in what hygienists do, among those who have been working with patients for 25 years as well as among new graduates.

She also sees the burnout model ending within the next five years. Owning one’s career leads to a desire for more education, a dedication to a higher level of care, and a better work ethic. The passion for this career is spreading like wildfire. “More and more people are saying this isn’t enough, and I want more…. That will make the next 5 and even 10 years look different…and the more [that] hygienists and dentists…hear this, the more excited everyone gets. It’s shifting the entire culture to more fulfillment and excitement. It makes me feel so hopeful.”

Periodontal disease. Centers for Disease Control and Prevention. Updated July 10, 2013. Accessed April 4, 2023. https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html

Group practices are here to stay and growing in popularity. What effect does that have on hygiene careers? Hear what the experts have to say.

Where Do We Go from Here? What a Hygiene Career Looks Like in Group Practice

Hiring new lab technicians in this hyper-competitive job market can be challenging. So let’s take a look at how labs can recruit new talent and retain the talented team members they already have.

Employers weathered a problematic recruitment environment in 2022 and should expect more challenges in 2023. Harvard Business Review predicts a lot of competition to recruit talent, tired employees, and more cost-controlling pressure—all under the shadow of a looming economic downturn.

HBR identifies trends that will help organizations be more successful. These include the following: 

Providing internal talent mobility, upskilling (additional training) opportunities, and leveraging new employment methods, including gig work

Increasing flexibility around working and employee experiences for all workers, including frontline workers

Hiring people who have the right skills but maybe not the experience

Enhancing managerial training and redefining and reprioritizing middle-management goals

Increasing support for work-life balance, paid time off, and mental health programs

Improving support for ongoing diversity, equity, and inclusion (DEI) initiatives

Increasing support for social skill development for all workers, including employee autonomy, straightforward messaging on the company purpose, and, well, fun

So what does that mean for dental labs? The same thing it means for everyone. Getting the best people means looking in new ways for talent and addressing the employee experience earnestly to make prospective lab employees an offer they can’t refuse.

Apex Dental Lab Group’s Tom Love, director of implantology and technical education, says most people labs want to recruit are employed at another lab. As a result, many labs use recruiting firms or other outside resources to attract these employees from their current lab to the new one.

However, employed lab technicians are a finite resource, so dental labs are getting more creative. Love says using local high schools and community colleges is another effective recruitment tool.

“Most high schools in the country now have CAD/CAM programs, which they never had before. So in a couple of the communities that we’re in, we have a partnership where we let them come into the lab and show them that we do this stuff for real,” Love says. 

Love says the relationship with the local community schools is like a co-op or a mini pipeline. Some students aren’t looking to go to college but are looking for a career. If they like designing things on a computer but don’t know what they could do with that in the real world, they might see a dental lab operation and find a path for themselves. Apex’s lab in California has 6 employees from that program.

“We get 1 to 2 each year out of this program. Some will stay, and we have some that have been here as long as 15 years,” Love says.

Love says they farm graphic design programs at the community college level because the students are skilled with computers and understand how to work with them. Love says it’s also essential to keep an eye out in your community. Many people you might not at first consider a lab technician might be an excellent fit—food service workers, baristas, grocery store employees.

Love says attitude and culture should be critical characteristics to look for when searching for new employees. Then train them how to work in the lab.

“One of our last hires here in California was a gentleman who worked in the fast food industry. He now runs our 3D printing department. He loves it, and it was a great change for him,” Love says. “We hired him 100% because of his attitude.”

“If you have a barista that you love and is very personable and you think they would do great at the bench, talk to them. Get them into your lab,” says Marybeth Starr, head of brand promise for Harvest Dental Products.

Starr also uses local high school programs and community colleges to generate interest in the dental lab industry. For example, she does a career day at a local high school and shows a video about the dental lab industry and what’s possible.

“These are kids that might not want to go to college. So I tell them, ‘Here’s a great trade that you can start at the ground floor and you can work up to owning your own business,’” Starr says.

Starr says hiring managers should leverage the network among lab technicians. Technicians from different labs talk a lot; when there is an opening at yours, see if any of your technicians know of someone who’s looking.

“They are going to be the first to talk to their buddy about coming over to work with you,” Starr explains.

Moreover, Starr thinks the dental lab industry could use more publicity. As a niche community, many people don’t know it exists. Starr says when she explains how she makes the products that make the teeth to her friends and family, many say, “I thought the dentist did that.”

