Due to lousy teeth from childhood on, Anna Baker was facing a difficult decision as an adult: get dentures or spend more than $50,000 for implants.
But after seeing a story on CNN about a woman who saved thousands of dollars by going overseas for dental work, Baker, of Westchester County, decided to look into that alternative.
She tracked down the woman, talked with friends, did Internet research, and decided to go to Argentina in 2008. In two visits, one that year and one last year, Baker, an executive assistant, had all her teeth replaced with implants at a cost of $26,000, including flights, hotel, meals and the dental treatment.
And when all the work was done, she went to see her dentist, who Baker said approved the work.
“I came back with a good set of choppers,” Baker told me. “It’s not as if they are doing something different there” than in the United States.
Baker is one of hundreds of thousands of Americans and Western Europeans choosing to go to developing countries each year for major medical work — especially dental work that isn’t covered by insurance – for a fraction of the cost they would pay at home. They are going to Mexico, Costa Rica, Panama, Hungary, Thailand and Romania, among other places, where they frequently find American-trained dentists and doctors.
But many U.S. dentists caution against leaving the country for dental surgery. They warn that consumers are taking serious risks by going overseas, where sanitary standards may not be as high, and there may be no recourse in case of errors, no central place for rating medical professionals and potential language problems.
Dr. Steve Farley, my dentist in Windsor – a perfectionist who has been an expert witness in court cases — said he has seen some substandard dental work that was done overseas. He said some dentists will not work on patients whose teeth were botched by others.
Two dentists who also teach at dental colleges agree, and suggest that people like Baker may come to regret the decision. While there are American-trained dentists in other countries, they said, few continue to receive post-doctoral training.
Dr. Edgard El Chaar, a clinical associate professor with the Department of Periodontics and Implant Dentistry, and surgical director at the Continuing Education Dental Implant Program at the New York University College of Dentistry, and a visiting professor at St. Joseph University in Beirut, Lebanon, said Thursday in a telephone interview that crowns made in other countries are not made as well as the ones in the U.S.
Dr. Edgard El Chaar
Dr. El Chaar said that what many patients don’t realize is that major surgery involving implants should be done over several months. Rushing it in one or two short vacations can result in serious infections.
One patient, he said, had such a serious infection that when he pulled the implant out, pus oozed from the hole. He said many dentists refuse to work with patients who have complications from overseas work, because of potential liability.
Dr. Greg Diamond, another highly respected New York periodontist, said there are cheaper alternatives than coming to him, and safer methods than going out of the country.
Dr. Diamond suggests that those who can’t afford him look into having dental work done at a teaching hospital. They can also get zero-percent financing through credit card companies that pay dentists up front, but take a percentage of the fee for providing the credit.
Dr. Greg Diamond
He said that before getting implants on the recommendation of a general dentist, patients should get a second opinion from a periodontist to determine whether the problem is with the gums or with the teeth.
If the problem is gum disease, he said, there are now relatively inexpensive laser treatments that can eliminate the need for implants. However, he said, not all dentists will recommend that treatment as their practice may include implants.
Baker, however says there is no question in her mind that she made the right decision. A close friend of hers, Robin Apton, and Robin’s brother, Jeff Apton launched a business that send patients to dentists they selected in Panama. Robin holds both BS and MS degrees from Columbia University School of Dental and Oral Surgery, Division of Dental Hygiene. She has thirty years of experience practicing as a registered dental hygienist (RDH) and has taught at the University level at Columbia and the University of Bridgeport.
Baker said if Robin Apton’s business were available back in 2008, she would have used it. Robin and her brother Jeff went to Panama to personally check five dental practices and ended up choosing three whom they refer patients for a fee. You can see their web site here.
Jeff Apton
Robin Apton
Apton has owned two Medical Education agencies working in the US and internationally and now serves as Vice Chairman and counselor for the northwest area Connecticut Chapter of SCORE, a non-profit association that has helped over 8.5 million small businesses owners across the US since its founding in 1964.
Well, the bottom line is that there is a lot to consider. Facing the possibility of major dental surgery, I think its wise to get a second opinion from a specialist to make sure that its not just gum disease that is the problem. That is much cheaper to repair. A teaching hospital or a dental university also makes sense.
