Posted on 02/27/2008 5:42:59 PM PST by Patriotic Thunder
COLUMBUS, Ohio - Chris Collier has been a patient of Dr. Dave Rummel for 30 years.
When it comes to teeth, Collier is more concerned about his health than his smile.
"The reason I come here is because I know I can trust the dentist I have," Collier said. "I know I can get good workmanship."
SLIDESHOW: Images From Report
Rummel is one of the few dentists in central Ohio who makes his own crowns, bridges and dentures, but most other dentists rely on outside dental labs, 10 Investigates' Lindsey Seavert reported.
The labs can be down the street or even overseas, increasingly outsourcing work to India, Mexico and China. Chinese imports, like jewelry and toys, have been under heavy scrutiny for the last year because of lead concerns.
The dental community is concerned that unsafe metals have reached their industry, too.
"It's one thing if it's a toy a child plays with for 20 minutes. It's another thing if it is somebody's mouth for a lifetime," Rummel said. "There is an issue here."
10 Investigates obtained a letter from the National Association of Dental Laboratories that outlined the concerns. The organization told the Food and Drug Administration that outsourcing would increase because dental work created overseas is cheaper.
Even more of a concern is that dental labs or mostly "mom and pop" shops are unregulated in Ohio and 46 other states. Because of that, labs can outsource and no one may ever know, Seavert reported.
"Currently, laboratories that are outsourcing work overseas are required to disclose that to their dentist through existing FDA regulations but that is where it stops," said Bennett Napier of the NADL. "That disclosure does not have to pass on to the patient."
10 Investigates learned the deception goes one step further. Sometimes labs don't tell dentists, leaving them to unknowingly place foreign products in patient's mouths.
In the U.S., the materials in dental work are FDA approved. It is supposed to be that way in foreign countries but the FDA has no way to enforce it, Seavert reported.
The NADL said the FDA approached them first in 2004 and then in 2007, concerned about the increasing number of imported dental devices passing U.S. borders and acknowledged the need to better enforce dental lab regulations.
With millions of products and not enough manpower, the work crosses borders to places like Ravenna, Ohio. There, a 73-year-old woman hired a lawyer to sue her dentist. It began when she received a new dental bridge last year. The pain became so severe that she could not chew.
"She began to have some pretty significant complications and reactions and infection that stemmed from the restoration that ultimately had to be removed," Napier said.
The woman, who requested anonymity, told 10 Investigates that she later discovered her bridge was made in China. Worried, she had a lab test it for hazardous materials.
The lab determined that the porcelain filed away in her mouth contained lead. She has since undergone two surgeries, Seavert reported.
With 300 unregulated dental labs in Ohio and an estimated 7 million crowns coming into the country each year, 10 Investigates wondered how much a threat lead is in outsourced dental work.
We ordered eight crowns from four labs in China that advertise in industry magazines. With help from Rummel's lab, we received our product 10 days later.
Only one lab identified materials in the crowns. 10 Investigates first used a device that screens for lead. Of the eight, one crown came up positive.
We sent our sample to a Cleveland lab - NSL Analytics - to provide scientific proof. They specialize in testing metals and began by separating the porcelain from the metal.
The crown is diluted in a test tube that becomes a solution chemists test for lead. The machines give an instant reading of lead. 10 Investigates' results came back at 210 parts per million. The Ravenna woman's bridge measured 160 parts per million.
"We don't know what the FDA or the American Dental Association considers to be a risk as far as lead content," said Carm D'Agostino, a chemist.
With no known research on lead in dental work, the lab can only compare to toy standards.
Toys leaching lead over 90 parts per million are hazardous, so what about 210 parts per million in your mouth?
"I guess that tells me I need to be a little bit more concerned about other potential sources of lead," said Dr. Marcel Casavant, who runs central Ohio's lead program and poison control center. "I never would have guessed somebody would have put lead into a piece or a part installed into a human being."
Casavant said adults can live with lead poisoning for years and not know it.
"The symptoms are what we call non-specific - a little ache or a pain - abnormal bowel function," Casavant said.
Even high blood pressure and kidney trouble could be symptoms, according to Casavant.
He said he would never link lead poisoning to dental work but would have to add it to his list of questions when asking people what kind of dental work has occurred.
The NADL said that 10 Investigates' findings prove that the FDA needs to do more.
"It reinforces the concerns we have as an industry and concerns the FDA expressed to us that the potential is there," Napier said.
The NADL letter asks the FDA to track dental work from foreign labs to patient records. They want the FDA to register all labs, require them to disclose where they get their dental work and label what materials are in it.
The Ohio Dental Board admitted that is not sure what is happening in the state's roughly 300 labs and has no plans to regulate them. Lili Reitz, the director of Ohio's dental board, said the burden relies on the dentist.
"Ignorance is not a defense when you are ultimately responsible for what is going into the mouths of the patients that you serve," Reitz said.
Rummel said that 10 Investigates' lead findings only prove outsourcing comes with a risk.
"If a medical device is made out of a foreign country, I think the patient should know," Rummel said.
He recommends that people ask their dentist where their work is made.
"I think you can't really get something for nothing and I think (if) we start going down that road, we all suffer," Rummel said.
In response to our story, the Ohio Dental Board on Wednesday adopted a recommendation to the dentists they regulate.
They are asking dentists to give labs a form that would require the labs to disclose where their dental work is made.
On a federal level, 10 Investigates has asked the FDA for a response to our findings for the past two months.
On Wednesday, they told us that they are reviewing our report and developing a strategy to address our findings on all imported dental devices.
