Bite this: American teeth, made in India

Chew on this: a patient in the US goes for a root canal treatment. His dentist orders a crown for him from a dental lab in the US. The lab then takes the patient’s tooth impression and ships to a dental lab thousands of miles away in Mumbai.

Based on the impression, the Indian lab fabricates the crown and ships it back to the American lab, which then delivers it to the dentist, who fits it in the patient’s mouth. Neat. And cheap.

Two factors — a shrinking number of qualified technicians abroad and lower costs in India — are luring more and more dental labs to outsource production. According to statistics from the US National Association of Dental Laboratories, between 10 and 15 per cent of the total number of restorations in the US — mostly crowns, according to Food and Drug Administration (FDA)  — are currently produced offshore, mostly in India and China. And with reports of lead being found in Chinese-made dental prostheses, dentists in the US and UK are now increasingly turning to Indian labs to outsource their dental work.

Dr Bhaskar Savani, a US-based dentist, has been outsourcing dental prostheses to China for the last five years. But he recently replaced the Shanghai-based firm with a dental lab in Mumbai.

He was not alone — about 800 other dentists in the US have done the same thing. Besides, over 200 dentists from London have been outsourcing 300 crowns from India on a daily basis for the past one year.

Says Dr Savani, “Initially, the Chinese government gave us good incentives, but over the years it got diluted. The cost of labour is also rising in China. As far as India is concerned, there is clearly a cost benefit as Indian-made prostheses are cheaper than the Chinese ones. But with India, there are problems of clearance and delays in transit, but I guess these will improve with time.”

While a crown fabricated in the US could cost the dentist Rs30,000-Rs35,000, getting the same done from India costs Rs20,000-Rs25,000 - upto 33 per cent saving in costs. But at the moment American laws do not require a dental lab to reveal whether the crown will be outsourced, and there are no tags that say where the crown is manufactured. Outsourcing dental labs either ship to a US-based broker laboratory that sends the work offshore, or ship directly to an overseas lab.

Sameer Merchant of Laxmi Dental Export Pvt Ltd, Mumbai, exports 500 crowns on a daily basis to dentists in the US and UK. He says, “There is great demand for Indian dental prostheses as it is five times cheaper to make them here than in the US. Also, the quality of an Indian-made prosthesis is similar to that of an American one.” Adds Dr Rajneesh Sethi, Mumbai-based dentist, “So dentists enjoy a larger profit margin when they get their prostheses made from India.”

According to dental experts, the technology is better in the US, but labour is cheaper in India. This has been the driver of the growing dental outsourcing business. “Dental prostheses are generally made by unskilled labourers which India has in excess, unlike the UK or the US”, says Dr S Yogesh, a Pune-based dentist, “The major outsourcers are private universities and dentists in the US and UK, along with a few dentists in Germany and Spain”. 

But outsourcing also has its own set of problems. The crown could be fabricated in unregulated labs, using materials that have not been approved for use in the United States. American laboratories have alleged that materials such as beryllium and lead are being used in foreign labs, especially in China, and these have been shown to create very serious health problems when used at levels higher than what is approved by the FDA.

There seems to be some ambiguity about Customs rules in India, says Savani. “Once a shipment was delayed by almost six months, causing unnecessary complications with patients,” he says. Merchant adds: “Customs officials charge Rs50 per rubber impression even though the impression is worthless.” Other countries like China, however, have no Customs-related problems. 

Notwithstanding health concerns, outsourcing is seen as a boon by many Indians as it has created new employment opportunities. Says Rajendra Dande, accounts manager, Katara Dental Lab, “The people who fabricate the prostheses are unskilled labourers. They have had schooling till the 10th or 12th. Dental outsourcing is giving them employment.”

Adds Dr Savani, “India has tremendous potential when it comes to dental outsourcing. We are expecting more colleges and training institutes for dental technicians to open up in India.”