0312dentalaudLocal dental lab owner Kamil Karroum talks about outsourcing to China.
First, it was the tainted pet food. Then the lead-contaminated toys. Now, the latest consumer scare from China involves something you may already have in your mouth.
An estimated 20 percent of dental laboratories in the United States — businesses that make crowns, bridges and dentures — are outsourcing some of their work overseas, mostly to China.
"The cost of labor there is maybe one-tenth of what it is in the U.S.," said Britt Allen, certified dental technician at Brittain’s Dental Lab on Thompson Bridge Road. "But those savings usually go to the lab or to the dentist and are not passed along to the patient."
In many cases, dental restorations manufactured in foreign countries are identical in quality to those made in the U.S. But because regulatory agencies such as the federal Food and Drug Administration have no jurisdiction in other countries, it’s not always possible to verify the safety of those products.
That became apparent recently when an Ohio woman had an adverse reaction to a dental bridge. After her dentist removed the object from her mouth, he revealed to her that the restoration had been made in China. She became alarmed and sent it to a lab for testing. The results showed a high level of lead contamination.
An Ohio TV reporter then conducted an experiment, ordering eight dental crowns from various labs in China. One crown tested positive for lead.
The issue was brought to the attention of the National Association of Dental Laboratories and the American Dental Association, both of which have sent out notices to their members. The ADA has also launched its own investigation to determine how widespread the problem is.
But the only way to know whether dental work is contaminated is to have a chemical analysis performed on it.
"You can call your dentist to find out the origin of your lab work," Allen said. "But the problem is, sometimes the dentists don’t know. There’s no law that requires the lab to inform the dentist."
Nor are dentists required to tell patients where their restoration was made. But that may change in the future.
"We’re trying to decide how to most appropriately address the situation," said Mark Ritz, president-elect of the 3,200-member Georgia Dental Association. "It’s certainly something we’re very concerned about. We’re discussing whether there needs to be legislation."
Allen, whose lab does not outsource, said he thinks Georgia should have a law requiring that whenever a patient receives dental work, a document is placed in their file identifying the origin of the materials used.
But Kamil Karroum, a partner at Southern Craft Dental Lab on Limestone Parkway, said what’s important is who makes the product, not the country in which it was made.
He said he tried outsourcing to China several years ago, "but we had a problem with the people changing the materials from what we had specified. That’s why I decided to open my own lab in China. We buy all of the materials here or in Germany. It was the only way to guarantee that the right materials were used."
A crown that costs $100 to $200 to make in the U.S. may cost only about $30 in China, partly because of lower wages.
"The only way to offer a competitive price to our customers is to do the work in China," Karroum said.
He said he was also attracted by the country’s large labor pool.
"We could not find enough qualified technicians here," he said. "The techs we hire in China work for us for six months before we give them their first dollar. We train them to our standards."
The same standards apply at Southern Craft’s Gainesville facility, Karroum said. "We give the dentist the option of having work done in Gainesville or in China."
But many dentists prefer not to use labs in China, even ones that are American-owned. Publicity about product recalls over the past year has made consumers skittish about anything that bears the China label, and dentists don’t want their patients to worry.
Gainesville dentist Mike Vetter said he doesn’t use outsource labs.
"I play it safe. I don’t like to roll the dice," he said. "Using a local lab allows you to know the person who made it."
In these tough economic times, everyone wants to save money, he said.
"But putting something in your body that was made in China is different from buying a flat-screen TV that was made in China," he said.
There are at least a dozen dental labs in the Gainesville area, and it’s not known how many of them outsource overseas. Some lab owners did not return phone calls from The Times. Those who spoke on record said they do not engage in the practice.
Alvin Gibson, co-owner of Gibson Dental Designs in Gainesville, thinks outsourcing shortchanges the public.
"An offshore lab is going to use the cheapest materials (it) can get," he said, "It costs $20 to $30 to make a crown in China. The gold alone is going to cost more than that, so there’s no way they could be using quality materials."
A dentist could increase profits by contracting directly with an offshore lab. Patients typically pay $800 to $1,500 for a crown. Gibson said he charges dentists $100 to $125 to make the crown. The rest of the price goes to pay for the dentist’s overhead, such as employee salaries, equipment and liability insurance.
If the dentist can get a crown made overseas for only $30, he could pocket the difference.
But for many dentists, the priority is their patients’ well-being and peace of mind, not making a few extra dollars. Gainesville dentist Brad Dixon, for example, contacted local labs last week asking for written verification that they do not outsource, and that they know where their materials come from.
"We want to be able to reassure our patients that the restorations we provide do not have unsafe lead levels and are not outsourced to other countries that do not have the same regulatory safeguards that the United States has," Dixon said.
But actually, those safeguards are not as strong as people may think. The FDA has no direct oversight over dental labs. And in some cases, a "lab" consists of a couple of people setting up shop in someone’s basement.
The National Association of Dental Laboratories is calling for stronger regulations and a series of reforms, including a requirement that every lab have at least one certified dental technician, and that all dental labs be registered either with the FDA or a state governing agency.
The government cannot ban the practice of outsourcing. Free trade policies give industries the option of moving their business to countries where labor costs are cheaper.
But if dentists and patients refuse to accept products made overseas, the demand for outsourcing may diminish. That will almost certainly be the case if it can be proven that people are being harmed by the products.
Dr. Anil Mangla, epidemiologist with the Georgia Lead Poisoning Prevention Program, said he has not seen a case of lead poisoning in an adult that was caused by dental work.
"But this (outsourcing) is a new phenomenon," he said. "If someone is concerned about dental work that’s already in their mouth, they should get their blood tested."
Mangla said any doctor can draw a blood sample and have it sent to the Division of Public Health to be screened for lead.
"If it shows no elevation, there’s nothing to worry about," he said.
A level of more than 25 micrograms per deciliter in adults is considered abnormally high. For kids, the threshold is 10 micrograms, because their brains are still developing, making them more vulnerable to the effects of lead.
Symptoms of lead poisoning in adults can include nausea, lethargy, headaches and cognitive problems.
The good news, Mangla said, is that the half-life of lead in the human body is 60 to 90 days.
"So if you remove the (contaminated) crown, you should see the blood level of lead dropping within a few months."
Allen said he’s glad people are finally becoming aware that their dental work might not be "made in U.S.A."
"It’s a public safety issue," he said. "This is something that those of us who don’t outsource figured would come up sooner or later."