Dental Laboratories

SIC 8072

Companies in this industry

Industry report:

This classification comprises establishments primarily engaged in making dentures, artificial teeth, and orthodontic appliances to order for the dental profession. Those establishments primarily engaged in manufacturing artificial teeth, except to order, are classified in SIC 3843: Dental Equipment and Supplies, and those providing dental X-ray laboratory services are classified in SIC 8071: Medical Laboratories.

Industry Snapshot

There were approximately 12,100 dental laboratories providing almost $3.1 billion worth of services at the end of the first decade of the 2000s. This industry employed some 56,750 people domestically. These businesses produced custom-made prosthetic appliances for the dental profession. At the end of the decade, the industry benefited from advances in technology and dental techniques, such as digital imaging, but also felt the effects of the economic recession, which had consumers delaying dental care, especially elective, cosmetic dentistry. The industry was highly fragmented with increasing pressure from offshore outsourcing gaining attention at the end of the decade. By the early 2010s, a slow recovery in the industry had begun.

Organization and Structure

About half of all individual dental laboratories are owned by corporate bodies, while the balance are owned and operated through sole proprietorship and partnerships. Most of the country's dental laboratories are located in large metropolitan areas, typically within approximately 50 miles of the dental offices it serves. Therefore, dental laboratories tend to be spread throughout the United States based on geography and population. However, with the increasing use of rapid delivery services, laboratories have become less dependent on physical location. In 2009 California was the leader, with more than twice as many labs as any other state. With about 2,149 laboratories, California employed a workforce of approximately 11,400 people in this industry and accounted for more than $474 million of the industry's sales. Ranking behind California were Florida, with more than 1,000 establishments, and New York, with more than 775.

Customarily, in creating an actual dental prosthesis, such as full or partial dentures, a bridge, or a crown, laboratories follow instructions provided by the individual dentist and use a wax or plastic impression of the patient's mouth that had been made in the dentist's office. In some cases, dental laboratory technicians work directly for dentists in the dental office itself to facilitate such procedures. Dental laboratory technicians working in separate labs may also have contact with patients in preparing and fitting the individual prostheses, but more commonly have no contact with patients. Dental laboratories typically purchase their materials from companies that manufacture products specifically for the health care industry (see SIC 3843, Dental Equipment Manufacturers).
Only a few states regulate dental laboratories, and although the federal Occupational Safety and Health Administration (OSHA) does not apply specific guidelines to dental laboratories, it does require labs to follow established standards for proper infection control procedures regarding blood borne pathogens. In addition, the Food and Drug Administration must approve all materials used in the manufacture of dental devices and regulates minimum quality assurance processes and practices. The industry also has in place voluntary standards of compliance for the step-by-step manufacturing of specific devices as set out by the National Association of Dental Laboratories.

Qualifying dental laboratories are eligible to apply for certification from the National Board for Certification of Dental Laboratories (CDL), founded by the National Association of Dental Laboratories, which has established specific standards for "personnel skills, laboratory facilities, and infection control in dental laboratories." According to the CDL, certification was potentially "invaluable in establishing credibility with outside third parties, including courts of law, insurance companies, and government." To receive certification, a laboratory is required to employ certified dental technicians in supervisory positions, document facility compliance with accepted health and safety standards, and maintain high levels of training and practice in infection control.

Background and Development

Restorative dentistry, as outlined by Bonnie L. Kendall in Opportunities in Dental Care, traced its beginnings to the Etruscans of central Italy, who made bridges and crowns. In the Roman Empire, numerous processes were developed for the artificial restoration of teeth. Few dental advances were made in the Middle Ages, when the main antidote for a toothache was extraction of the offending tooth. It was not until at least the sixteenth century that anatomical study led to new discoveries about teeth.

Restorative dentistry in the American colonies consisted of tooth transplants, false teeth, and a hygienic dentifrice. Such items were generally fashioned by the same individuals who treated toothaches. As the population of the United States grew, "dentists" began to establish permanent rather than itinerant practices. According to Kendall, silversmiths and goldsmiths periodically assisted in the creation of artificial teeth, working either independently or with dentists. By the nineteenth century, the majority of dentists made such prostheses themselves or employed apprentices to assist in their production. With the 1840 opening of the United States's first dental college in Baltimore, students began to receive training not only in dental procedures but also in the preparation and setting of artificial teeth. Nationally, by 1986 there were 58 accredited training programs for the education of dental lab technicians. The precise date when independent laboratories first appeared is not known, but approximately 2,000 laboratories were operating in the United States by 1920.