If you still want to go out of the country I would suggest doing your homework, insist that you want to talk to patients who had surgery more than five years ago, and plan on spending more than a week or two to make sure that the dentist has plenty of time. But then Panama, Costa Rica and Argentina would be wonderful places to spend a month or more.
Asking US-based dentists what they think about dental tourism is like asking Republicans what they think of Obama Care. Dental tourism ends a US-dentist monopoly on dentistry and the accompanying high fees that patients are forced to pay. What would you expect them to say?
Our company Pan American Dental Tours was presented accurately in this piece. In a round-about way, this supports the value we bring to patients who want to travel for quality dental work using the services of reputable and knowledgeable companies.
It was disappointing to read the usual “dental urban legends†quotes from these US dentists about poor standards of sanitation, and botched work done by incompetent dentists outside the US.
For a more balanced of dental tourism (without scare tactics) than presented by the dentists quoted in this piece, visit the web site of the American Dental Association (ADA). No urban legends here. The ADA recognizes that the Global economy and its ability to provide quality care present a challenge to American dentists. The ADA has a large international membership. Ten percent of dental professionals at their annual meetings are from outside the US. Do you think these dentists don’t know about germs? To pretend otherwise would be an insult to its own members.
The author might have consulted with less biased dentists for the piece, such as Dr. Stewart Hirsch, Associate Dean of New York University College of Dentistry, who said, “Every year we bring to NYU 110 dentists from 33 countries, train them in advanced procedures, and then they go home. There is no reason to assume the quality of care is any lower overseas.”
I have pored over the literature of dental tourism and found maybe one or two cases of patients who were treated by bad dentists outside the US. That is not much, considering that the number of dental tourists in any year have been estimated to be as many as 750,000.
At the same time, in any given week (this month alone), I find several stories about bad care much closer to home: the Mass. dentist who used paperclips in root canals, the NJ dentist dumping medical waste in the ocean or the dentist who took time from sedating a patient to beat his wife /assistant. See our blog at (www.panamdentaltours.com/blog) for these incredible stories. Does this mean you be more careful before choosing a dentist in the US? Probably, you should! But if bad care for patients treated abroad was common, you would be hearing more about it in our expose-ridden media.
The recommendation to visit dental school students works out well for some patients and certainly saves money. There re many more horror stories of bad and painful treatment at the hands of students than you will ever find about botched surgery abroad.
Comments were also made by two dentists in this piece about not treating the mythical patients who went out of the country and returned with major problems. As medical professionals, dentists have a responsibility (Aesculapian oath) to alleviate pain. Not to treat a patient because they went elsewhere would be pure vindictiveness. Whether this really happens is questionable. In my own experience, I have changed dentists to repair earlier bad work that was done, and have never been turned down for care.
The idea that we or any other dental tourism facilitator irresponsibly recommends procedures like implants shows a lack of knowledge for how dental tourism facilitators work. Our potential patients must provide a treatment plan with x-rays that is reviewed by our dentist in Panama. They may or may not agree with the work suggested. In the case of Anna Baker mentioned here, the dentist she visited outside the US reviewed her records and recommended less work, and a procedure that turned out to be better than the one her US dentist suggested.
Is dental tourism for everyone? Of course not. But dental procedures are mostly effective and safe, to the credit of the profession. And there is no disputing that quality care and great savings are available outside the US.
Jeff
I would have loved to have written a column giving full support to dental vacations. My father–in-law went to Costa Rica and saved money and had a good job done.
So I approached the story with the hope that the facts would support me giving unqualified go ahead for people to go out of the country for major dental surgery. But after talking to both sides – including patients with positive experiences – I could not take that position. My job is to give the best advice I can to consumers.
There is no question that there are great dentists practicing all over the world. Whether trained in the U.S., Costa Rica, Israel, Argentina, Panama and Hungary (where by the way both my father and grandfather were noted doctors). And if I had a dental emergency overseas I would feel absolutely comfortable that I would find a competent dental surgeon.
And for smaller procedures like a couple of crowns, and maybe for some cosmetic work, a dental vacation makes sense, especially if you wanted to go to that country anyway.