The Ohio Dental Association said that it would require their members to fill out the form in hopes of giving it a better idea of how many labs are outsourcing.
bump
That's one theory of what happened to Rome. Do you think there's any basis for basing the estimated risk on the actual amount of lead involved, or is that just foolishness?
They didn’t know any better.
If i find out my new crown was made in Leadsville china, I am punching someone’s teeth out!
“Kind of odd that people can walk around with bullets (990,000 ppm?) in them for years and not have that happen.”
I’m still walking around with a fair amount of a bullet in my left leg. Been there for about thirty years. No problem.
Elemental lead is not dangerous: It’s the oxides of lead (and other lead compounds)that are dangerous as the body can easily absorb them.
Isn't occupational exposure based on external levels?
...and then that would be affected by the possibility of breathing in lead-laden dust, etc. depending on circumstances.
Here's a related question. There is still epidemiological evidence on toxicity of lead-based paint, on inner-city children who eat chipping paint.
Would it be possible to back into a toxicologically significant dose (crowns and paint chips both are inside the mouth...) from that data?
Cheers!
In this case, the body has to separate it from an amalgam/alloy (at 210 ppm) first. I'm just not seeing the potential to get enough lead exposure from one of these to cause the problems that are being attributed to it.
I'll try again tomorrow...
Thanks, and
Cheers!
Look at the video and see the inflammed tissue and try saying that again. While your at it, inform the Ohioan lady in this video “It’ll be okay”
“I’m just not seeing the potential to get enough lead exposure from one of these to cause the problems that are being attributed to it.”
I kinda doubt it myself. People just freak out when the word lead comes up.
I always get someone warning me about how dangerous casting my own bullets is. The biggest danger is spilling hot lead on yourself!!
I actually have some molds for lead soldiers that kids of my grandfathers generation used to make their toys!
The 40ug/dl is blood levels. If you work around lead and your blood levels get above that you're supposed to get moved to some less contaminated environment until they drop below that.
As far as the other question goes, I guess it might be possible (lots of "ifs" there), but if this person suspected they'd gotten lead poisoning from their dental work I'd think they'd go get the bloodwork done to verify it, and we'd be reading about it in the article.
Cheers!
They found lead in the crown, so that has to be what caused it. No other explaination is possible or any other possibility worth considering? You're way too easy.
So my gold crown could have lead in it?
Yesterday, I received an email from the National Association of Dental Laboratories (NADL), outlining this problem with Chinese dental lab products.
They pointed me to their website to get updates on the story. When I got there, the story and updates were only available to NADL paying menbers with a site user account. Pretty useless.
Do a search online for dental labs; you should get plenty of hits. Dig a little deeper and look for fee schedules or price lists. You won’t find many. The story was much different, even 5 years ago. Lots of labs published their prices.
The dirty little secret is that the $600 - $1200 you paid to a dentist for a crown has a lot of in dental office markup.
In most cases when a dental office sends out crown work, the cost of a crown from a domestic dental lab to that same dentist is $80 to $250. (I know some of the folks getting $250, they are very exacting artists/craftsmen, worth every penny. They represent a very small fraction of the work sold in the US today) Work sent overseas commands as little as $55. Sure, the dentist did a crown prep and took impressions, and then cemented the restoration into place, but did he really deserve that huge markup?
The story also seeks to portray the dentists as victims of underhanded dental labs, both domestic and foreign. What a crock. Did anyone seek to find out just what percentage of dental work sent to China from the US is sent by labs and what percentage is sent directly by dentists? Of course not, or the average dentist greed would be shown to be even more pronounced.
Did you know that it is illegal in most states for a dental lab to deal directly with the public? Some latitude is allowed for labs to take shades for restorations which are prescribed by dentists, and some very few states have denturist legislation, whereby people can get lower cost dentures.
Dentistry is a closed shop. Break a tooth out of a denture and a dental lab can’t help you without a dentist’s prescription. The lab may charge a dentist $50 for the single tooth repair. How much does the dentist then charge the patient?
Your kid loses his retainer after orthodontic treatment. The lab bills the dentist for less than $45 for an average retainer. How much did the dental office charge the parents for the replacement?
Dental technicians are unregulated. Anyone can call himself a dental technician. Reputable technicians have tried for years to institute minimal standards for their profession, but to little success. The dentist lobby has blocked most of these attempts. Ask a dentist why.
The NADL has has an adjunct, the National Board for Certification, or NBC. It sponsors a voluntary certification process, which awards the title of CDT or Certified Dental Technician, to successful candidates.
Some states, such as Texas, require that dental labs in their state have at least one CDT in the lab operating in Texas. There are no broad requirements for all dental technicians in their state.
Did you know that there are no specific standards for US dentists who do their own lab work? I have seen the lab work of many dentists, few could meet the standards of the voluntary CDT program. Neither the states nor the state components of the American Dental Association seem interested in regulating dental technology as performed by dentists, nor establishing objective criteria for the regulation of dental technology.
Caveat emperator, let the buyer beware.
“The lab determined that the porcelain filed away in her mouth contained lead. “
It appears that the porcelain cap was filed in her mouth upon insertion and the filings contained lead.
Ironically, I think that China and the third and fourth world overall is recycling our own foreign electronic components.
Regular solder contains silver and lots of lead. It’s pretty common for the poor to cook it off of circuit boards to sell to those to refine it further for jewelery or whatever.
Good thing I'm alone; I wasn't as polite.
It's about time for a check up anyway. Looks like I'll have to ask just where the 10K+ of dental work I've had done over the past 4 years has come from. When they said the 'lab' was doing the crowns, it never occured to me that the damn lab might be in China. jeez...
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