Kendall said that in 1933 the government ruled that the dental laboratory industry should be operated by "a code of fair practices," and a group was established to formulate these guidelines. In 1951 the American Dental Laboratory merged with the Dental Laboratory Institute to form the National Association of Dental Laboratories (NADL). The NADL opened its offices in Washington, D.C., in 1952 and by 1958 had set up its Certified Dental Technician (CDT) program. The NADL's voluntary national program for laboratory certification (the National Board for Certification of Dental Laboratories) was instituted in 1977.

One of the most significant developments in the course of the dental laboratory industry's existence, aside from a gradual movement toward an increased emphasis on dental care, was the widespread use of orthodontic appliances. Attributable in part to the growing affluence of the nation as a whole during the 1960s, this increase was also a result of technological advances made in that decade. Prior to the 1960sa, when only the most financially secure could afford orthodontia, dental surgeons had to adhere each metal band to individual teeth, one at a time, pinching the band around a tooth, then soldering it permanently in place in an arduous and time-consuming task. By the 1960s, however, significant advances had been achieved in the manufacture of metal braces, taking orthodontics into mass-production and eliminating the need for the piecemeal application of braces.

With these developments, the number of orthodontic patients increased, eventually creating one of the primary market segments that would support dental laboratories in the years to follow.

In the mid-1990s, health-related issues were of particular importance to the dental laboratory industry as a whole. Topics of concern included infection control guidelines, occupational risk of exposure to HIV and other blood-borne diseases, and occupational lung diseases. There was a significant increase among all areas of dentistry in hygienic precautions regularly taken to reduce the risk of exposure to blood.

Infection control guidelines from the U.S. Centers for Disease Control and Prevention applied not only to workers in dental offices, but also to employees in dental laboratories. Occupational lung diseases caused by exposure to a variety of dusts also presented a risk to dental technicians, according to Infection Control Weekly. According to a study by French researcher D. Choudat, several respiratory and non-respiratory ailments were identified as being possibly related to the inhalation of dusts present in dental laboratories, specifically silica, alloys, and acrylic plastics. Although this was of more concern in small, independent labs than in large establishments, and more a problem abroad than domestically, dental laboratories were encouraged to install and maintain adequate ventilation systems to reduce potential exposures for all employees. Choudat noted that these risks appeared to be cumulative, manifesting themselves to a greater degree and at a higher incidence among employees who had worked in dental laboratories for many years. Additionally, employees who smoked were considered at greater risk of contracting these occupational illnesses.

The dental laboratory industry earns about three-fourths of its income from the production of artificial teeth, dentures, and other orthodontic appliances specifically based on prescriptions and orders from dentists. Laboratories provide record-keeping services that account for the remainder of its income. The industry's finished products add more than $2 billion to the materials, energy, and other consumables used in manufacture.

The dental laboratory sector, which employed 46,303 lab technicians, included 10,852 establishments posting more than $1.9 billion in 2005. Laboratories responsible for crown and bridge production numbered 719, employed 4,550 lab technicians, and posted revenues of $332.8 million. The orthodontic appliance production sector had 368 labs, some 1,553 lab technicians, and revenues of $55.2 million. There were 290 denture production labs employing 1,739 lab technicians, and 233 artificial teeth production laboratories with 1,760 lab technicians and $64.9 million in sales.

According to Dental Economics, issues facing the dental laboratories during the first decade of the 2000s included the lack of dental technician education, which was becoming scarce in the United States, and heightened competition from offshore laboratories. If the closing of dental schools in the United States and reduced numbers of students entering the field of laboratory technology continued, the only method left for education would be "on-the-job-training." Furthermore, if outsourcing to other countries continued, a number of domestic lab closures were anticipated.

