Color and Shade Verification
Position Statement of the American College of Prosthodontists
The process of fabricating fixed and removable dental prostheses often requires the selection of a tooth shade, or color that either matches or blends with the natural dentition or existing restorations. In some practices it is often common practice to recruit the service of a dental laboratory technician who can verify the shade already taken by the dentist. This is an artistic, not a therapeutic procedure, and might be assisted by the individual who actually will be fabricating the prosthesis, inasmuch as color may be difficult to communicate precisely between the dentist and the dental laboratory technician. For reasons of quality control, difficulty in determining the best shade, or convenience, many dentists send the patient to the laboratory for this procedure. Whether patients can be sent directly to a dental laboratory is dependent on State regulations.
This practice, which is still illegal in most states, places the dental laboratory technician in a dilemma. Concerns relative to insurance matters, legal parameters, and possible transmission of disease are considerations the laboratory must address. It is apparent that this situation could be rectified, perhaps by legalizing, under strict guidelines, what is already a common practice in some offices. Proponents of laws allowing dental laboratory technicians to become involved in this process contend that the verification of tooth shades does not constitute the practice of dentistry. Those against this practice contend that it is solely the dentist’s responsibility to select the shade or color.
The American College of Prosthodontists supports the legalization of a dental laboratory technician assisting in the shade verification process, either in the dental office or in the laboratory which may not be part of the same facility, providing the following parameters are strictly met, discounting any other conflict with State laws:
1. That the procedure and referral be performed under the direction of a written prescription by a licensed dentist.
2. That the dental laboratory technician is verifying or confirming the shade as previously determined by the dentist. Changes from the shade prescribed by the dentist will be made only after further consultation and agreement with the prescribing dentist.
3. If there is substantive disagreement with the shade recorded by the dentist, the patient is referred back to the dentist for confirmation by the dentist.
4. That the process involve only this verification and exclude other actions such as removing and recementing provisional restorations, or provisionally cementing permanent restorations.
5. That the laboratory maintain strict aseptic barrier techniques as determined by American Dental Association (ADA), Occupational Safety & Health Administration (OSHA), and Centers for Disease Control and Prevention (CDC) guidelines which would prevent the transmission of organisms via shade tabs, hands, etc., and that these asepsis techniques be subject to routine inspection and upgrading if necessary.
Stephen F. Bergen, DDS, MSD, FACP
Revised and Approved ACP Board of Directors:
November 4, 2014
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