Current status, crisis and trends in Chinese dental technicians

Abstract

Background: Chinese dental technicians play a significant role in the globalised market of dental prosthesis fabrication, but this subject has not been investigated in detail. The demand for dental prostheses increases as individuals pay increasing attention to their oral health. Therefore, it is important to investigate the status of Chinese dental technicians. Objective: To evaluate the current status of Chinese dental technicians. Methods: Dental technicians’ resumés, which reveal information regarding dental technician manpower, degrees, working age and salary, etc., were analysed and compared with those abroad. We also estimated the future demands of dental technician manpower, and discussed some potential solutions. Results: There are fewer dental technicians in China than in other developed countries; they are also of a lower standard. Male technicians outnumber females. The education level of technicians is insufficient, and the education programme is still in its exploratory stage. Conclusions: The development of dental technician teams in China represents both an opportunity and a challenge. It is important to move forward from the current situation to yield long-term development. This article provides information on the Chinese dental technology industry, identifies the problems and offers solutions for its development.

INTRODUCTION

Dental technicians are an essential component of a dental team and play indispensable roles in meeting a nation’s oral health needs. They fabricate all types of prosthesis, including dentures, crowns, bridges, removable partial dentures (RPDs) and other kinds of oral therapy equipment, to help dentists complete dental therapy. This is a career that combines science and art, involves relatively stable tasks and is needed worldwide. Dental technicians need to have a thorough understanding of oral medicine, materials, mechanics, foundry processes and aesthetics to make excellent dentures for patients in order to rebuild dental function and appearance.

Dental technicians, dental assistants and dental hygienists make up the allied dental workforce. However, in China, the allied dental workforce mainly includes dental technicians, because dental hygienists are usually replaced by dental nurses.

INTERNATIONAL STATUS

Although the dental technician is a member of the allied dental workforce, this vocation is not well recognised. Many laypeople do not even know that it exists. Most dental patients have no idea where or how their dentures are produced. In general, dental technicians are not well recognised by nations and governments, and allied associations attach little significance to this part of the team (Table 1)¹.

Table 1.

Numbers of dentists and dental laboratory technicians (DLTs) in different countries

Country/year	Dentist	DLT	Dentist/DLT ratio
Germany/2008	65929	58000	1.14
UK/2008	31000	7094	4.37
USA	173574 (2003)	54000 (2000)	n.a.
Japan/2004	92874	36765	2.53
Australia/2008	4206	550	7.65

n.a., not available.

Dental technology in most developed countries has reached a certain standard level. Education and employment are standardised, such as in the USA, Japan and Germany. A certain number of students are trained each year and these graduates enter the workforce. Although they may have problems in meeting their own demands, these countries are in a better position than China. They have a stable number of employees and standard qualifications, which meet the technical needs of their domestic situation.

In Europe, training generally takes place in special schools, sometimes associated with dental schools. In Germany, training lasts for 1 or 2 years, often following prior training as a dental technician. The total training period is 3 years, 40% in vocational schools and 60% in dental laboratories. After successful examination by the Chamber of Handicraft, graduates are awarded a registered qualification. In the UK, training for a dental technician is provided by 11 universities and colleges. The period for basic training is normally 4 years, with an additional period of up to 2 years for more specialised work².

In the USA, dental technicians receive accredited education and training through programmes at junior colleges, technical colleges, universities and vocational schools. A high school diploma/General Equivalency Diploma is the minimum requirement for entrance into most dental laboratory technology programmes. Dental laboratory technicians are certified by passing an examination that evaluates their technical skills and knowledge³.

SITUATION IN CHINA

The first dental technician, Deng Zhenming, was trained by Dr Ashley W. Lindsay, who is honoured as the ‘Father of Chinese Dentistry’, in 1912. However, dental technology did not develop quickly until the 1980s. There are 188 dental schools in China⁴, but only a few provide dental technology education. Dental technicians are mostly trained in technical schools and junior colleges, and most practitioners in dental laboratories lack a formal education.

The dental technology industry originated in the 1990s in southeastern China, and has undergone approximately 20 years of development. Although the developmental processes in Japan, Europe and the USA have been studied, the Chinese dental technology industry has unique characteristics because of its special environment. As a result of low labour costs, China is widely known as the world’s factory for the manufacture of dental prostheses. Both opportunities and challenges exist on the road ahead for this important and emerging field.

Manpower

World Health Organisation (WHO) data indicate that China had 21,043 dental technicians in 1995 and 136,520 dentists in 2001. A report from the Chinese Stomatological Association showed that there were 182,100 dentists and 133,000 dental technicians in 2009⁴, and the dentist/technician ratio was about 1.37. However, with a population of 1,339,724,852⁵, the number of dental laboratory technicians per million inhabitants is about 99.2. Despite some overseas production, dental prostheses are also manufactured by Chinese dental technicians because of the low labour costs; therefore, there is a severe shortage of Chinese dental technicians.