“We are a tiny community,” Starr says. “So the more we can spread the word, the better it is for our work community.”

Now that you have hired employees, including many who have never worked in a dental lab or, in some cases, anywhere, you need to train them. It is essential to develop a comprehensive training program for these new people. New hire training has a few characteristics that improve effectiveness, as follows: 

Involve your existing team in what should be in new-hire training, ideally from your key employees who understand what the job needs and what gaps might exist in the current program.

Create an ongoing, task-oriented, customizable program assigned to a performance standard instead of a fixed time spent training with regular updates.

Train for team or company culture in addition to the basics. Fitting into the company culture is essential to onboarding, especially for employees entering the workforce.

Accommodate different learning styles—visual, hands-on, or reading—to give new team members the best chance at success.

Recruit your current team members with excellent leadership skills to be involved with onboarding and training new team members.

Love says the change to hiring for attitude rather than skill significantly impacted the lab’s culture, especially regarding simplifying training. Ignoring these soft skills was not giving them the culture they wanted, which is an essential value at Apex.

So now in the hiring process, the hiring manager takes the candidate around to meet the team to see if the candidate is a fit for the whole team. Using a positive attitude as a guidepost for hiring has made things easier for the lab regarding training.

“If you get someone with a can-do attitude that’s positive, that’s eager, that wants to learn more, they’re almost infectious in your environment,” Love says. “If they do, man, it’s easy because the whole team will help train them.”

Love says they get new hires with little to no dental lab experience started on training with PTC Dental, whose program teaches form, function, and shapes of teeth as the foundation of training for inexperienced lab technicians. They learn the same vocabulary as the rest of the team, so when they starts talking teeth, everybody understands the discussion, Love says.

Starr agrees that there is an enormous amount of free education offered right now among manufacturers, distributors, and dealers. YouTube has videos, recorded classes, and webinars that can help train inexperienced technicians.

“There’s a lot of great resources out there,” Starr says. “You could bring somebody in that has zero knowledge about the dental community and you could sit them at your bench with your best technician and teach them on the job."

A term you hear in business these days is upskilling, which means enhancing an employee’s current ability with new ones. Unlike reskilling, which is teaching someone to move into an entirely new role, upskilling is all about improving the employee’s knowledge and experience to make them more versatile in the organization.

points out, versatility isn’t the only benefit of upskilling; it’s reducing employee turnover. Pew Research Center indicates that people leave an organization because they do not have an opportunity to advance. Other research supports this, suggesting that employees leave also because they feel there isn’t enough career development where they are.

Hanging on to staff by providing upskilling opportunities overcomes losing employees to turnover and builds an internal talent pipeline. Recruiting internally saves the costs associated with bringing in external talent. Moreover, learning new skills increases employee job satisfaction and boosts productivity.

Starr is an advocate for upskilling. Once you have a technician started with the basics, Starr says, you can begin to cross-train them. For example, maybe the lab starts the new employees with modeling then moves them over to crown and bridge, followed by removables. Then a lab can train them in CAD/CAM design.

“The more knowledgeable you make your team, the better off you are,” Starr says, adding that the newer generation craves variety in their work. “Some of these younger kids don’t want to do 1 thing all day long. So they might want to try something new. They’re looking over at the guy at the bench, thinking that job looks interesting.”

“So if you can—and I know now with the employee shortages, it’s difficult—then I would 100% cross-train because that embeds them into your lab life and keeps them part of your lab family,” Starr explains. “If you hire well and it’s somebody that you see eye to eye with in general anyway, then it starts as a good relationship.”

Love agrees most people today want to know their career path. He says the younger generations in the lab have pushed management to tell them what their job might look like in 3 to 5 years. They also ask management why they should stay at the company or what the company has to offer.

Love says giving people a road map or succession plan for moving up in the organization is essential. If your organization works in levels, employees need to know how to progress from 1 level to the next, ie, from everyday technician to supervisor. They want to know that the organization is going to teach them not only the technical skills they need to work in the dental lab but also communication and leadership skills.

Moreover, because many of his recruits are students, they must understand how to work with coworkers. Navigating this transition is essential because the business world, coworker to coworker, differs from the academic world of student to student.

“You have to give them a development plan,” Love says.

