Lead in Dental Crowns from China: Whose Fault Is It?
Protecting the Public from Tainted Dental Lab Work
Since news broke a few weeks ago of lead-tainted dental crowns from China, I’ve been giving you background information and sharing my opinions. This week, I’m going to take a back seat. Instead, let’s see what dentists had to say when responding to my survey. (Read the complete dental lead scare survey results.)
First, the numbers: When asked who should be responsible for protecting the public from tainted dental work, here’s how dentists replied:
- 31% said the FDA
- 25% said dental labs should police themselves
- 41% said dentists should take responsibility; and
- 3% said the burden should be on patients.
Two out of three dentists thinks this is likely to be nothing more than a tempest in a teapot, while the remainder expect it to be the next big health scandal. The scope of the threat is not clear, as further research has yet to be released. “We don’t know if this is a crisis,” a Washington dentist pointed out. “The labs and FDA need to test a large number of prosthetics that are produced in USA with foreign materials and in foreign countries.”
In Canada, dentists are required by law to have patients sign an informed consent form if their restoration has been manufactured in a foreign dental lab. In the US, dentists have no such notification requirement. “Patients have been systematically kept in the dark when it comes to dental procedures,” wrote a California dentist. “They should be given informed consent when choosing materials. Otherwise dentists will continue to do what they want to do.”
To many, the most important issue is that dentists take responsibility for the quality of their lab work. “Government oversight would not prevent an unscrupulous lab from farming out work,” a Pennsylvania dentist pointed out. “As with most business relationships, one of the best ways to really know what you getting is for the doctor to establish a personal relationship with the lab. This means meeting the owner/director, asking questions, and judging the lab’s honesty.”
Indeed, “judging a lab’s honesty” is one of a dentist’s most important responsibilities. Most dentists have nothing but criticism for colleagues who seem to value low prices over quality materials. “Too many dentists are accommodating low insurance payment schedules by buying their dental materials and laboratory fabrications that are too cheap,” seethed a Maryland dentist. “It doesn’t seem to matter that it compromises the health of the patient.”
To me, the critical question here is: Just what are a dentist’s responsibilities when it comes to evaluating if a dental lab is worthy of the doctor’s trust?
“My lab has assured me that their products are all manufactured in the US,” said a North Carolina dentist. “But so what? People don’t always tell the truth, but we must put trust in something. I trust my lab and I hope the system is not broken.” A Michigan dentist agreed, asking, “I expect that my US labs are not sending my work off shore and using the quality of material I specify, but how do I know for sure?”
One comment really hit a nerve with me.
“I am certain the FDA will be monitoring all materials any US lab uses. It only stands to reason that overseas labs conform to our regulations.”
There’s some very dangerous logic going on in that statement! When it comes to ensuring the health and safety of your patients, you don’t get to just “take it on faith.” This isn’t just ethical guidance I’m giving you — this is legal guidance as well! If you don’t do your due diligence in checking out your dental lab, you could be legally liable. (The woman in Ohio who allegedly got lead poisoning from her Chinese crown? Word is, she’s planning to sue her dentist.)
So who should be in charge of making sure toxic materials aren’t used? The FDA seems the obvious choice. Indeed, the FDA does regulate dental products, but it’s an open secret that they do very little actual testing. In fact, the Nation Association of Dental Labs have been working with the FDA for several years to improve regulation. (Thanks to this scandal, I think we’ll finally start to see some progress on that front!)
I’ll leave you with the words of an Illinois dentist who concisely summed it up: “If you wouldn’t put it into your own mouth, you don’t put into a patient’s mouth.”