However, these critical facts need to be considered before going to another country for major reconstructive – especially implant – work.
1) If you are told by your dentist – who may have a conflict of interest – that you need implants, you might not. You first need to check with a specialist.
2) If something goes wrong overseas you have no legal recourse unless Jeff and others in the business in America of sending people overseas have insurance that will cover malpractice.
3) American dentists will not be thrilled to work on your teeth if you had problems caused by a dentist from another country. Your dentist in America will rightly have to consider whether she or he will end up being sued by you even though someone else botched the initial job.
4) It makes sense that for major work you will have to spend months of make many trips to another country to make sure your mouth heals after each step.
I am anxious to hear what others have to say.
George
George:
Thanks for the reply. You are an investigative journalist (and a good one) which is why asking 3 dentists who have a vested interest their opinionseems a little unfair( one being a guy you better keep happy…his drill is sometimes in your mouth).
Anyway a few further clarifications to your comments:
1) General dentists do more implants than all specialists, to the chagrin of specialists. And there does not seem to be some widespread problem. We send implant people to a US-trained periodontist, so presumably even if the referring dentist was a general one, our specialist could certainly evaluate the need….and at no expense to the patient
2) There is always a likelihood of something going wrong. We can offer a low cost and high reimbursement indurance policy to the dental tourist that will cover them for many months following their return. Does that handle what is a very unlikely but reasonable concern?
3) I stand by what I said. Good dentistry dictates they help, and by the way, how will the dentist in the US know where you were treated? This is totally unbelievable. Drop this one!
4) For implants you will need to make 2 trips, but if you need 2 or more of them in the States, you will still have 2 vacations and save money. Many people prefer the anticipation of a “vacation” and it makes going for dental work a little less horrible.
One thing I did not mention in my previous post was that one of your dental authorities says crowns made out of the US are often inferior. Is he not aware that many US dentists now send their lab work out of the US, as far away as India? This is one area where the global economy benefits dentists.
Check out a comment on Twitter relating to you article:
What do dental tourism and generic drugs have in common? healthcare urban legends http://bit.ly/cSVuyv
I spent thousands of dollars with my local dentist including two crowns that fell apart…they were placed after root canals had been done. The crowns lasted just barely two years…I had no recourse…the dentist said that sometimes they fail, individuals vary so no guarantees in the dentist biz…. so what difference does it make. This same dentist wants to send me out to a Vancouver ‘specialist’ for implants who quotes $10k including the crowns….so hello to searching for the right dental ‘vacaton’ where I will not lose any protection because dentists stick together and don’t guarantee there work anyway. I am expecting to pay around 5K travel included for the two implants I need.
Thank you for the information. I will be taking a dental implant vacation soon.
Recently I learned I have metal allergies and all the dental metal that has been placed in my mouth for decades has caused trememdous bone loss and tooth erosion. I have not had dental insurance for years because I’m self-employed.
However, when I did have insurance, I had extensive dental care including root canals, crowns, bridges, bonding, etc. Eight years ago, after getting an expensive care treatment plan to save my remaining teeth, I had them all pulled (26) and got a top denture and bottom partial (attached to two bridges). Two years ago I made the mistake of having a chairside reline and the problems began. Turns out I’m also allergic to the materials used in dentures and, because the three relines and five pairs of upper and lower dentures a denturist made for me were not processed long enough, I developed horrible mouth sores and now have Bullous Phemphigoid in my mouth. I have been under treatment at the major medical University in my area and yesterday got estimates to have implants done at the student dental clinic. The prices are ludicrous, more than local dentists charge. I’ve had many estimates, from many providers, on costs for various implant plans (from two implants to hold a bottom denture and a full top denture to 8 implants on both upper an lower and ceramic caps) and they are all over the place. I was absolutely shocked at the prohibitive cost for STUDENT care at the University. Apparently it’s all about how stupid the patient is and how much the “market will bear”.
I would be happy to travel to someplace in the United States if there is a provider who is willing to help me solve my problems for a reasonable price. Otherwise I’ll be helping out the global economy.
