Foreign Dental Labs Cause a Stir Among Dentists (video)

Foreign dental lab safetyIn light of reports of dental crowns manufactured in Chinese dental labs that may be contaminated with lead, we conducted a survey of dentists on the topic of foreign dental laboratories.

Two out of three dentists think that the current publicity is just a tempest in a teapot, while the remainder expect it to be the next big health scandal.

Read more: Dental Lab Safety Concerns

CEREC May Not Be Effective Dental Marketing

Cerec & dental marketingDentists are split over whether CEREC is an effective dental marketing tool. In this survey, 58% of dentists said the name “Cerec” means nothing to the average dental patient.

But among dentists offering Cerec restorations, 61% think it’s a useful dental marketing tool. And only 15% of Cerec dentists report they are disappointed with it.

Don’t know what CEREC is? The name stands for Chairside Economical Restoration of Esthetic Ceramics. Cerec dentists use computer-assisted technology to fabricate a customized porcelain restoration, often a dental crown. You can get a Cerec restoration in a single appointment, while traditional porcelain crowns are fabricated by dental labs and require two appointments.
Learn more here:

Here’s what dentists have to say about CEREC:

  • “The idea is great, but the restorations are not close to the quality of lab-fabricated restorations.” (Tennessee dentist)
  • “It has been the best investment I have made in my practice.” (General dentist)
  • “It only means something to the average patient if you call it ‘same day crown.'” (Minnesota dentist)
  • “Cerec is the greatest invention in the history of dentistry. Those who don’t like it are either not willing to take the time to learn it or haven’t bought it and need an excuse as to why.” (Illinois dentist)
  • “I am glad I got the Cerec, but there were times along the way I would have gladly given it back if I could have got a full refund. It definitely is where the future is going, so we need to master this technology.” (California dentist)
  • “I’ve replaced many fractured Cerec restorations that come into my practice.” (General dentist)
  • “The best economic investment we ever made in our practice. It has allowed our practice to experience an 8% growth in 2009 while the majority of the practices in our state experienced a 30 to 40% decline.” (Michigan dentist)
  • “Puts you in the special list of dentists that are on top of the newest, the best and ahead of the crowd.” (Pennsylvania prosthodontist)
  • “Powder all the teeth and then the patient swallows and all the powder is gone and then you re-powder and they swallow and all the powder is gone…repeat ad infinitum until you get tired of it and throw your ($100,000) machine away.” (California dentist)
  • “The smartest thing I have EVER done in my career is to purchase (and master) a CEREC machine. The restorations are more precise, beautiful, and predictable than any lab… I get tons of referrals because I have one; it just continually blows my mind that more dentists have not clued into this. NO WAY would I practice without it.” (General dentist)
  • “We’ve had Cerec for 1 1/2 years are are now pretty satisfied. But the learning curve was LONG and I’m still learning.” (New Mexico dentist)
  • “Initially I was disappointed with CEREC due to a steep learning curve, technical shortcomings and disruption to our normal scheduling routine. But now I must admit that with experience and the latest camera and software upgrades I love it, and I’m getting restorations that are often better than my lab. Patients really appreciate single visit dentistry and they are fascinated by the technology. It has reduced my lab bills significantly which more than offsets the cost of the machine.” (General dentist)
  • “I do not think Cerec has the name recognition of Invisalign or Lumineers or Zoom tooth whitening, and therefore I think the name means nothing to the public at large.” (General dentist)
  • “Few people know (or can remember) what a ‘CEREC’ is. Quite frankly, because it is a stupid acronym! Almost all people understand what a single visit crown is! If a company wishes to capture the market for this, then provide a moniker to do so.” (Nevada dentist)

Read more: Cerec Dentists Split over its Dental Marketing Value

Federal Employees Could Be Getting Foreign Dental Work

Government Dental Plan Soliciting Bids from Offshore Labs

The US government employs several million individuals. As their employer, it’s the government’s job to provide health care coverage to all of these people: soldiers and politicians, maintenance workers and administrators.

Health care benefits for federal employees are managed through the U.S. Office of Personnel Management (OPM). There are seven insurance carriers that provide supplemental dental and vision benefits under the Federal Employees Dental and Vision Insurance Program (FEDVIP). Four of these are nationwide plans, and the other three provide coverage in certain regions.

