Updated: Feb 16, 2020
The latest information shows the possibility of dental restorations, contaminated with the deadly coronavirus (nCoV2019), being introduced to dental practices and their patients in the United States through their dental labs. As a result of the information below, dentists and their staff may want to get information on additional precautions to take at their practice when unpacking and delivering dental restorations from uncertain manufacturing locations to their patients.
US dental laboratories manufacture dental crowns, bridges, dental implants and dentures for dentists in the United States. It is estimated these labs send 38% of their work to other dental laboratories located around the world, mostly in countries such as China with 59,000 coronavirus cases reported as of this writing, as well as India, Malaysia, Singapore, South Korea, Thailand, and Vietnam where the outbreak has also spread.
US dental labs that use these offshore labs do so primarily to achieve cost savings and often without the knowledge of the prescribing dentist.
Here is what we understand about the Coronavirus and how it applies to dental practices and their patients.
1. The World Health Organization still does not know exactly how the Coronavirus spreads however they do say that such viruses are usually transmitted through droplets created when an infected person coughs or sneezes or through something that has been contaminated with the virus.
2. A study by The Journal of Hospital Infection goes on to specifically say that “nCoV2019, the coronavirus strain involved in the current outbreak, is a droplet-based infection and can be spread directly between people or by touching contaminated surfaces.”
3. The Journal of Hospital Infection further states, “many strains of coronavirus can live on surfaces such as glass, plastic or metal for up to nine days.” The obvious concern here being “infected droplets” on dental restorations which are glass, such as all ceramic or PFM crowns, metal such as partial frames and various crown types, plastics such as acrylic used in partials and dentures, and packaging material such as crown boxes and bubble wrap.
4. Although many dentists do not know this, almost four out of ten dental restorations are sent offshore to be manufactured. We know many dental labs of all sizes use offshore outsourcing as part of their cost savings strategy and, in many cases, have not disclosed this to their dentists.
5. Many labs in the US send to intermediary labs that are also located in the US so that 1. Cases can be bundled together to save on shipping and shipped overseas together and 2. By first shipping to another lab in the US, the lab can say they outsource to a lab in the US, regardless of where that lab then sends the cases to for manufacturing. While the regulations are murky, and not well policed, these labs can typically still claim their restorations are made in the US, or at the very least, do not have to provide any markings or notification the restoration was manufactured outside the US.
6. While dental labs are supposed to disinfect cases as part of their standard precautions, this disinfection is done when the cases are received at the lab. There is no requirement for any disinfection whatsoever before a case leaves the dental lab and is shipped to the dentist.
Because cases and packaging materials are not disinfected when leaving the dental lab, dentists and their staff may want to consider additional precautions in how the handle offshore manufactured cases and packaging and deliver those restorations to their patients.
Additional Information for US Dental Labs
US dental labs should likely implement new precautions when offshore cases are received by an offshore lab. The standard precautions used by dental labs today apply only to the case when it is initially received by the dentist. However, the following should be considered by every lab providing dental restorations to US dentists now that there is a possibility of a coronavirus contamination of the restoration, models and packing materials received from the offshore lab:
1. Train your lab staff about the coronavirus, the way in which it spreads and proper handling of cases received from offshore labs.
2. Consider applying standard precautions, including all PPE, to all cases and materials being received by your lab from the offshore lab.
3. Ensure your disinfectant will kill the coronavirus and precisely follow all directions for use.
4. Ensure all of your cases and packaging are thoroughly disinfected before shipping cases to your doctors.
5. Although in most cases there is no requirement to do so, dental labs should inform their dentists they are using offshore labs and of any cases that were ultimately manufactured by an offshore lab by providing the exact patient ID and case ID.
6. Dental labs should provide their dentists the option to cancel any cases currently in progress and dispose of those case materials – do not send those case materials back to the dental practice.