Dental tourism

Dental tourism (also called dental vacations) is a subset of the sector known as medical tourism. It involves individuals seeking dental care outside of their local healthcare systems and may be accompanied by a vacation.

Reasons for travel

While dental tourists may travel for a variety of reasons, their choices are usually driven by price considerations.^[1][2] Wide variations in the economics of countries with shared borders have been the historical mainstay of the sector. Examples include travel from Austria to Hungary, Slovakia and Slovenia,^[1] the US to Mexico, from the Republic of Ireland to Northern Ireland,Hungary,Poland,Turkey and Ukraine . While medical tourism is often generalized to travel from high-income countries to low-cost developing economies, other factors can influence a decision to travel, including differences between the funding of public healthcare or general access to healthcare.^[2]

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     Aging populations in US and developed countries; i.e. Baby Boomers just turned 65
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     Rising health care costs and/or long waiting periods in US and developed countries
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     Inadequate health/dental insurance coverage in US and developed countries
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     Technological and dental care standard upgrades in developing countries
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     International accrediting organizations[3]
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     Dramatically lower medical costs in developing countries
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     Added value of leisure and tourist activities in addition to receiving medical/dental care
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     Relatively low-cost of travel to developing countries

Mobility of labour

For countries within the European Union, dental qualifications are required to reach a minimum approved by each country’s government.^[4] Thus a dentist qualified in one country can apply to any other EU country to practice in that country, allowing for greater mobility of labour for dentists (Directives typically apply not only to the EU but to the wider designation of the European Economic Area - EEA).^[5] The Association for Dental Education in Europe (ADEE) has standardization efforts to harmonize European standards. Proposals from the ADEE's Quality Assurance and Benchmarking taskforce cover the introduction of accreditation procedures for EU dentistry universities as well as programmes to facilitate dental students completing part of their education in foreign dentistry schools.^[6] Standardization of qualification in a region reciprocally removes one of the perceptual barriers for the development of patient mobility within that region.

Pricing and quality

There is substantive debate about pricing and quality differentials between locations. Much of this debate centers around the question of whether or not these price differentials imply quality differentials. Another concern is whether or not large scale dentist procedures can be safely completed abroad in a relatively short, "holiday-sized" time period. Surveys of dentists show that high speed large scale dental treatment more often require remedial work.^{[citation needed]} The legal recourse of patients is often uncertain with dental tourism. Another issue affecting this debate is the lack of a independent inspections committee for dental similar to the Joint Commission International for medical.

An instructive case study for this debate is an analysis of patient outflows from the United Kingdom and The Republic of Ireland, two large sources of dental tourists. Both countries were the subject of a report from the Irish Competition Authority to determine whether consumers were receiving value for money from their dentists.^[7] Both countries’ professions were criticised for a lack of pricing transparency. A response to this is that dentistry is unsuitable for transparent pricing: each treatment will vary, an accurate quote is impossible until an examination has occurred. Thus price lists are no guarantee of final costs. Though they may encourage a level of competition between dentists, this will only happen in a competitive environment where supply and demand are closely matched. The 2007 Competition Authority report in the Irish Republic criticised the profession on its approach to increasing numbers of dentists and the training of dental specialties – orthodontics was a particular area for concern with training being irregular and limited in number of places. Supply is further limited as new dental specialties develop and dentists react to consumer demand for new dental products, further diluting the pool of dentists available for any given procedure.

Aside from the above issues, it is possible to compare the prices of treatment in different countries. With the international nature of some products and brands it is possible to make a valid comparison. For instance, the same porcelain veneer made in a lab in Sweden can be as much as 2500 AUD in Australia, but only 1200 AUD in India. The price difference here is not explainable by reference to the material cost.^[8]

Procedure	United States	El Salvador	Mexico	Hungary	Poland	India	Thailand	Romania	Ukraine
Implants, with crown	$2990 to $5,000	$900	$990	$1000	$900	$600	$1700	$950	$590
Veneers	At least $800 to 2,000	$440	$495	$360	$450	$220	$240	$240	$240
Root canal	$699 to $2,000	$220	$300 to $450	$60	$150 to $200	$80	$90 to $200	$100 to $200	$65
Crowns	$750 to $3,000	$440	$495	$285	$280 to $ 800	$80	$210 to $390	$240 to $600	$190
Bonding	$150 to $300	$50	$70	$70	$60	$25 to $30	$80	$75	$40 to $50

Clearly then from above, there can be significant financial incentives to undertaking expensive treatment overseas. Such activity even including the travel expenses and accommodation can be significantly cheaper than undertaking procedures at home.