Gender

Of the 1876 dental technician resumés available from the websites http://www.kqzp.cn and http://www.kq520.cn, 1276 are male and 600 are female. Thus, there is a strong imbalance between males and females (male to female sex ratio, 2.08). Furthermore, the male to female sex ratio increases with increasing working age. This may be the result of the heavy workload.

Regional distribution

Figure 1 displays the locations of the 3943 dental laboratories. Data were collected from http://www.kq36.com. It shows the number of dental laboratories in each province of China. It can be seen that laboratories have a higher density in some of the southeastern provinces, such as Guangdong Zhejiang, and in some large cities, such as Beijing and Shanghai. These regions have fast-developing economies, convenient transportation and an adequate supply of labour. These provide the power for the dental technology industry, which, in turn, boosts economic growth.

Figure 1.

Dental laboratory distribution in different provinces.

Educational level

Figure 2 shows the educational level of dental technicians. The data were analysed from job resumés on the website http://www.kqzp.cn. Sixty-four per cent of Chinese dental technicians graduated from junior college and technical secondary school. Only 3% of technicians have Bachelor’s degrees. Thirty-three percent of dental technicians graduated from middle school or high school, and most have no professional training. After graduation, they work in large dental laboratories as trainees, where they are usually trained in a fixed procedure, such as dyes or wax patterns. Thereafter, they focus on practising this specific procedure. Many are experts on one step, but totally naïve with regard to others. This situation can cause misunderstandings, disrupt the coherence and continuity between two procedures, and lead to failure of the prosthesis.

Figure 2.

Distribution of degree of education of Chinese dental technicians.

Other

From the 464 online job resumés collected from http://www.kq36.com, the average expected salary is 3482 Renminbi (RMB) a month. This increases with age and experience.

The income of dental laboratory technicians is not attractive. As a result, many employees cannot live on their incomes and, after 3–5 years, many young technicians leave their jobs to find better employment.

The gap between China and developed countries does not involve only the learning and application of new technologies, such as implants and attachment technology, but also professional quality and basic skills, such as occlusion design and the correct use of articulators. Numerous technicians lack awareness of model protection. The exactitude of dyes and casting is poor. Therefore, the direction of dental technology education should give priority to basic theories and techniques. Only in this way can we improve the dental technology level in China.

CRISIS AND GOALS

Numbers

According to the data in Table 1, there is a wide gap between the number of technicians in China and those in developed countries. In accordance with the international division of labour, Chinese employees will, in the future, take dental work from abroad, so that more technicians will be needed. Moreover, large numbers of ageing dental technicians will retire from practice during the next 10–15 years, and some of the younger generation will leave the workforce because of the low salary. The dental technician workforce is disproportionately under-represented relative to the size of the general population. Thus, there is a critical shortage of manpower that threatens to impair the ability of dental technicians to meet future demands for dental services.

At the same time, the quality of Chinese dental technicians is low, with few experienced technicians. The growth of the current team of dental technicians is largely driven by quantity, not quality. If we ‘eliminate’ substandard technicians, the number of dental technicians will be far less than the lowest level of requirement.

In Table 2, Japan is taken as a reference standard, because the level of oral health care in Japan is the highest in Asia and its dental prostheses are fabricated by domestic technicians. Dental technology education and industry are more mature in Japan because of their longer development. There were 36,765 dental technicians (Table 1) and a population of 127,787,000⁶ in Japan in 2004. Therefore, the number of dental technicians per million inhabitants is about 287.7 in Japan.

Table 2.

Estimated numbers of dental laboratory technicians (DLTs) in 2015 and 2020

Year	DTL per million inhabitants in Japan (2004)	Predicted population of China	Estimated number of DLTs
2015	287.7	1362640000	392032
2020	287.7	1381160000	397360

Table 2 shows the forecast numbers of Chinese dental technicians needed in 2015 and 2020. China’s population will reach 1362.64 million by 2015, and 1381.16 million by 2020, based on population estimations⁷.

Highly educated professionals

We can also see from Figure 2 that dental technicians in China have a low level of education. Most dental technicians in China are not as well educated as dentists. They are only high school graduates without any professional education. This causes communication service barriers. Dental technology education requires a degree one level higher than that awarded to programme graduates, which is a Bachelor’s degree, but the majority are awarded junior college degrees. Therefore, the need for experienced and well-educated dental technicians is paramount.

Moreover, almost all dental material and equipment companies possess weak independent innovation ability. The firms are of small size and the product quality is unstable, limiting their options to reproduce the techniques of foreign companies – another bottleneck in the transformation from ‘Made in China’ to ‘Created in China’. Therefore, there is a desperate need for high-quality technicians to help with research work.

