ANYONE who's ever needed a crown, bridge or denture to restore their ring of confidence will have good reason to be grateful to dental technicians.
"They're handmade bits of bespoke tailoring for the mouth," says Tony Reed, executive director of the British Dental Trade Association. These appliances need to fit perfectly so that a person can eat without pain and smile without fear.
And this imitation of nature is made not by a dentist, but by a dental technician.
"Dental technicians get a copy of a person's mouth and make a one-off appliance for that person. It's a very rewarding and creative job," according to Tony Griffin, chair of the Dental Technicians Association. "It needs technical knowledge of oral health, metals and ceramics combined with an artist's ability to sculpt and match colour."
But 80 per cent of dental technicians have no formal training and some are paid no more than supermarket shelf-stackers. Technicians report that the industry is so under-funded it is "close to meltdown".
"The main problem is recruitment of staff," says David Smith, chair of the education committee for the Dental Laboratories Association. "There are very few people in training, and in the first five years 50 per cent will leave the industry completely."
Hospital dental technicians start on pound;13,000 and can earn up to pound;32,000. But in private laboratories, which employ 90 per cent of technicians, individual employers set pay and career structures. Some workers are on the minimum wage.
There has never been compulsory registration or training for the 10,000 dental technicians in the UK. Only 1,800 have registered voluntarily with the Dental Technicians Association and Tony Griffin estimates that about 230 people enter training each year.
The usual route is by Edexcel national diploma or certificate by day-release over three years, followed by further courses in universities or colleges up to degree, professional and postgraduate level, or in-house training in the bigger laboratories. Alternatively, there is a full-time or sandwich degree after A-levels.
Manchester Metropolitan University offers the entire range of courses from national certificate to postgraduate research. Chris Maryan, head of its dental technology centre, says that the national picture is patchy, as technicians outside the big cities struggle to find training.
Course closures, which occurred as the pool of teenagers shrunk in the 1980s and more stayed on to do A-levels ,"slowed down the normal academic development of the subject". And although funding comes from the Welsh and Northern Ireland Assemblies, the Scottish Parliament, the Learning and Skills Council, the Higher Education Funding Council and employers, there has been no money from the Department of Health, so no coherence.
"It's a whole area of healthcare with virtually no strategic input," said Mr Maryan.
Finance also drives the production side of dental technology and therefore the employers' ability to support training. Labs sell appliances to dentists, who shop around for the best deal.
Some labs are doing well. Portland Ceramics, now owned by Boots Dentalcare, sponsors staff through courses at Manchester Metropolitan University and provides in-house training, which is also sold to technicians from other labs. It sells appliances to dentists other than Boots, but does not take on NHS work.
Many in the trade argue that NHS payments to dentists to buy appliances are far too low for good quality. Larger or specialist dental labs may work with the latest equipment and techniques, but NHS dentists are likely to turn to low-price, small-scale, production line businesses that fail to support good training.
But this is about to change. Healthwork UK, the national training organisation for health workers, is developing national standards for dental technicians. Parliament is legislating to include dental technicians on the compulsory register of the General Dental Council, which currently regulates the professional conduct of dentists, from 2003.
But there is a debate about where standards should be pitched and how the industry can be financed. Anthony Laurie, creator of the Dental Excellence laboratory, believes that techniques are now so far advanced that the profession should be all-graduate.
Status and pay levels would rise and the job could become more attractive. "We need to get into schools and get groups of children to come into labs. Then they would want to do dental technology," says Mr Laurie.
"With the right sort of encouragement there would be a lot of interest and excitement. We need sensible government intervention and funding in education at the right level."
But Tony Griffin, who is also head of dental technology education at the People's College Nottingham, thinks there is still a place for less individualised products.
"Most companies are three or four-person operations - there's a niche for everybody, and these people also need to earn an income."