  • Aetna Life Insurance Company
  • Government Employees Health Association, Inc. (GEHA)
  • MetLife Inc.
  • United Concordia Companies, Inc.
  • Group Health, Inc. (New York state area)
  • CompBenefits (Southeastern US)
  • Triple-S, Inc. (Puerto Rico)

I have heard that one of these dental insurance companies has been soliciting bids from offshore dental laboratories. They’re looking to provide a low-cost product option to their network of providers, and it’s nearly impossible to compete with the prices offered by some foreign labs. ($29 dental crowns from China, anyone?)

There are any number of reasons why this might be cause for concern, but chief among them is the Buy American Act. Passed in 1933, this legislation states that the US government should preferentially purchase American products over foreign-made goods. Though exceptions can be made for price or quality issues, the basic principle is that America’s government should patronize American businesses whenever possible.

About GEHA

Since 2007, the Government Employees Health Association (GEHA) Connection Dental FederalSM dental plan has provided comprehensive dental benefits for federal employees. (GEHA also offers federal employees health plan options.) GEHA’s proprietary Connection Dental® network includes more than 43,000 dental provider locations across the country. GEHA has grown to be the second-largest national health insurance plan serving the federal market.

With reports surfacing that some dental crowns and bridges may be contaminated with lead, there are also health concerns about outsourcing dental restorations. The FDA doesn’t directly regulate overseas labs, and the National Association of Dental Labs warns that there are significant holes in the FDA’s oversight of dental lab manufacturing.

And yet we have GEHA shopping for cut-rate bids from foreign dental labs… Am I the only one who sees a problem here?

Post your own comments

ADA Left Holding the Bag in Dental Lab Controversy

When Scandal Strikes, Some Bury Their Heads in the Sand

Dentists and dental labs have been in the spotlight recently due to the news of lead-tainted dental products like crowns and bridges. Right now, we don’t know if it’s a widespread problem, whose fault it might be, or whose job it is to resolve this whole mess.

Though the story broke a few months ago, there’s been precious little actual information released on the subject. So what’s going on behind the scenes? Let’s examine the paper trail… You have to read between the lines a little, but it’s frightening how no agency seems willing to take responsibility for this public health hazard.

The correspondence starts on March 6, when the American Dental Association (ADA) sent nearly identical letters to both the Food and Drug Administration (FDA) and Centers for Disease Control (CDC). Does this circle of ineptitude remind you of anything?

Here’s what the ADA had to say to the CDC: (PDF)

“Staff members from the ADA… have been in contact with the CDC’s Oral Health Division. We are undertaking our own efforts to study the problem, including random, objective testing of prosthetics from both overseas and domestic labs and will be happy to share that information with the CDC. Of course, any such testing by the ADA is no substitute for the CDC and other government agencies performing their mandated functions to protect the health and safety of the public.

“Although we are not aware of any risk to health based on the small amount of information available, we and our patients are looking to CDC to affirm that this is true or, if it is not, take the appropriate steps to protect the public. Accordingly, we request that the CDC keep the ADA informed of its efforts to identify the extent of the potential contamination and the health effects of lead in dental prosthetics as well as any CDC plans for action.”

The ADA wrote the same thing to the FDA. (PDF)

“Staff members from the ADA divisions of Science and Government and Public Affairs already have been in contact with the FDA’s Center for Devices and Radiological Health Dental Devices Branch…. Of course, any testing by the ADA is no substitute for the FDA and other government agencies performing their mandated functions to protect the health and safety of the public.”

Let me translate: “”The ADA is doing our own research, but it’s really the FDA’s or CDC’s job to determine if this is a problem and what we should do next.”” The ADA’s point is legitimate; a professional organization should not be expected to provide the same public health services as the government.

On March 18, the ADA again wrote to virtually identical letters to both the FDA (PDF) and CDC (PDF).

“Media reports on ‘contaminated’ dental materials produced in foreign dental laboratories have become more frequent. The reports have an increasingly alarming tone and a sense of urgency since we first wrote to you on March 6. As a result, dentists are fielding more inquiries from concerned patients and there are disquieting reports of patients declining recommended treatment because of unsubstantiated fears.

