IDental laboratory

work

authorization

forms: A survey
Tex.

F. Dean St. Arnault, D.D.S., M.Ed.,* and Don L. Allen, Jr., D.D.S.** The Ilniversity of Texas Health Science Center at Houston, Dental Branch, Houston,

Dental laboratory work authorization forms embrace a diversity of material content and design. This survey examined 61 dental laboratory work authorization forms and delineated each content item and format features into a frequency percentage. This information has a high potential for use in changing prospective dental laboratory and authorization form design. (J PROSTHETDENT 1990;64:497-601.)

ental laboratory work authorization forms, occasionally referred to as dental laboratory prescriptions, are not uniform or standardized. A review, study, and computation of these differences could be of great value in determining a composite form that would consist of the items most frequently found in a wide selection of forms. The potential is great for use of this information by dentists, dental laboratories, state licensing boards, and the American Dental Association for designing uniform dental laboratory work authorization forms. METHODS AND MATERIAL

A telephone solicitation of 103 dental laboratories in the greater Houston area was conducted early in 1988. The laboratories contacted were invited to participate in a survey of dental laboratory work authorization forms by sending a copy of their customarily used form to investigators at the University of Texas Health Science Center at Houston, Dental Branch. Seven laboratories declined to participate, two said they had no form, and the remaining 94 indicated they would send one of their forms. Fifty-one dental laboratory work authorization forms were ultimately received and became the data source for this study. RESULTS The data from dental laboratory work authorization forms were tabulated item by item as they appeared on each separate form. Seventy-four individual items were delineated. The total number of times a certain item occurred divided by the total number of forms in the survey (51) was calculated and reported as that items frequency percentage. Two items, form width and form length, were recorded in inches for each form and then computed to determine the average size form. Fig. 1 lists the items by the title and number each were assigned as the

observers recorded the data. In addition, Fig. 1 lists the frequency percentage of the items and immediately following that is the actual number of times that item was encountered. Statistical calculations found the mean frequency percentage to be 31.5%. Plotting each item from Fig. 1 on a graph with the item frequency percentage on its vertical axis and the total number of items on its horizontal axis resulted in the distribution curve shown in Fig. 2. Items with the highest frequency percentages are located at the top left side of the graph. Items with the lowest frequency percentages are found at the lower right side of the graph. The frequency percentage distribution curve drops rather evenly from the higher percentages to the lower percentages until reaching just below the mean frequency percentage. From that point, the lower frequency percentages seem to level off. For ease of item identification, the number assigned each item in Fig. 1 has been superimposed by that items frequency percentage location on the distribution curve of Fig. 2. DISCUSSION The importance of the doctors personal signature was apparent as 50 of the 51 forms in the survey required the signature. One form did not require a signature but did leave a space for the doctors name. Forty forms required the doctors signature and name stated separately. The doctors address and telephone number were not in as great demand with respectively 43% and 112% of the forms requesting these. The doctors license number was required on 46 forms. A small amount of patient demographic information was asked for on dental laboratory work authorization forms. However, the patients name was requested on 50 forms. Requests for the patients age (47% ) and sex (53%) appeared more frequently than requests for the patients address (12%). This seems logical because age and sex are important factors for the dental technician, especially in esthetic development. A form title such as Dental Laboratory Work Authorization was seldom present (12 % ), but the Rx abbreviation

*Associate Professor, thodontics. thodontics. 10/l/22664

Department

of Occlusion

and Fixed Pros-

**Clinical Instructor, Department of Occlusion and Fixed Pros-

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A 1. 2. 3. 4. 5. 6. 7. 8. 9. IO. I1 12. 13. 14. 15. 16. 17. 18. 19. !O. !I. !2. !3. !4. !5. !6. !7. !8. 19. 10. Il.

