Interview: “Dental laboratories will be left in an extremely vulnerable position”
Close cooperation between dentists and dental technicians generates synergy and helps to ensure high-quality prosthetic dentistry. However, the COVID-19 pandemic has diminished the confidence of many professionals working in the dental field and has created much uncertainty about the future of dental technology. In this interview, Dental Tribune International discussed the topic with Barry Tivey, an accomplished dental technician and owner of Ceramic Techniques, a dental laboratory that produces crowns, bridges, implants and aesthetic restorations.
Mr Tivey, could you tell us something about yourself and your background in dentistry?
I completed my apprenticeship over 35 years ago in a crown and bridge laboratory. On leaving school, I joined the civil service; however, I used to watch my future father-in-law in his laboratory and was fascinated by the intricacies and artistry of the profession. After much persuasion, he agreed to train me, and I enrolled on a day-release course at a local college. He was an old-school technician, and when I presented most of my early work to him, it was greeted with a shake of the head and a trip to the waste bin. I took over the running of the laboratory 25 years ago, and since then, we have introduced implants and digital technology into our portfolio of services.
Continuing education has always been important to me, and I completed a Master of Science in Dental Technology in 2015. I am currently president of the Dental Technologists Association (DTA) in the UK. In my spare time, I like to play golf and ride my motorcycle.
In light of the pandemic, many dental offices were instructed to close their doors and to provide emergency care only. How has the COVID-19 pandemic affected work in your dental laboratory?
Let me try to put this into perspective. Five years ago, we moved into a purpose-built laboratory, and I thought that it was the most stressful situation I would ever encounter. How wrong I was! In the week before the lockdown, work had started to slow down quite dramatically, and that was the situation until dental surgeries started to reopen on 8 June. Work is returning slowly, but it is nowhere near pre-lockdown levels. Our laboratory provides crown, bridge and implant restorations, and we have a mix of private and National Health Service (NHS) clients. However, according to my experience, it is mostly private surgeries sending work at present, and only a handful of cases are coming from NHS practices.
A great deal of research has been done on the economic, social and psychological effects of COVID-19 on general dentists. What impact has the pandemic had on you?
The pandemic has had an impact on every aspect of life. From a business perspective, turnover has been dramatically affected, as no work has come into the laboratory for over three months. It has been a very fast-moving situation, and a lot of information has been posted by government and professional bodies daily. Just trying to keep up with that has been, in itself, very stressful. On a personal level, my daughter was working abroad when the lockdown began and had to try to arrange a flight home, and I had several elderly relatives who were in the SARS-CoV-2-vulnerable category and needed suitable care arrangements to be put in place.
The DTA kept members informed of the financial help that was available to them, as well as provided them with general health and welfare advice; however, there was very little constructive guidance specifically offered to dental technicians by any governing bodies. I spoke to other dental technicians and laboratory owners and found that the majority of them are small business owners. There is much anxiety surrounding cash flow, future business and how to manage staffing requirements with so much uncertainty surrounding the volumes of work that can be expected in the future. Many staff members fear that they may be made redundant owing to the current lack of work in the industry.
“We have experienced quite a substantial drop in the number of cases coming into the laboratory every month”
Most dentists use a dental laboratory to manufacture dental prostheses. Have dental laboratories recently experienced a reduction in the number of prescriptions for custom-made dental appliances?
Yes, we have experienced quite a substantial drop in the number of cases coming into the laboratory every month. In fact, owing to the restrictions on aerosol-generating procedures (AGPs), many of us face receiving very little or even no work at all in the coming months. The 60-minute fallow time significantly reduces the number of appointments a clinician can offer to patients, and I feel this will potentially reduce the amount of work a dental laboratory can expect to receive. When you combine the AGP restrictions and the phasing out of government-funded schemes in October, I think that dental laboratories will be left in an extremely vulnerable position.
Dentists in the UK have received continuous support from the government during the pandemic. Has this also been the case with dental technicians? Has the government shown tangible support for dental technologists and dental laboratories in terms of rescue packages, grants or value added tax (VAT) cuts, for example?
My understanding is that the majority of dentists are being supported via the NHS and continue to receive a percentage of their monthly payments, though private dentists do not benefit from this. Dental technologists do not receive any support directly from the NHS or via clinicians. In fact, I have been made aware that some technicians still have unpaid invoices for work that they completed in March. My business was fortunate enough to be eligible for several grant schemes, and I am aware of technicians who have been able to apply for grants through the Self-Employment Income Support Scheme or the Coronavirus Job Retention Scheme; however, unfortunately, some technicians have been unable to claim either. I have heard of a number of laboratories that have closed as a result of the financial impact of the pandemic.
There was a brief VAT cut on personal protective equipment, which helped purchases when preparing to return to work, but nothing specifically relating to dental laboratories. I suppose that, on the whole, we are a small profession, of which not many members of the government are aware. Many people do not realise that their restorations are custom-made by highly skilled technicians, rather than being taken from a shelf marked “Mrs Smith’s teeth”!
The DTA was very proactive in supporting technicians during the lockdown and provided some excellent advice for technicians starting back to work. It also provided the Dental Laboratory Crisis Management Pack.
“The dental technology profession is made up of many small businesses that are extremely concerned for their future. I fear that many will not survive this pandemic”
The coronavirus is changing business practices around the world. Do you think that the pandemic will create any lasting workplace changes in dental laboratories?
Yes, from a technical view, we are already used to cross-infection control and disinfection procedures. However, in the long term, there may be a quicker move to intra-oral scanning by dentists rather than taking impressions. This will push forward the digitalisation process.
From a business aspect, the dental technology profession is made up of many small businesses that are extremely concerned for their future. I fear that many will not survive this pandemic, resulting in a loss of skills which will have an impact on the whole dental team and could result in patients suffering long delays for their custom-made appliances.
As president of the DTA, I am also very concerned about our dental technology students currently in training. Closure or downsizing of dental laboratories will have a great impact on many of them. However, the DTA will continue to focus on education to meet and cope with future challenges.