Reader responds to outsourcing of dental crowns to China

April 1, 2011
This letter is in response to the January (2011 DE) cover story "Battling for Your Business." I lived in China for four years, and worked in the dental laboratory business in that country. So my experience gives me a different perspective than most people.

Carl Cochrane, Artistic Dental Technologies

This letter is in response to the January (2011 DE) cover story "Battling for Your Business." I lived in China for four years, and worked in the dental laboratory business in that country. So my experience gives me a different perspective than most people. I worked with several large U.S. and two Chinese laboratories, as well as large U.S. dental practices. This includes Heartland Dental Care, the second largest dental practice in the U.S. I helped several of these U.S. firms set up outsourcing programs for dental prostheses. I know the quality can be very high and the cost savings significant for labs, as well as large- and medium-sized dental practices.

The key to buying high-quality crowns from China is the same as buying anything else; you get what you pay for. If you want to pay $13 for a Chinese-made crown, you will get a very cheap and poorly made crown. If you're willing to pay more, you can get an extremely good crown, but at a lower price than you would pay in the U.S.

It is possible for a dental laboratory or any large dental practice (cutting 30 or more crowns a week) to get very high-quality crowns from China at savings of 40% or more from what they would pay in the U.S. There are several labs in China and Hong Kong that produce very high-quality work. I am currently working with a lab where Dr. Frank Filser supervises the all ceramic work. He is the inventor of the Cercon and one of the first people to use zirconia as a dental material. How much experience do you want? The quality is very high. There is German management, training, and supervision, but significant savings are possible because Chinese labor is not as expensive.

There seem to be three main objections to using outsourced crowns from China. One is that many dentists and labs think it is unpatriotic and damaging to the U.S. to sell or use crowns that are not made in America. That argument has been made in the past with cars made in Japan. It is fine if people feel that way, but globalization is here to stay and most large U.S. labs have an offshore component to increase what they offer their dentist customers. Those labs that don't are missing an opportunity for growth that can help them take care of their employees. More profits with the same number of employees can mean more money for training and benefits, such as constantly rising health insurance costs.

Most labs get 80% of their business from 20% of their customers. There is little to be gained from not offering customers what they want, and that is often a lower-priced alternative. One quality U.S. lab technician I worked with kept saying that Chinese crowns we were bringing in were as good as his.

But in the end, he decided not to add them because changing his business model was too much for him to handle at this point in his business. Most of his dentists sent him only their most difficult implant cases and large bridges. They sent their single posterior cases elsewhere to cheaper labs. But he decided not to go after that business. Why pass up business? It still makes no sense to me.

Second, there is a fear of getting substandard materials, especially lead in crowns made in China. One person in the article was quoted as saying, "… I know my materials are approved by the FDA." Other than teeth for dentures, I have never seen any lab in China use materials to formulate their crowns that were not made in Europe, the U.S., or Japan.

The teeth for dentures were made in China at a German-owned factory. The Chinese labs have no interest in using substandard materials. The key to their success is long-term relationships. They want to keep their customers happy, and are very concerned about what they produce. The lead scare is really not anything of significance. The bridge in question simply did not fit well, and the media blew the entire event out of proportion. The amount of lead was insignificant and not a health risk. The ADA did a study of lead in both U.S.-made and outsourced crowns. Nothing was ever released warning about outsourced crowns because there was no risk found.

The third reason given against outsourced Chinese crowns is that they produce inferior products in sweatshops. If you are buying a crown from China at $13, it probably is a low-quality product made in a sweatshop. Making crowns is a craft. It is a skilled job that requires careful and trained labor. If the workers feel abused, they will not produce a quality product and lab owners know this. Most workers live in dormitories and eat in company cafeterias. But this is what they expect if they are single. It helps them save money and get ahead.

The labs treat their employees well. If they don't, they can't produce a good product. Producing a marketable product is what any business must do. The quality of the Chinese labs depends on what their customers want.

One lab I know has a six-story building and produces a different quality product for a different price on each floor. The highest quality is superb, and they also do large bridges, whole-mouth restorations, implants, and other technically sophisticated work. The price is, of course, higher. It is expensive for China but much less than one would pay in the U.S. You get what you pay for. Nonetheless, it is possible to get a bargain.

All dentists should have a good relationship with their dental labs. It is common for a dentist to use several labs on a regular basis. They may want to discuss difficult cases, anterior crowns, large bridges, and implant cases; however, most cases are fairly simple, single-unit posterior crowns. These can easily be outsourced to a high-quality offshore laboratory. The practice can save money and give patients high-quality products.

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