The development plan includes education opportunities and not just those inside the lab. Love says Apex likes to introduce employees to the idea of the dental lab community, including conferences like LMT Lab Day Chicago or Lab Day West and programs offered online or in person by vendor partners. Also, Love likes the Foundation for Dental Laboratory Technology, which offers hundreds of educational videos for team members.

“The education has to be a key component that you can offer to them to motivate people to become certified dental technicians,” Love says, adding that Apex pays for the certification and yearly licensing fee for its employed Certified Dental Technicians and ensures they meet their annual education requirements.

All employers are looking for ways to retain employees. Firms address employee retention in today’s market by creating mentorship programs, making DEI programs a priority, and leveraging career development officers. Job market conditions also necessitate competitive compensation and employee benefits packages.

One of the most successful ways that Love says Apex keeps its bench filled is by offering more flexibility. For parents who have kids in school or employees who hate working before 10 AM, Love says Apex tries to accommodate these needs or preferences whenever possible. While Love admits that flexible schedules require a new level of finagling for managers, the flexibility in the workday has made a significant difference in morale.

Apex has early and late shifts in many of its labs and can let supervisors or managers choose what staff will cover these shifts. They have to keep an eye on due dates and time lines to meet the client demands because that’s what ensures the lab gets paid. Love says this flexibility requires a bit of a balancing act, but the benefits are worth it. 

“We all have families. We all have lives. And the 1 thing our organization has tried hard to work on is work-life balance. Because if they’re right in their personal life, man, it’s amazing. They’re much better at work,” Love says. “But if they have things going on and they feel really tense, there is stress that’s put on them. So if you can relieve some pain points, they are loyal to the team.”

Apex offers a complete benefits package, including employee health insurance, a 401(k) matching program, paid time off, and sick time. It also provides short- and long-term disability, employee life insurance, and flexible spending accounts. This package is essential for employees, Love says, especially the health insurance, which can be expensive.

“It’s a crucial part for most people, especially those with young families,” Love says.

Starr thinks culture is critical to retention, but not a culture that relies on beanbags, ping-pong tables, and nap pods. Instead, she says, a respectful workplace that allows the sharing of ideas is the best retention tool.

“There’s a lot to be said about working at a company that you admire and respect and feel respects you,” Starr says.

1. McRae ER, Aykens P, Lowmaster K, Shepp J. 9 trends that will shape work in 2023 and beyond

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3. Hall J. Why upskilling and reskilling are essential in 2023. February 24, 2023. Accessed April 13, 2023. 

https://www.forbes.com/sites/johnhall/2023/02/24/why-upskilling-and-reskilling-are-essential-in-2023/?sh=3ae14fae4088

Top reasons why employees quit. U.S. Chamber of Commerce. October 5, 2022. Accessed April 13, 2023.

https://www.uschamber.com/co/. Available at: https://www.uschamber.com/co/run/human-resources/top-reasons-why-employees-

In an uncertain job market, how can companies retain workers?. New York Times.

 Updated February 25, 2023. Accessed April 10, 2023. https://www.nytimes.com/2023/02/13/business/employee-retention-quitting-companies.html 

How can dental labs recruit and retain their talent? We look at how labs can fill the bench, train it, and keep it full. 

Filling the Bench: How to Find, Train, and Retain Lab Technicians in Today’s Competitive Market

Scanner technology has come a long way over the past 10 years and continues to make extraordinary leaps in functionality, but are there still some areas of dentistry where a traditional impression is better than a digital one? Unfortunately, as of now, the answer is still yes.

Intraoral scanners are a popular technology for dental practices and labs that have embraced a fully digital workflow. Scanners take digital impressions, which are faster to complete than traditional impressions and are more comfortable for the patient. Some experts say that improvements to scanner systems and digital impression techniques might soon replace conventional impressions.

Part of this sweeping prediction is that digital impressions have many advantages over traditional impressions. A 2021 ACE Panel report suggests that of the 369 panel members, 53% use an intraoral scanner. Of those respondents, 70% said it improved their clinical efficiency. Nearly half of the respondents (40%) said the intraoral scanner provides better outcomes than conventional impressions. Also, 90% said they use the scanner the most for single tooth–supported crowns.

 However, clinicians use digital impressions in many other restorative situations including inlays, onlays, fixed partials, crowns, aligners, occlusal devices, and surgical guides.