B
Title of Form Printed serial number Case Number Laboratorys name Laboratorys address and telephone number Laboratorys registration number Doctors name Doctors address Patients name Patients sex Patients age Diagram of occlusal surfaces of maxillary and mandibular arches Diagram of upper six anteriors Diagram of pontic Additional diagrams Amount of ridge relief Shade Shade guide used Tooth mold Material(s) to be used in fabrication 112 of form left with blank space for written instructions 113 of form left with blank space for written instructions 114 of form left with blank space for written instructions Reverse side of form stated to be space for written instructions Process patient identification intoappliance Try-in date Finished date Date form was completed by Doctor Doctors signature Doctors license number Statement on form that regulations require retaining form for specified time Single copy form Duplicate copy form Triplicate copy form Extra copies when duplicate or triplicate on colored paper Form on white paper Form on colored paper Form printed with black ink Form printed with colored ink Laboratory logo printed on form Form was printed single sided Form was printed double sided Rx appeared on form

c
12% 4% 31% 98% 94% 20% 78% 43% 98% 53% 47% 53% 29% 22% 22% 12% 94% 25% 20% 57% 57% 25% 12% 6% 2% 67% 92% 86% 98% 90%

D
6 2 16 50 48 10 40 22 50 27 24 27 15 11 11 6 48 13 10 29 29 13 6 3 1 34 47 44 50 46

C
12% 8% 6% 41%

D
6 4 3 21

;2. !3. 14. #5. ;6. #7. 8. 9. 0. 1. 2. 3.

l

0% 49% 45% 6% 100% 94% 6% 65% 35% 27% 82% 18% 41%

0 25 23 3 26 48 3 33 18 14 42 9 21

,44. Used Dentsply International, Inc. Form #3351 45. Laboratory has Doctors preference guide on file 46. Form doubles as an invoice 47. Form was for a special purpose, i.e. RPD, FPD, Ortho, etc. 48. Average form width 5 318 49. Average form length 7 518 50. Patients address 51. Type of crown margin desired by Doctor 52. Other items infrequently encountered, thus, no individual item field 53. Request by Doctor to have laboratory send more case shipping containers and blank work authorization forms 54. Degree of proximal tooth contact(s) required 55. Degree of occlusal tooth contact(s) required 56. Laboratory progress sign-offs 57. Doctors telephone number 58. Laboratory Technicians signature 59. Type of restoration to be fabricated 60. Delivery method of completed case back to Doctor 61. Articulator number on which case is sent 62. Occlusal records and/or impressions enclosed 63. Diagnostic wax-up enclosed 64. Facebow transfer and/or study casts and/or patient photo enclosed 65. Multiple spaces and/or boxes for varied directions not listed as separate items 66. Weight of metal used in appliance 67. Chart of tooth numbers only 68. Plastic or porcelain teeth desired 69. Statement of how account is to be paid 70. Type of artificial teeth to be used, i.e. flat plane or angular cusps 71. How porcelain is to be glazed and/or stained 72. Call Doctor regarding case 73. Type of occlusal coverage for porcelain-to-metal crown(s) 74. Shade guide tab enclosed with case

12% 16%

6 8

16%

14% 2% 2% 12% 12% 2% 33% 6% 6% 10% 10%

7 1 1 6 6 1 17 3 3 5 5

14%

27% 4% 14% 24% 8% 16% 8% 2% loo/, 10%

14 2 7 12 4 8 4 1 5 5

This item in Fig. 2, because of computer program used, is recorded as frequency percentage of all forms (51); consequently, on distribution curve its location is 51%. A - Arbitrarily assigned item number; B - title or name of item; C - frequency in percent that item appeared on all forms; D - actual number of times item appeared on survey of 51 forms. Fig. 1. Summary of items appearing ticipating dental laboratories. 498 on work authorization forms collected from 51 par-

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I I

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TWO OF THE 74 ITEMS IN THE STUDY (FORM WIDTH AND LENGTH) ARE NOT FREQUENCY PERCENTAGES AND THEREFORE ARE NOT PLOTTED.
. 43.17

I -

l-

I-

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I 30 NUMBER 40 OF ITEMS

50

60

7072

Fig. 2. Numbers along graph refer to item number in Fig. 1 and dots indicate how many items had same frequency percentage and actual times of occurrence.