Meanwhile, the American Dental Association (ADA) urged the U.S. Food and Drug Administration (FDA) to take action requiring foreign dental laboratories to disclose their name and address via a labeling system on completed dental prostheses prior to shipping. These recommendations followed the ADA's Resolution 83H-2005, which stated: "laboratories outside the United States are obviously not subject to the same standards of laws as dental laboratories within." In addition, "inferior products or those that may result in potential harm to the patient do not fall under the authority of the U.S. court system."

The global economic recession at the end of the first decade of the 2000s adversely affected the dental laboratory industry as consumers delayed dental work to conserve money. In particular, consumers put off elective procedures and cosmetic dentistry. At the same time, dental laboratories were confronting the need to make significant capital investments in new technology. The future of dental restorations was clearly in laboratories' ability to offer computer-assisted design and computer-assisted manufacturing (CAD-CAM). However, upgrading to the equipment required to implement such new technology required significant investment by laboratories.

Current Conditions

In the early 2010s, most dental laboratories continued to operate as single business units. National Dentex; Dental Services Group; Dental Technologies, Inc.; and Novadent were among the exceptions that operated in several markets. Some dental laboratories, such as Glidewell Laboratories, operated online via a mail order basis, and more companies were creating a presence on the Interne. However, the largest threat to the industry was the growing trend to outsource to large, modern dental laboratories in low-wage countries, particularly China, greatly increasing the competition for business in the low-price segment of the market. China-based laboratories often partnered with or purchased U.S.-based labs to do business outside China. For example, in September 2009, one of China's largest makers of dental implants bought the largest U.S. dental implant company in the Northwest and merged its Los Angeles and Chicago operations to create Modern Dental Laboratory USA. By 2012 Modern Dental Lab had 2,000 technicians working through the Hong Kong-based lab and four U.S. distribution centers. Sometimes offshore companies would strike deals with dental practices to provide laboratory services, particularly with large, price-focused dental chains. This influx pushed the price down and the availability of the lower-end product up, causing some in the industry to reevaluate their strategy. Some U.S. labs partnered with manufacturing operations in foreign countries, particularly China, to offer a low-cost restorative product while continuing to manufacture its own higher end products. However, other U.S. companies chose to keep close to their U.S. roots despite the opportunity of higher profits. For example, in 2012 Demar Dental Labs of Mahwah, New Jersey, turned down a lucrative offer from a dental lab in China because, according to Demar Dental partner Rob Santelli, "It can't only be about making more and more money. If I had said yes, I would have agreed to take work away from America and jobs away from my fellow Americans." Quality control was also an issue for outsourced lab work.

Industry Leaders

This industry remained highly fragmented in the early 2010s, with the vast majority of dental laboratories operating as single business units. However, several companies served broader regional or national clientele. DENTSPLY International, Inc., headquartered in York, Pennsylvania, operated through distributors in several continents and sold its products in more than 120 countries. The publicly held firm reported sales of $2.5 billion in 2011 and employed 11,800. Privately owned Glidewell Laboratories in Newport Beach, California, served a broad client base across the country via mail-order.

Workforce

The industry employed about 37,600 people in 2010. Although the few largest dental laboratory corporations could employ hundreds or even thousands of employees, most labs had just a few employees. Overall, the average dental laboratory employed five people. According to the U.S. Bureau of Labor Statistics, in 2011 a dental laboratory technician earned an average annual salary of $38,550. Dental laboratory technician jobs were expected to grow at a less than average pace as more business was driven overseas and as better dental practices and procedures reduced the overall need for major restorative devices, such as full dentures.

The formal training of many dental laboratory technicians may begin as early as high school, through specific vocational courses, or via apprenticeship. Trainees normally work under the guidance of experienced practicing technicians and generally gain skills over at least three years. Individual technicians seeking to gain professional credentials as a Certified Dental Technician apply to the NADL's appropriate governing board for certification.

According to the U.S. Department of Labor, dental lab technicians, in the course of their daily work, may engage in such tasks as employing a variety of hand tools for extremely detailed work; reading dentists' prescriptions and examining dental impressions and models; grinding, polishing, and soldering dental appliances; attempting to resolve problems in the design and setup of dentures; consulting with individual dentists for problem resolution; and fabricating full or partial dentures and crowns.

© COPYRIGHT 2018 The Gale Group, Inc. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. For permission to reuse this article, contact the Copyright Clearance Center.

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