Although some think it is a good idea to simply go to the country as a tourist and find a dentist there, rather than to find dentists on the Internet, you take a great risk just walking into a clinic having done no research. Pricing can be researched on the internet by comparing sites that provide lists, but one thing that is even more important is that researching online, one can also get a better idea as to the qualifications of the dentists. Through e-mail contact, you can ask for references, ask about payment options, and even get information about accommodations. When you just walk in off the street, you don't know what they will charge, or if they are reputable. Price is not the only consideration. For example, in Mexico, many dentists, who are just general practitioners, have taken a course for a couple of months and start placing dental implants. The same is true in the USA - one should always insist on a certified specialist for serious treatments. You cannot expect them to do as good a job as someone who has had 2 years of intense training on implants and who is now board certified as a specialist. On the internet, one at least can initiate contact, ask for credentials, references, prices beforehand, and schedule with the clinic to be able to get the work done in the quickest manner, without delays. In this way you can make an informed decision, and choose wisely.

One other important consideration is location. If you go all the way to India or Singapore or Argentina for a dental procedure, and something goes wrong, it is a long way to go to have to return and get them to fix it. Many^{[citation needed]} Americans choose to go somewhere easily accessible from the US, such as San Salvador or Tijuana. Due to the ongoing narco-violence in towns such as Tijuana and Ciudad Juarez, clinics in safer towns 1,000 miles south of the border - Cabo San Lucas, Puerto Vallarta, Mazatlan etc. have recently started offering large treatment patients airfare or resort stays. (See info below.) Since procedures often require multiple steps, or subsequent checkups, the patient may have to return to the same doctor for those reasons. Or, in the case of dental implants, if the implant is placed in another country but is restored by another doctor locally, the information about the implant can be difficult to retrieve from the original doctor. Typically though, a patient takes 2 trips to have implants. The first to set the base and a temporary, the second trip 4-6 months later after ones mouth has healed and accepted the implant-one has the temp removed and the permanent crown set. 2 one-week trips are necessary. One-Day-Implants are not recommended for dental tourists due to the higher failure rate of the system.

Other considerations that a patient may take into account include the lack of availability of a dentists, long appointment time delays and the need to take extra time off work. However, when combined with a holiday, as the name implies, dental tourism can be an opportunity to do two things for much less than the price of one of them.

See also

• Medical tourism
• Tooth
• Dental care

Notes and references

1. ^ ^{a b} "Cross-border care in the south: Slovenia, Austria and Italy" WHO Report on patient mobility (retrieved 19 October 2007)
2. ^ ^{a b} "Catherine McNerney and Desmond Gillmor" Experiences and perceptions of rural women in the Republic of Ireland: studies in the Border Region (retrieved 19 October 2007)
3. ^ http://dentaldestinations.com/1/about.html
4. ^ EC Dental Directives (78/686 and 78/687 EEC) (retrieved October 19, 2007)
5. ^ "EU Manual of Dental Practice" Includes comparative study of member countries dental systems: 3rd edition currently in preparation (retrieved 19 October 2007)
6. ^ ADEE Taskfore document on quality assurance and benchmarking (retrieved October 25, 2007)
7. ^ Irish Competition Authority Report (retrieved 19 October 2007)
8. ^ "More Fun Than Root Canals? It’s the Dental Vacation", New York Times, 2008-02-07

External links

• "See Panama Canal, get Root Canal" Naples News, (US)
• "Tango with the dentist : Final in a series on wintering way down south", The Calgary Herald (Canada)
• "You don't need a tooth fairy to make the big bills vanish", Independent Newspapers (UK)]
• "Warning as dental tourism booms", Daily Mail (UK)
• "Me love you long tooth", The Sun(UK)]
• "Open wide for your next holiday" The Observer(UK)
• "Rise in women seeking 'holiday' from health bills", Independent Newspapers (Ireland)
• "The inciDENTAL tourist", USA Today
• "Dental Tourism in World Crisis Time", Dental Health Magazine
• "Medical Tourism Economic Report: Turkey"
• "Mexico Dental Tourism", Dental Tourism Mexico