Research also shows that using digital impressions instead of conventional ones positively impacts implant dentistry. A 2016 

 study suggests that dentists and dental students found that intraoral scanning for making impressions was relevant and more straightforward than making conventional impressions for implant therapy.

 Both groups also considered an intraoral scanner more effective, although more students thought that than practicing dentists. Moreover, 76% of the students preferred intraoral scanning. By contrast, 48% of dentists preferred conventional, whereas only 26% liked intraoral scanning better than traditional impressions. (The remaining 26% of dentists thought either method was acceptable.) Investigators concluded that for single-implant sites, the scanner with its quadrant method scan was more time efficient than a conventional full-arch impression technique.

Where are Conventional Impressions Better?

With that said, there are still some areas where a conventional impression is a better choice. A 2016 Finnish study published in the 

 suggests that the traditional impression technique is better than digital for full-arch impressions.

Moreover, a September 2020 article published in 

 discussed digital dentures and concluded that a conventional impression was still best for the workflow. The biggest challenges with digital impressions that the authors cited include the following

The learning curve’s perceived difficulty

The ongoing costs associated with subscription fees for the equipment and software

However, there were also the physical challenges of using an intraoral scanner on edentulous patients, namely the tricky nature of accurately capturing the mouth’s complicated anatomy and soft tissue position. Specifically, the investigators indicate that capturing the mucosa in 1 pass is essential because it moves, and going back to recapture missing information results in errors in the digital impression.

A lot has changed with scanning technology since then, but the full-arch scan can still be problematic. In a 2022 article on the American Dental Association’s website, Jacob G. Park, DDS, a clinical professor in the Department of Comprehensive Dentistry at the University of Texas Health at San Antonio, suggests that digital impressions might not be as accurate as a traditional impression for complete-arch digital scans for tooth- and implant-supported prostheses and removable partial and complete dentures.

Scott Dickinson, DMD, general dentist and owner of multiple private practices with 6 offices, including one in Gulf Breeze, Florida, says that part of the problem with scanning for dentures is that intraoral scanners need hard tissue stops, which enable the software to orient in the mouth. When performing a complete denture, this is incredibly challenging, he says. Although he thinks the scanner manufacturers are getting close, the digital impression cannot get all the anatomy that enables fully removable prosthetics to fit without many adjustments. However, he is seeing promising results when scanning for many partial dentures.

“You still have the same problem if you get a long Kennedy Class I or II. They have a difficult time when you get long stretches of edentulous areas. You have to learn some field tricks to get the scanner to work,” Dr Dickinson says. “But I still use polysulfide when it comes to a fully removable. The digital impression just isn’t there yet.”

Another area where Dr Dickinson has difficulties using an intraoral scanner are in roundhouse situations. For example, if he is crowning teeth 3 to 14, he still wouldn’t scan because even though the intraoral scanners capture the prep beautifully, they can’t grab a proper bite for a crown or bridge case that significant. Dr Dickinson says the computer gets lost.

“Then when you get it back from your lab, you have to grind,” Dr Dickinson says. “What ends up happening is you have to adjust the occlusion so much that you have to kind of remake it. So, for a really big crown and bridge case, whether that’s all on 4 or a multiunit implant or cosmetic work, I still go back to a conventional impression.”

, agrees that sometimes a digital impression isn’t as good as a traditional impression, but that these instances are becoming rarer as scanner technology improves. These days, what makes a digital impression challenging to take is the same thing that makes a conventional impression difficult to capture. For example, he explains that if the margin is deeply subgingival, then the dental impression quality will suffer, whether the impression is digital or traditional.

Another situation that could compromise the digital impression is when clinicians use the scanner to capture a digital impression of patients with unhealthy periodontal situations. It is challenging to capture an image when blood, saliva, and other contaminants are in the area. However, those impressions would be difficult with traditional materials as well, he says.

“Digital impressions always work better when the margins are obvious,” Dr Flucke says. “My preparations have a finish of a shoulder or a heavy chamfer, but there might be a situation where a doctor might need to do a feather-edge margin, and that would be harder for a system to pick up. It is not a deal breaker, but I could see where it might be hard for a scanner to pick up.”

