The relationship between technicians and their dentist clients is not always easy. Unpaid bills, work sent overseas and a lack of respect are just some of the complaints voiced by discontented technicians. But when the relationship works well it doesn't just make life more pleasant, but more profitable too.

It can't be a coincidence that so many technicians working as sole traders in the UK are unhappy about their working relationship with their dentist clients. Yet despite the inevitable ups and downs of any close relationship, technicians who have begun to nurture communication between practice and laboratory and are reaping the dividends.

In some situations, however, it isn't easy for technicians to be constructive. One incident, described by a London technician who for obvious reasons did not want to be named, epitomises how bad things have got. Not so long ago, the technician received a phone call from a dentist client who said he would not pay for a bridge because it wasn't good enough. 'I am so sorry,' the technician responded. 'Let me have it back and I will alter it.'

'You can't have it back,' the dentist told him, 'because I have fitted it. I am not paying for it. Take it or leave it.' So the technician took it - he shouldered the loss to his income and the blow to his self-esteem because it was Christmas and he did not want to lose the client.

Why has this happened? How has it got so bad? The technician in question has his own theories: 'Dentists want the work done as cheaply as possible so they can maximise their own profits. When I started working in this area, dentists sent work to local technicians. Now they want the cheapest work and it is going to different parts of the country and even abroad.'

He added: 'Some are friendly but try getting money out of them at the end of the month and its very hard. There are some who treat you with respect, but they are in the minority. I do not see things getting better in my lifetime.'

Another technician with similar views is Simon Newbold (above) who says that registration of technicians is unlikely to make a difference.

'I would like to think it will, but I don't see how. In countries like Switzerland and Germany, technicians are treated as fellow professionals, but here, the effect of the NHS is for quality and prices to be constantly driven down.' He is now planning to share premises with another highly rated technician, Richard Gidden, and to attract business from further afield.

David Bentley is the chairman of the Dental Laboratories Association and based in Dorchester, at the Casterbridge Dental Studio. His perception is that there are still some very volatile relationships between laboratory and dental practice, particularly in London's West End, although things are getting better.

He enjoys good relationships with his customers and sometimes invites them to his laboratory for a course. This helps breaks down barriers, he says, and ensures both sides understand what the other's needs are.

Paul Evans, a partner in Cardiff Orthodontic Laboratory has found that developing a rapport with a receptionist or nurse can help. In his view the value of a face-to-face meeting is unbeatable and he always meets clients when he starts working for them. There is always the potential for things to get confrontational, he says, but having a positive approach helps.

There have been times when he has been rung by an orthodontist complaining because something isn't ready, but he knows it's a ruse to deflect the anger of an angry parent. 'The call is for the mother's or father's benefit. That is when the relationship with the nurse comes in because she will ring later and apologise.'

David Kramer, a dentist in the outskirts of London as well as a lecturer at the London Hospital has only used three or four technicians in 23 years. One of them is Steve Mason (above), whose Milford and Mason laboratory is in Surrey. Why does their relationship work?

Perhaps because David is happy to be managed. 'I will send instructions to Steve and if he is not happy with them he will ask us to clarify. I rely on him to do this and identify a difficulty before the patient is back in the chair. It's an amicable and professional working relationship which is focused on getting the right result for the patient.'

Steve says: 'The key factor is that David is prepared to listen. I know the material I work with and its limitations, and I like to share this information with the dentists I work for. It's not a one way thing, there is a flow of information and we learn things too.'

But things haven't always been perfect. There was a time when the bite wasn't right on many pieces of work. Steve and David got together, shared their views as well as their part in the misunderstanding and sorted the problem.

The number of technicians in this country is woefully low and good technicians are going to be in demand. To deliver high quality care a practice needs a good lab.

Advisors to dental businesses are now stressing the value of a strong working relationship between dentist and technician. George Manolescue, a senior partner in Dental Business Solutions, commented: 'The dentist needs to build a strategic relationship with labs or be in danger of losing out. The number of technicians in this country is woefully low and good technicians are going to be in demand. To deliver high quality care a practice needs a good lab.'

One of his dentist clients believes so strongly in a strategic relationship he is a co-director of a laboratory that is directly beneath his practice. Myles Dakin is very appreciative of the skills of technicians, partly because he carried out his prosthodontic training in the USA which involved doing much of his own technical work. This afforded him a clear insight into all the processes involved.

'There are some great technicians in the UK, but for the most part they are not given the freedom to do their best. They need to be treated with respect and as an equal and paid appropriately.'

Like Simon, he believes the mentality engendered by the NHS payments system is to blame. As dentists' fees have been driven down, they have looked for ways to cut practice costs and the technician has too often taken the brunt. The result is that many technicians find it difficult to put up prices because they are frightened of losing business. Many have left the industry altogether, compounding the shortage problem.

There are other theories as to why the relationship between dentist and technician is so fragile in the UK. Some says it's because it's based on mutual dependence which some personality types don't feel comfortable with, others attribute it to the English class system which allows a professional to look down on a supplier; the more cynical say it's greed.

But despite the difficulties the relationship is worth nurturing. When it becomes a partnership underpinned by mutual respect, it benefits both parties and makes good business sense too.