for prescription was found in 21 of the 51 forms. Generally it was located preceding the blank space on the form specified for the doctors handwritten instructions. The laboratorys name (98 % 1, address and telephone number (94%), and the laboratorys logo (27%) appeared at the top of most forms. A printed serial number on the form was found only twice but space for an assigned patient
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number was provided on 16 forms. Three forms were devised to become billing invoices when the prosthesis was completed. It was a common occurrence (41% ) to find a form designed for one aspect of dental laboratory work only, such as orthodontics, removable prosthetic dentures, or fixed prosthetic dentures. The Texas Dental Practice Act, effective in January 1989, requires dental laboratories 499

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to be registered with the Texas State Dental Board and the assigned registration number to be placed on the form. At the time of this study only 20 of the forms carried a Texas dental laboratory registration number. Three definite calendar dates were requested on the forms. The most frequent was the date the doctor wished the restoration to be completed (47), followed closely by the date the form was initiated (44), and a try-in date (34). Tooth shade information is fundamental to the dental technician and most (94%) of the dental laboratory work authorization forms provided space for this item. However, the name of the shade guide used by the dentist in shade selection was requested in only 25 % of the forms and only five forms allowed the dentist space to .include the actual shade tab used. In removable prosthetic dentures, the type of teeth (plastic or porcelain), the mold, and the degree of cusp inclination of artificial teeth to be used in a prosthesis are basic information for the dental technician, yet the frequency percentages of forms requesting these were all below the mean frequency percentage. The material to be used in the prosthesis was sought in 57% of the forms but only 33% asked for the type of restoration. The specific type of crown margin desired by the dentist was sought on eight forms. Marking diagrams is a good method for communication and diagrams were found on most of the dental laboratory work authorization forms. The most popular diagrams displayed the occlusal surfaces of the entire set of maxillary and mandibular teeth arranged in an arch form. Just over half of all forms used this type pictoral presentation. Line drawings of the six maxillary anterior teeth were found on 15 forms and simple arrangements of tooth numbers in a chart format were shown on seven forms. Diagrams devised solely to convey pontic design to the laboratory were seen in 22 % of the forms. Eleven forms had individualized type diagrams, each for a special purpose. The investigators grouped these in the category of additional diagrams. Space for the dentists written instructions and directions to the dental technician occurred on 48 of the 51 forms. We estimated the amount of blank space for instructions on each form and grouped the forms into four size categories. Twenty-nine of the forms left half of the forms total space blank for written instructions. Thirteen forms devoted a third of the forms space for individual orders, and six forms provided a fourth of their space for this purpose. Three forms directed the dentist to use the reverse side of the form for instructions. The remaining items are of low frequency (Fig. 1). Because the dental laboratory work authorization forms intrinsic and extrinsic architecture is important, the survey patterned design items to probe some of these elements. Single copy (49%), duplicate copy (45%), and triplicate (6%) forms were encountered. When forms contained copies, these copies were always printed on colored paper. Generally, the original was printed single-sided (82%) in

black ink (65 % ) on white paper (94%). Four distinct size ranges predominated. These categories arranged by width and length in inches were as follows: Size I-Width Size II-Width SizeIII-Width SizeIV-Width 4% to 4Y2, length 7 to 7% 41/2, length8 to 8% 5%) length8% 6% to 8%, length8%

Form size III wasmost frequently found, with 16forms; sizeII, 11forms; sizeI, 12forms; and size IV, only six forms. There were four forms whosedimensionsdid not conveniently fit any of these four categories.When the sizesof all 51 forms were averaged the composite form measurement to the closest l/s inch was 53/s inches wide and 7% inches long.