Jason Goodchild, DMD, vice president of clinical affairs for Premier Dental Products Company in Plymouth Meeting, Pennsylvania, agrees that the challenges are multifactorial. For example, sometimes the problem with capturing the scan is access, but he says the sensors are getting smaller to address the intraoral scanner’s role in that situation. With that said, the sensor size cannot address how wide the patient can open their mouth or the state of their soft tissue.

Dr Goodchild says the preparation of the tooth, specifically hemostasis and tissue retraction, will often dictate whether the area is scannable. If you cannot achieve appropriate tissue retraction, the scanner can’t work. Intraoral scanners are optical devices; they cannot see through tissue and blood. Moreover, Dr Goodchild explains that clinical situations exist where a digital impression won’t work. “If the margin is subgingival or if you need to put a bevel or a knife-edge margin on a bevel on a tooth, that’s not going to scan very well,” Dr Goodchild says.

Then there is the situation where a dentist’s lab is not digital. For example, Dr Flucke’s small denture lab in the Kansas City metropolitan area in Missouri cannot accept digital impressions. In those cases, Dr Flucke will print the models and send them to that lab, which he finds frustrating.

“It’s sort of like having to ride a horse to send a fax, if you get what I mean,” Dr Flucke says. “Also, this is a bit technical, but I do sleep apnea cases, and there is one very large lab here in [Kansas City] that will take my models via digital, but sleep appliances require a very special bite registration that shows how the arches are oriented when the mouth is open. So that lab requires me to send them a bite registration in the impression material.

“I quit working with them when I told them there was a way to do that digitally, and they told me [there wasn’t]” Dr Flucke continues. “I found that obnoxiously funny because I was working with a lab that could do the whole process digitally.”

Dr Goodchild says that since the first commercially available scanners in the mid-1980s, the technology has been improving, from the technology to the software and everything else. So, there are areas where digital scanners aren’t going to work clinically, but it isn’t because the technology is not improving all the time. “It’s like a new iPhone; they’re introducing the next big thing every year or 2 years,” Dr Goodchild says.

Moreover, clinicians want to integrate digital into the daily workflow across the clinical day. Incorporating all the puzzle pieces—from the patient record to occlusal relationships to the treatment plan and digital scan—and making that visually accessible in the operatory is a standard many dentists look forward to achieving. However, Dr Goodchild says the technology cannot support this workflow yet. “There [are] still probably a ton of times when you do [a] simple crown and bridge [where] you just can’t use a scanner,” Dr Goodchild says. “That’s something we are getting better at, but we’re not there yet.”

Dr Goodchild thinks some digital workflow manufacturers think traditional impressions have a life span that will run out as technology improves. However, he doesn’t envision a future where traditional impressions have no place in a dental practice. Dental professionals will always need a work-around because one way to do things does not work for all situations. “The ratio of scanning to traditional impressions is going to continue to move toward the digital side, but I still think there will be a need for those silicone-based impression materials and everything else,” Dr Goodchild says.

Dr Dickinson is optimistic about the future of intraoral scanning technology and digital impressions for full-arch or large-span restorative cases. He is confident the scanner companies will fix the problem because the market for this area in dentistry is enormous. As a result, Dr Dickinson estimates that dentists will see improvements in this area in the next couple of years.

"I think they’re going to get there. I would stake a claim that in 5 years from now, it will be super rare to use impression material,” Dr Dickinson says. “You will always keep it in the office because you don’t want to get caught without it when you need it, but you are going to throw it away and reorder it every year because you won’t use it all before it expires.”

By contrast, Dr Flucke says he already rarely takes traditional impressions. “Sometimes, if we are really busy and someone needs bleaching trays. Other than that, though, it’s pretty uncommon,” Dr Flucke says.

Having both iTero and Trios intraoral scanners in his offices, Dr Dickinson says the future of taking impressions is digital. Moreover, he thinks general dentists without scanning capabilities should invest in one for the office. Having the hardware is essential because he sees that the upgrade will be in the software. “I don’t like to be the first guy on the block to buy the new technology, because I want to see [whether] it works. This really works,” Dr Dickinson says. “If you are a general dentist and are not nearing retirement, this equipment should be in your office.”

Schmidt A, Schlenz MA, Liu H, Kämpe HS, Wöstmann B. The influence of hard- and software improvement of intraoral scanners on the implant transfer accuracy from 2012 to 2021: an in vitro study. 

Traditional impressions may become a rare practice in dentistry because of the advantages of digital impressions, but they are not yet a thing of the past.