“We are eager to understand the extent of any problems with dental materials, whether they are produced in foreign or domestic dental laboratories. In particular, we ask that you provide some context for claims of possible health impacts of lead in dental prosthesis in the amounts reported in the media. While recognizing that much remains to be learned about this issue, some general information from the CDC/FDA about the likelihood of harm would be of great interest to both dentists and patients and should come from the federal agency whose mission is to protect the public’s health.

“We also look to your agency to reassure patients that recommended dental treatment should not be ignored. The ADA is asking both the CDC and the FDA to consider providing a media update that will reassure the public that government agencies are taking appropriate steps to protect dental patients and that oral health care should not be postponed.”

Let’s translate that again: “Hey, guys, this goes beyond the scope of the ADA’s job… Can the government please offer some guidance?”

On April 14, the FDA responded to the ADA.

“The FDA is taking this report very seriously. FDA’s Center for Devices and Radiological Health (CDRH) is also working to obtain information on the presence of lead in dental prosthetics.

“At this time, FDA will not be issuing a consumer update; however, the agency will consider further actions after careful examination of the scientific evidence.”

Translation: “Sorry ADA, the FDA has nothing to say on the topic. Ask us again later.”

On April 17, the CDC replied to the ADA’s letters.

“Thank you for your correspondence regarding media reports about the lead content in a dental prosthesis made in a dental laboratory in China. The CDC became aware of this issue through conversations with staff at the ADA’s Divisions of Science and Government and Public Affairs and through media interest in this story.

“As you indicated, the FDA has regulatory authority over dental products, including dental prosthetic materials, and for the registration of foreign laboratories that import dental products into the United States. It is our understanding that the FDA is already acting on this information, At this time, CDC has had no formal request for any type of engagement from a state of local health authority.

“Although CDC has no specific information regarding the case to which you refer, we can provide you with some general information on lead exposure. Many consumer products contain lead in trace amounts, and federal regulations limit the amount of lead in consumer products… Certainly, CDC recommends against the unnecessary use of lead in consumer products, including dental crowns.

“The recent media reports of lead in dental porcelain/metal crowns suggest a level of approximately 200 parts per million. Such small amounts of lead as reported, however, are extremely unlikely to cause adverse health effects in adults because the dental products wear out slowly, so the lead would be released in tiny amounts over time. Even at an increased rate, it is highly unlikely that this amount would be a health risk to an adult.

“It is our understanding that testing for potential leaching of lead from these products is being conducted in ADA laboratories. CDC would be happy to assist ADA in interpreting the health impact of the testing of dental porcelains/meals that is currently underway. CDC will also provide any support if requested from the FDA, as that agency conducts further testing of these products.”

Translation: “It’s the FDA’s job, not the CDC’s. Maybe it’s the ADA’s job, but definitely not the CDC’s. And the amount of lead in dental prostheses is probably safe.”

Are you as amazed by what you’re reading as me?!? Here are a few of the most bothersome points:

  • “It is our understanding that testing for potential leaching of lead from these products is being conducted in ADA laboratories,” writes the CDC, suggesting that it is the ADA’s responsibility to monitor the safety of dental products. The ADA is a private, voluntary professional organization funded by dues from member dentists. Testing and regulation is the government’s job, not the ADA’s.

    The ADA points this out in their initial letter, saying that “testing by the ADA is no substitute for the FDA, CDC and other government agencies performing their mandated functions to protect the health and safety of the public.”

  • The CDC became aware of this issue through conversations with staff at the ADA and through media interest in this story,” wrote the CDC.

    Really?!? Why was the ADA the one to bring this issue to the CDC’s attention? Does the CDC only investigate health threats that receive media attention?

  • “At this time, FDA will not be issuing a consumer update; however, the agency will consider further actions after careful examination of the scientific evidence,” says the FDA.

    The FDA took over a month to respond to the ADA. The organization in charge of regulating dental materials (you know, making sure they’re safe and lead-free) hasn’t offered the public any guidance on this threat.

The CDC’s passing the buck to the FDA, and the FDA doesn’t appear to be doing much of anything. But dentists are worried, patients are panicking, and public is desperate to know more. As the public face of dentistry in the US, the ADA is now forced to stand in for do-nothing government agencies. Doctors, it’s time to put on your hip-high waders… it is going to get really deep before anyone in the government takes action or gives definitive guidance.