Post your comments to this story or read the complete Foreign Dental Labs survey results
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April 16th, 2008 at 12:07 pm
I think that too many dentists seek out lower priced labs to up their profits. Theses savings are never passed on to the patient. Now the Dr. can pay $40. for a crown and charge $1000. Before he would pay approx $100. and charge $1000. If the labs must disclose where the crowns are being made, the Dentist should disclose his enormous fee percentage! You wont find a Dr. to admit it but they dont all look for a quality lab, they want cheap prices. I dont know a poor dentist but I do know some lab owners really struggling to compete with China’s prices. Bye the way, it would help if the dentists would pay their lab in full, on time every month instead of the lab having to call for a small partial payment! Again, they will all tell you “I pay my lab in full all the time”
April 21st, 2008 at 4:06 am
Dear Jim,
After being a dental assistant and a prosthetic lab sales woman for the past 25 years, as well as a patient whose family has invested in four crowns in the last 90 days, I have a few questions. Why is it taking such a long period of time to isolate the component responsible for the lead readings? Is this component only present in Chinese imports? I have been researching the most recent info available-and seem to have reached an impasse. The ADA promised a complete analysis a month ago-where is it? I have been assured by an importer of Chinese products that his source uses all of the same products as domestic labs. He travels to China regularly to oversee production and has relayed to me the fact that, at least the lab he uses, is clean and professional and uses all of the same techniques and materials as our domestic labs. There is a suspicion-as mentioned by the ADA that the lead is present in the pigments being used. If the stain and colorants used in imports are the same as our domestic ones-shouldn’t our domestic crowns be tested as well? Maybe this is why information is so slow in coming. What a complete mess-if we were to find the problem wide spread over the course of many years. You have previously mentioned accountability and left out a very responsible party. The manufacturer of the component responsible for the lead in the dental prosthesis. I had to guffaw even at this most serious juncture. To ask a dentist or a dental lab to disclose ANYTHING that would jeopardize their existence as we know it- will not happen without government intervention. At least we don’t have to worry about that, because the government is either to busy elsewhere or doesn’t care. Will this be a case of protecting patients or pocketbooks? The older and more demographically expanded this problem gets-the more dancing will be done. A straight and honest path would require too much sacrifice-so let’s just blame China! What happened to getting facts FIRST and then causing hysteria? From A Worried Dental Assistant
May 21st, 2008 at 9:04 pm
I am a dental technician in Rochester, NY. I have watched this issue closely for some time, and felt it was only a matter of time before contamination in some products was confirmed. Of course labs need to be responsible for producing a safe product. The major complication is holding a Chinese lab responsible, when they may disappear overnight if a problem arises, and regulation is much more difficult. I have not heard any reports of contamination as yet from a US made product.
This is where our Dentists need to be resposible- in either choosing a lab which manufactures it’s restorations in the US with FDA approved materials, or at the least, informing their patients that their restoration will be outsourced overseas. Dentists should also make every effort to determine whether or not their US-based lab outsources overseas. Until foreign made restorations are strictly regulated and tested, this will continue to be a major issue. While we are all concerned about rising costs, and doing our best to keep those costs down for patients, our primary duty is to protect our patient’s health and safety, and that is a responsibility we all share.
October 4th, 2008 at 10:00 pm
As I find your article interesting I also find it somewhat biased. Dentists have the responsibility to disclose the price of the crowns and the name of the lab to their patients and therefore choose to justify their huge fees however they wish. As Doctors should be able to make a good living they are too often becoming business men before public servants. They are the ones who control the quality of the crowns by doing business with labs that charge $50 to $100+/crowns…seriously,what kind of product do you expect for 50 bucks?? In any case, it is every patient’s fundamental right to know how much they’re actually paying for the crown and it is every dentist responsibility to have a close relationship with their lab and demand certainty that their crowns will not be outsourced by the lab.
I see more troublesome news for the future of our industry, lately one of the biggest Dental school in MA is closing their lab and sending all their cases to China. Something must be done right now! and patients should also take matters in their own hands, and demanding the lab fees would be a good start.
November 6th, 2008 at 2:20 am
This is a global problem. Split the fees! The only way to solve these issues is by having the patient pay the laboratory directly. There are four benefits to this. 1. This means that the patients know where the crowns come from. 2. It also reduces the enormous buying power that dentists have over laboratories. 3. it allows a better cash flow for laboratories. 4. It exposes the massive mark-up the dentist empose on the public, often disguised as “it is the lab that is so expensive!” Afterall it is the dental ceramist creation that rebuilds the mouth and not the “cosmetic” dentist that cuts teeth down to the pulp.