There are about 188 dental schools in China⁴. Each school needs two to three teachers to teach dental technology lessons to dental students; therefore, about 376–564 dental technicians with Master’s degrees are needed.

Quality of education

Whether or not educated technicians can meet the needs of dental laboratories will be an important measurement of success in education. Students who are not well trained in skills at school need to practice first when they enter the workforce. Most large laboratories would rather train technicians themselves than recruit graduates from a technology school. Under these circumstances, graduates have difficulties in finding jobs with reasonable salaries. Meanwhile, the enrolment of freshmen becomes more and more difficult. Therefore, it is very important to improve the quality of education, and to find a correct mode of education.

Technicians’ living conditions

There is a saying that there must be a great dentist behind a beautiful smile, and there must be an experienced dental technician behind the dentist. This dental proverb tells us the importance of a dental technician and also the fact that dental technicians are not well recognised. Salaries for dental technicians are another issue that must be considered. Some experienced technicians have worked for years, only to achieve about 5000 RMB a month, almost the same as a newly graduated dentist.

Heavy workloads, low salaries and low social status make it more difficult for dental laboratories to keep their staff. Moreover, schools have difficulties attracting new students. Dental technicians are urgently needed, but a number of technicians change their career to become dentists after graduation. They would rather be third-rate dentists than a talented dental technician in pursuit of a higher income and higher social status. Alternative methods of rewarding technicians should be sought.

DISCUSSION

Supporting technician education

As a result of the present situation in dental technology in China, the training of dental technicians should combine school academic education and vocational training. The quality of school education should be improved and systematic standardised vocational training should be provided to employees; technical certification could then be awarded.

School training is the best way to yield talent. After studying in schools, students achieve a basic knowledge which is needed in future work as scientific guidance. Through daily practice, they will become the core talents of the industry.

It will be necessary to provide training courses for experienced technicians who have been working for years, but without qualification certificates. After training, if a technician reaches practitioner level, a qualification certificate should be awarded.

As dental technology has a strong connection with materials and process improvement, and materials and technology are updated rapidly, it will be necessary to host and attend academic conferences frequently, so that technicians will be able to understand the most advanced technology and have an opportunity to exchange their experiences. Only by broadening our views can we take part in international competition.

Establishment of curriculum standards

Standardisation in curriculum content should be developed. Education in clinical dentistry and dental technology should be integrated to improve integration between dentists and technicians. Schools and dental laboratories should be integrated into clinical dentistry and dental technology education.

Training supplies, such as tools and materials, are bought by students themselves in some foreign countries. However, in China, the decision to purchase must be made by schools. Funding sources should be allocated to existing schools to provide students with training materials during their educational period.

China has run several dental technology undergraduate programmes in certain colleges. They are at a primary stage and face numerous challenges. Sichuan University started the first dental technology undergraduate education programme in 2005. Students are enrolled after the college entrance examination and, after 4 years of study, obtain a Bachelor’s degree. Table 3 and Figure 3 show the course structure as an example.

Table 3.

Curriculum arrangement for dental technician education at Sichuan University

Figure 3.

Subject proportions in different courses. Others include computing, mathematics, physics, etc.

Improvement of certification system

The Ministry of Labour proposed the certification system in 1999. It requires dental technicians to undertake rigorous skills training and to pass the examinations conducted by the Ministry of Health Guidance Centre.

The value of certification should be increased. Manufacturers, as well as relevant organisations, should promote the importance of dental laboratory technician certification. Technician certification should be made mandatory. Allied organisations should legislate dental laboratory regulations and technician licensure. The need for a formal education in dental technology for certification should be emphasised. Only in this way can the quality of dental technicians be guaranteed.

Protection of employees

The income of a dental laboratory technician is not attractive. Moreover, the lack of recognition for graduates of the educational system in the dental laboratory makes it difficult to attract qualified graduates.

Personnel protection policy is highly recommended. Salaries should be defined by ability. There should be a mechanism to differentiate between qualified technicians and those who carry out piecework in laboratories. Methods should be developed to identify technicians who have achieved various levels of proficiency or excel in their respective areas.

Increased public awareness

Public awareness of dental technology should be increased. A public information website should be developed to allow patients to become educated about dental technology. Certain large dental laboratories could establish the brand and promote their products through advertising.

Acknowledgements

We would like to extend our sincere thanks to all those who helped with the manuscript. First, we are deeply grateful to all staff at the Dental Technology Center (SCU) who provided information on the dental technology industry 20 years ago. Thanks are also due to the teachers and friends who helped with the language in the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest with respect to the submitted work.