SUMMARY
This survey indicates that several items are deemedimportant to dental laboratory work authorization forms becausethey obtained high frequency percentages. Foremost among these items are the name, address,and telephone number of both the dentist and the laboratory. Requirements of somestate dental practice acts would require the doctors license number and the laboratorys registration number be on the form. Regardless of these requirements, prudence would dictate their use. The doctors signature seeminglyis essentialfor a contract, order, or legal authorization. Patient statistics consistingof name,age,sex,and various shadeinformation are all important to the dental technician in the fulfillment of the doctors orders. These all had high occurrencenumbersin the survey and must be consideredfor inclusion in the designof any dental laboratory work authorization form. Basic dates that are indispensableto both the dentist and the laboratory are the execution date of the form, the date of try-in (if one is desired), and the date the work is to be finished. The high overall frequency percentage of these three dates coupled with the absence of other dates indicates the importance of these three. The item frequency percentage of type of restoration wanted and the material to be usedin its fabrication would indicate their desirability on any dental laboratory work authorization form. Information is conveyed with diagramseasily and with limited risk of misunderstanding.Thus, their useis an important consideration for any dental laboratory work authorization form. An entire maxillary and mandibular arch occlusalview drawing wasthe most popular pictorial arrangement;however, severalothers were used,especially on special-purposeforms. Possibly a drawing of the maxillary and mandibular arch occlusalview on which a prosthesislocation and designcan be madereadily discernable is a good choice. A maxillary anterior one-by-six outline easily lends itself to shadesketchings.Any work authorization form must provide a generousspacefor the written instructions of the dentist. It is here that details are best

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stated to the dental technician. Consequently, it is understandable that half of a forms space might be left open for these written and/or illustrated orders. The dentists use of diagraming in this open space to transmit instructions needs to be a serious consideration. Many items that infrequently appeared on forms pertained to specific factors of prosthesis fabrications. To attempt to include all these numerous items on any one form is not realistic. Accommodating many of these differences might be accomplished better by having the doctor file a preference guide with the laboratory or designing a form with multiple lists of item boxes to be checked off as desired by the doctor. Under no circumstances is it the intent of any written laboratory work authorization form to preclude personal communication between the dentist and the dental technician. The telephone rings both ways. Duplicate copy forms were almost as frequent as singlecopy forms. Copies make good sense because they give the dentist and the laboratory a replica of exactly what was ordered, which helps to avoid communication problems and misunderstandings. Forms with black ink printed on only one side were overwhelmingly popular probably because of custom, convenience, and expense. Form size apparently is related to the case tray or pan size used in the individual dental laboratory. It is a wise custom in most dental laboratories to attach the work authorization form to the back of the pan so that it will accompany the case as it progresses through the laboratorys departments. Most pans have backs that measure approximately 5 wide and 7 high. A

dental laboratory work authorization form with dimensions close to the composite size form determined in the study would serve this purpose well.

CONCLUSIONS
This inspection of dental laboratory work authorization forms established that these forms come in a variety of sizes and formats extending from small and simple to large and complex. No one form design can encompass all circumstances and/or cover all contingencies of dentistry, but a printed form meeting local state law requirements with basic doctor, patient, laboratory, and patient conditions conceivably would fulfill the need in most instances. This procedure should be supported by the dentists diligent and resourceful use of the written instruction portion of the form. The purpose of the dental laboratory work authorization form for dentists is to order a unique and distinct restoration or device for a particular patient and it must impart adequate information to the dental technician to accomplish the task. It also is a record of each individual transaction. Ultimately, the responsibility for the direction and control of the project rests with the dentist.
Reprint requests to:
DR. F. DEAN ST. ARNAULT DENTAL BRANCH UNIVWITY OF TEXAS AT HOUSTON P.O. Box 20068 HOUSTON, TX 11225

Guides

for authors

available

The Guide to Preparing Articles for the JOURNAL OF PROSTHETICDENTISTRY, revised by Professor Paul Barton, Editorial Consultant to the JOURNAL, and the editors, is available to prospective authors. The guide provides the format for developing different types of scientific manuscripts, a checklist for effective writing, and detailed instructions for preparing manuscripts in the style acceptableby the JOURNAL. Also available are the Guidelines for Reporting Statistical Results and an Authors Guide to Controlling the Photograph. Guides can be obtained from the office of the Editor (Dr. Judson C. Hickey, The Journal of Prosthetic Dentistry, Medical Collegeof Georgia,School of Dentistry, Augusta, GA 309121.

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