Want to catch up on our coverage of this story?


Dentists: Do You Trust Your Dental Lab?

The Hidden Costs of a $40 Dental Crown

The relationship between dentists and their dental labs is a close one – but is it close enough?

The other shoe has dropped. The lead scandal, a story that The Wealthy Dentist has been covering for the last two months, has now gone national. ABC’s Good Morning America ran a segment about this potential crisis on May 8th. Doctor, you better have your story straight when you patients start asking you where your lab work in being done.

Dental labs have been in the spotlight due to the recent scare over lead apparently finding its way into dental restorations such as crowns and bridges. Dentists are realizing that they are ethically (and possibly legally) responsible for the quality of their dental lab’s work.

How much do you really know about dental labs?

The following information was provided by the National Association of Dental Labs (NADL). All numbers apply to the US.

  • $80 billion: Annual revenue generated by dentistry
  • $7 billion: Annual dental lab sales
  • 12,000: Total number of dental laboratories
  • 5,000: Number of those that are single-technician labs
  • 48,000: Number of full and part-time dental technicians
  • 11,000: Number of dental technicians predicted to leave the profession by 2014
  • 68%: Percent of surveyed NADL labs outsourcing at least some work to domestic labs
  • 5%: Percent of surveyed labs outsourcing overseas

There are a number of holes in the current system. Allow me to point out just a few…

Start at the beginning

Once upon a time, would-be dentists studied alongside would-be dental technicians. The two professions are inextricably connected, and each would do well to understand the needs of the other. How better to foster this relationship than by educating students together?

Today, however, that is certainly not the case. At most schools, dental students and lab students have little to no exposure to each other. The communication gap that begins in school tends to continue into the working world.

“Most dentists don’t meet a technician until after they graduate and that’s criminal. The pre-clinical students and dental laboratory technology students are able to learn from each other, which helps them hone the skills they have and build new ones.”
– Bob Schneider, DDS, University of Iowa Hospitals and Clinics Professor (Journal of Dental Technology, June/July 2006)

Bridge the communication gap

One of the biggest complaints dental lab technicians have about dentists is that they often don’t give the lab all the information they’re supposed to. A proper prescription for a dental prosthesis includes detailed information about the materials to be used in its construction. When the dentist doesn’t provide all the details, it’s up to the technician to make these important decisions.

“Most dentists rely on the dental technician to choose the materials needed for the fabrication of the prosthesis. With lack of adequate information, all too often the design, fabrication, and completion of the case is left up to the technician. Therefore, our results indicate an apparent trend to which technicians are left to make crucial decisions for dentists.”
– Z. Afsharzand, DMD et al. (from the Journal of Prosthodontics, Vol 15. No 2 March-April 2006 pgs 123-28)

Know your partners

One dentist will have been working with the mom-and-pop dental lab down the street for thirty years. Another will use a major domestic lab after personally visiting the premises. Another will prefer the US-based chain with the lowest prices. Another will go online to find a Chinese lab that offers crowns for $39.95.

The dentist’s relationship with his or her lab isn’t something the patient can see. It’s not even something most patients would think to ask about. But even if it’s invisible to the patient, it’s likely to be the factor that best predicts the quality of the dental work they receive.

Patients deserve disclosure

In the US, dentists are not required to tell patients if their dental prosthetic was manufactured outside of the country. In fact, dental labs are not always required to tell dentists where the device was manufactured. (And since many US labs use partners overseas, a domestic return address is no guarantee.)

However, expect the laws to start changing soon. A number of states are already considering legislation mandating that labs inform dentists and/or dentists inform patients of work fabricated outside of the country. In Canada, for example, patients must sign an informed consent form before receiving any foreign dental work.

Keep on working

It may be as long as year before the ADA announces the results of their testing. Perhaps it’s a big fuss over nothing; perhaps we’re all slowly dying of lead poisoning. I can’t predict what the science will say. But I can definitely predict this: you, the dentist, are going to be held responsible for your dental lab work. Here’s hoping you can be proud to stand by your restorations.

Post your comments about dental labs


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