George, I had no idea this is a growing trend. I have not read or heard about this anywhere before. Thanks for bringing the “dental vacations” topic front and center. Dave
Some excellent points were raised.
Another important consideration with implants is the understanding that there are as many different implant systems and manufacturers as there are auto makers. Some of them are marketed exclusively to different regions of the world.
I had a patient recently who went to India to have implant surgery and save some money. He then wanted to return to the US to see his restorative dentist to complete the treatment. This patient was referred to me, a periodontist, for second stage surgery to uncover the implants. Since a foreign brand was placed, I would have had to order instruments and compatible components that would cost the patient more than he saved. Even if an implant is inserted competently, the restorative work may still need to be serviced.
And while there are excellent dental practices outside the US, there are also lower quality outfits that are operating. Being in a foreign country naturally makes it more difficult for an unsuspecting patient to seek remediation if that situation arises.
The point about lab work is very important: there are many dentists right here in the US that send their work overseas to save on costs. There are also generic dental implant systems that are cheaper than the big names. In the end, the consumer may get hurt. It remains to be seen.
The trend in dentistry today is to replace unhealthy teeth with implants. It is more predictable and sometimes “easier” than trying to save a diseased dentition. But as technology develops and advances, we are now better able to predictably treat what used to be teeth with a poor prognosis. Whether it be laser assisted periodontal surgery, tissue engineering or advanced endodontic therapy, patients should be aware of all their options before they make a decision. I encourage patients to seek multiple opinions so that they are better informed about their oral condition.
The bottom line is that extensive dental treatment is an important decision to make and any patient should do their due diligence. There are lots of “what-ifs” to consider.
MS
Mr. Gombossy’s blog is so full of self-serving ADA industry misinformation I hardly know where to start.
Dentists in Mexico use the same materials ordered from the same supply catalogues as American dentists. Many attend specialist schools in the US or Oxford. One does have legal recourse to Mexican dentists via the Mexican health authorities and courts for malpractice etc. Mexican dentists study dentistry for 4 years plus perform a years public service in a government clinic before going into private practice or continuing on for another 2-3 years of specialist training. The year of public service is in repayment for government subsidized medical training for doctors and dentists. Consequently, Mexicans have free basic health care and clinics throughout the country. Obama take note.
Cabo Cosmetic Dental in Cabo San Lucas Baja California Sur Mexico has been treating American and Canadian patients for over 30 years and our full-mouth cosmetic restoration specialist has an additional Certification for specialist training in cosmetic restorations – something that is not taught in US dental schools, as cosmetic dentistry as a specialty is not recognized by the ADA.
One does not need many multiple visits to Cabo to have a full mouth restoration of 27 crowns etc. One 10 day to 2 week visit works. Implants require a 2nd visit 2-4mos later after the mouth has had time to heal.
Cabo Cosmetic Dental also pays r/t air or up to 2 weeks hotel for makeover patients and offers patients up to half-off area resort room prices to lesser treatment patients. Ex. A waterfront balcony view room at the Tesoro Resort is only $56US for our patients (including breakfasts) vs. the rack rate of $125.
With Cabo San Lucas being only 2-4 hours away from all major US cities – Cabo offers a convenient, affordable alternative to overpriced US dentists – not to mention a world-class vacation experience.
Thanks to George and the other commenters, this page has turned out to be quite a great balanced introduction to dental vactions. I don’t know if I could afford to travel abroad for dental work, but for anybody interested I highly recommend the first commenter’s site (http://www.cabocosmeticdental.com/) as well as the Apton’s (http://www.panamdentaltours.com/). Lots of great infomation on those. Also I recommend simply shopping around in your area and comparing costs. My wife and I did last year and found the providers who contract with dental discount groups usually offered lower rates. We signed up with a Signature plan (http://www.dentalwellnessplan.com) and were able to save quite a bit of money on a porcelain crown and a few other procedures. Sure would have been nice to have it down in Cabo though.
Interesting thoughts. I wonder is it only the high cost of dental care in the U.S. that drives it’s citizens to developing countries to get the dental care they need? There has to be a solution what would keep dentists making a living and their patients being able to afford treatment. Is this an insurance issue?