“Doctor, was that crown you just gave me from a Certified Dental Laboratory?”

“No, but I did stay at a Holiday Inn Express last night.”

These are clearly words dental patients should never really hear. The popular television commercial for the hotel chain has a commercial that begins in an operating room. A man that appears to be an instructor at an open door is guiding first time jumpers out the door. He coaches each of them, "Pay attention, right, heads up, at 4,500 feet, look, reach, pull. Go, come on you can do it." A woman about to jump stops and asks the man, "How many times have you done this?" He answers, "None but I did stay at a Holiday Inn Express last night."

There are 150,000 dentists in this country, about 12,000 dental laboratories and yet only three states have regulations requiring certification of an owner or operator of a custom manufacturer of dental prosthesis. Only another 341 laboratories have achieved Certified Dental Lab status (CDL) by complying with a voluntary set of uniform standards for health and safety processes set by the National Association of Dental Laboratories (NADL). Many more could if they applied, made small changes and stepped up the task.

My dentist, physician, EKG technician, airline pilot, medical prosthesis manufacturer and fitter, even my wife’s nail technician all have to be certified or licensed.  I even need a license to hunt or drive a car. In Rochester Hills, Mich., we need a temporary certificate to burn leaves in the fall. It seems incomprehensible to me that in dentistry, the custom manufactured and fitted medical devices (crowns, bridges, implants and dentures), so designated by the FDA, are not necessarily made in a licensed or certified facility or under the guidance of a certified dental technician.

Is the facility safe and up to date? Who oversees the processes? What materials and especially what type of alloy (metals) is used? These are things we should be certain of when we visit our dentist. Allergic reactions to alloys are a serious concern to many patients. Insurance companies want assurance that the alloy used in the restoration matches what they were billed for by your dentist. They are unlikely to come and remove the crown and assay the metal underneath.  That has led to the use of alloy identification stickers provided by the manufacturers through the Identalloy Council. Most laboratories use these to assure the dentist, patient and the insurance company if questioned of the alloy content of the restoration.

As patients, we should be asking:

    * Does your laboratory employ Certified Dental Technicians?

Preferred Answer: Certified Dental Technician (CDT) is the recognized designation for dental technicians who meet a uniform standard of textbook knowledge and applied skill in dental technology. The Certified Dental Technician is the only program for dental technicians recognized by the American Dental Association. Technicians who hold the CDT designation take 12 hours of continuing education annually to ensure that the dental restoration your dentist receives and are ultimately used by the dental patient are of the highest quality and meet the patient's needs.

    * Is your laboratory a Certified Dental Laboratory?

Preferred Answer: Commercial dental laboratories are largely unregulated in the United States. However, through voluntary certification, laboratories can become certified. Certified Dental Laboratories (CDL), just like individual technicians, have met a uniform standard for health and safety processes within their laboratory. One of the requirements of the CDL program is that the laboratory must employ a Certified Dental Technician in each department of the laboratory.

    * What Materials are going to be used in my restoration?

Preferred Answer: Laboratories maintain Material Safety Data Sheets (MSDS) on each material used in their laboratory. The materials used in dental laboratories that are used in the manufacture of dental restorations are approved by the U.S. Food and Drug Administration. Some dental patients may have allergies to certain types of materials. Ask your dentist to review the materials used in your restoration to determine if you are prone to any allergies from certain types of dental alloys or metals. Your dentist should have an Identalloy sticker on hand that was provided with the restoration.

    * What infection control procedures does your laboratory follow?

Preferred Answer: With today's environment of infectious diseases changing rapidly, its important to understand the importance of infection control in the dental setting. Dental laboratories must comply with federal OSHA standards on infection control including standards regarding blood borne pathogens. Proper infection control must take place both in the dental office and the dental laboratory to ensure that the restoration placed in the patient's mouth is free from bacteria. Certified Dental Technicians are required to receive training in proper infection control procedures every year.

Texas, Kentucky, South Carolina and Florida either require CDTs or registration with the State Department of Health. I hope that a few years from now, the ratio will be reversed and there may be just a few that have not stepped up to this level of professional commitment. Then, we can stay at any hotel we want!