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Some local dental laboratories are frowning on the fact that a large concentration of the crowns, veneers and dentures used to repair the smiles of Texans are being imported from abroad.
Dentists across the nation have been bypassing thousands of American dental labs that make these products. They are choosing instead to import them from countries like China and Mexico, where the costs are cheaper. Domestically made implants can cost more than double, and that expense could be passed on to consumers.
Like other industries, the domestic makers of dental implants are hoping the Trump administration will really put teeth into efforts to revamp national trade laws. The labs have long been "fighting the overseas competitor," and they are optimistic about Trump, said Cade Tippett, president of the Dental Laboratory Association of Texas.
Laws that curb the demand for cheaper goods from abroad can hopefully return the focus to products being made in the U.S. and help local dental labs stay in business.
"The workforce reduced when overseas started," Tippett said.
A “voracious market for discount choppers” has resulted in more than a third of the $8.5 billion national market for dental restorations coming from abroad, Bloomberg recently reported.
Dental laboratories hire and train technicians who use molds and impressions of a patient’s teeth to create products like crowns and dentures. There were about 2,260 dental technicians in Texas in 2016, according to the Bureau of Labor statistics. Texas-based labs employed the third highest number, after California and Florida.
But labs across the nation say they’re having to lay off technicians more frequently, or shutter business altogether. Of more than 2,900 labs registered with the Texas State Board of Dental Examiners, only 641 are currently in business. More than 900 are permanently closed.
Most have simply let their licenses expire and would need to reapply.
The state board licenses the labs, but the agency does not investigate the reasons for closings except among those that break the law.
But about half of all U.S. labs have closed over the past decade. Smaller facilities have consolidated with larger companies. Entrepreneurs who once ran domestic labs are moving on.
"Every time I had to tell someone, 'I can't afford to have you around any longer,' it's difficult," Doug Kilborn, a dental lab owner in Michigan told Bloomberg. “That’s the face of American manufacturing nowadays."
From Vietnam to Central America, cheap labor and less regulated working conditions helps other countries take a big bite out of the U.S. dental restoration market, according to industry reports.
The standard turnaround for products like inlays, crowns and veneers is about 10 business days. It may cost a dentist more than $100 to purchase a crown from a lab in the U.S., but less than $40 to get one from another country. That’s a significant savings for a dentist trying to cut overhead.
"But it puts us at a competitive disadvantage. And there's nothing we can do about it," said David Lesh, president and founder of Concert Dental.
His Richardson-based dental lab has about 30 people on staff, many of whom he says he hired from nearby labs that had closed.
"Trump talks about this all the time -- about laying people off, making goods overseas and then bringing them back across the border," Lesh said. He appreciates the administration's intention to stop the practice.
"Or at least affect the economics of it," he said.
As dentists consolidate, the larger companies have more negotiating power. They can dictate which dental labs are used, and there is a major focus on reducing costs.
Even some of the domestic dental labs now succumb to the lure for overseas products. That’s leaving a bad taste in the mouth of dentists, who also worry that quality and customer service may be compromised.
About 15 million Americans have crown and bridges to replace missing teeth, estimates the American Academy of Implant Dentistry.
There is good reason why consumers may want to ask where those teeth are coming from, said Dr. Frank Higginbottom, a former board member of the Texas Dental Association.
"Low cost may come at high risk. You compromise training, infection control and you get cheaper materials," said Higginbottom.
His private practice dentistry office in Dallas has been around 46 years and specializes in restoration. Higgenbottom only uses U.S. laboratories.
So does Dr. Sarah Tevis Poteet, chair of the media committee for the Dallas County Dental Society.
“I don’t think patients have a clue where their crowns come from,” she said. "I would rather pay more knowing that I'm going to get good quality."
After threatening to completely withdraw the U.S. from the North American Free Trade Agreement -- a deal signed in 1994 by President Bill Clinton that eased trade with Canada and Mexico -- President Trump called the leaders of those nations in April saying he’d like to renegotiate the terms.
He and advisers like Speaker Paul Ryan also want the tax on imports to be set at the regular rate of corporate income, instead of allowing companies to deduct imports from their taxable income. That proposal has generated substantial opposition from retailers.
Dental implant makers say new laws could curtail the outsourcing of fake tooth manufacturing that has reduced their job supply. But could the renewed local tooth-making market make dental implants more expensive for consumers? That’s the part many are still chewing on.
The average cost of a crown -- depending on the material used to make it -- can range between $500 and $3,000 per tooth, according to the website Cost Helper. A dentist charges a base amount that covers all the overhead costs, including manufacturing.
Because of that Lesh, for one, doesn't think it will necessarily lead to price hikes.
The advantage of importing from abroad is a savings of about $60 extra per crown. “There was this opportunity they saw to get it from someone else for less. But the economics still work,” he said.
As with seemingly everything in health care, however, others say the cost always trickles down to the patient eventually. Poteet is in private practice and only purchases dental implants from Texas-based laboratories.
She likes that patients can go directly to those labs if they want the color of their implantable tooth to be matched perfectly and says she has easy access to the facility if there are concerns. But, her practice is not in-network for health insurance, and her patients pay out-of-pocket, generally at a higher price.
Texas’ Dental Practice Act requires that technicians who build fake teeth be certified and tested on things like anatomy, pharmacology and hygiene. They must undergo continuing education training, and specialty training if they work with orthodontists. And the labs must register and remain in compliance with state and federal laws. That’s not to mention minimum wage laws.
“Those things add to costs. We charge a higher price because we have to, and that probably will be transferred to the patients,” Tippett said. “But I also think we produce a more patient-centric device.”
Concert Dental Labs was founded by David Lesh, CDT to provide top-notch restorations using state-of-the-art dental technology. All restorations are made in the USA at Concert's ISO 9001:2008 certified facility. Additional information on Concert Dental Labs may be found at www.concertdental.com
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Concert Dental Labs is the nation's leading, direct-to-dentist technology lab creating the highest-quality restoration products using only FDA-approved materials.