Destination Dentistry: Talking to Patients About the Risks of Dental Tourism

As dentists, you see the same scenarios pop up over and over again without a second thought. But every now and then, you get a case that hits a nerve and triggers serious emotions. This two-for-one tooth story involving dental tourism is one of those scenarios, and it raises the question of how we as dentists can get our patients to see the value in their own teeth.

The stars of this double tooth story are two patients who came to me in desperate need of dental treatment. They had taken it upon themselves to get their dental care in another country, and now both of them were suffering with severe pain because the teeth they had treated overseas were reinfected.

NOTE: Before I proceed, I want to make it clear that my concerns about dental tourism have nothing to do with a belief that the United States provides inherently superior care. There are highly-qualified dental professionals all over the world who do fantastic work! I simply believe that there’s a risk to seeking treatment in a country that isn’t your own—no matter where you live. Regulations and standards of care differ from place to place, and it’s never a good idea to get a procedure done by a provider you don’t know and trust—and that goes for the treatment and the follow-up. Thinking about who’s going to care for you afterward should be top of mind when making decisions about where to receive your dental care.

Let’s take a look at these two cases one-by-one and see what we can learn from this unfortunate situation.

Dental Tourism Case #1: Previously Treated and Symptomatic Apical Periodontitis

The first patient in this dental tourism double feature had a root canal and crown done on tooth #8 abroad, and now that tooth was tender to percussion and incredibly painful.. The diagnosis was Previously Treated and Symptomatic Apical Periodontitis.  

At first glance, I was really concerned about the crown. The margins didn’t seem closed and ideal, and that meant it was likely leaking and allowing bacteria to get into the tooth.  

I was also worried about the condensation of the obturation. I felt that it could’ve been improved and that perhaps the cleaning and shaping process was compromised. Because of this, we have two problems: old bugs may have never gotten out, and new bugs could be getting in. 

In my opinion, both of these factors were most likely contributing to the formation of the periapical lesion, as well as the infection you can see at the apex of the root. Look at that bone loss!

So, what was my intended treatment plan? Well… to start over! Which meant 

I knew that the crown was leaking and that it would likely come off during my treatment.  While that would actually make my life a little easier, it wouldn’t be ideal for the patient. It was the patient’s front tooth, and I didn’t want to have them walking around toothless for a few days until they got in to see their dentist. So that meant I had to redo not only the root canal, but the crown, too. Talk about EXPENSIVE!

With that in mind, I set the patient’s expectations, letting them know that even though the crown could come off during treatment, they would need a new one regardless. Once that was understood, I felt comfortable to move on to the retreatment, after which she could get her new crown. 

Dental Tourism Case #2: Previously Treated and Symptomatic Apical Periodontitis #6

The second patient was referred to me for tooth #6, which had a root canal that was tender to percussion and was starting to develop a periapical radiolucency at the apex. Upon evaluation, my diagnosis for the tooth was Previously Treated and Symptomatic Apical Periodontitis #6. 

But there was so much more to this case!

I discovered that the patient had sought dental care outside of the US for their front teeth (both top and bottom), which had been loose, mobile, and infected. There had been so much periodontal disease around the teeth that the dentist overseas had extracted them and replaced them with a bridge. 

But their dental tourism trip hadn’t gone according to plan. The patient was extremely swollen around the gum area because they were unable to clean under the bridge. This had created a very unhygienic environment in their mouth and meant that their periodontal condition was not at all favorable. The tissue was more upset than the tooth itself, and there was even mobility to the bridge. It didn’t appear to be fully seated, which was creating a doorway for bacteria to get in. To be honest, I actually thought the whole bridge was about to fall off!

As I dug further, I realized that the patient had actually had numerous root canals, a maxillary bridge and a mandibular bridge. (The story just keeps getting crazier and crazier!)

Fearing the worst, I decided to zoom out and see what else was happening. To my disappointment, the other abutment teeth that were anchoring the bridges all had root canals… and they ALL had infections. This is what her panorex looked like:

My concerns for this case were twofold. First, I was worried that the span of both of these bridges were too long and would stress all of the abutment teeth, potentially leading to tooth fractures down the road. Plus, if we were to put all our eggs in one basket (a.k.a one bridge), we could be in big trouble in the future. If one tooth goes, then all nine teeth go!

Second, I didn’t understand why all of the abutment teeth needed to be root canalled in the first place. Now, every single one of those root canals had visible periapical radiolucencies, indicating infections. 

This meant the risk this patient took by seeking care through dental tourism was all for nothing, and everything they had invested in needed to be redone (just like tooth story #1). In fact, I told the patient I was so uncomfortable starting treatment on them that until they developed a comprehensive treatment plan with their general dentist, I wouldn’t touch their teeth. But don’t worry—I still managed their pain and infection with some antibiotics and some over-the-counter pain medications so they could get by in the meantime.

Getting Patients to Recognize the Value of Their Teeth

As I mentioned before, these patients’ tooth stories aren’t isolated incidents. Dental tourism has only grown in popularity with the steady rise of medical and living costs, and I’m sure you’ve seen your fair share of the consequences. In fact, I read recently that the global market size of dental tourism is $5.7 BILLION DOLLARS, and it’s growing over 20% every year. Holy moly!

But I think this is a bigger conversation than the price tag on dental care. Don’t get me wrong—finances are a valid concern! It’s a huge reason why I started my E-School LIVE program, which gives community members who can’t afford the cost of a root canal the chance to receive the care they need for cheap by pairing them with dentists in need of endodontic training. 

At the end of the day, the real question at hand is: How do we get our patients to recognize the value of their teeth?

Let’s Examine the Root of the Problem

If your finger was crushed in an accident, what lengths would you go to to save it? Would you complain about the cost and refuse treatment, or would you do whatever it takes to get the care you need and figure out how to manage the cost later? Despite being an incredibly important part of our overall health, the average person doesn’t give the same consideration to their teeth—and that, my friends, is the problem.

As providers, we need to help our patients understand that their teeth are worth fighting for! Because if they saw their teeth in the same way they saw other parts of their body, they would understand that it’s a smart investment to get reliable, high-quality dental care, rather than an outrageous cost. On the contrary, what’s outrageous is taking a huge risk by choosing dental tourism and having to undo everything that was done, with additional costs and pain to boot.

But before you can show your patients the value of their teeth, you first need to reflect on your own beliefs. Do you recognize the importance of teeth? Do you view oral health as a crucial part of a person’s overall well-being? Do you see the value in your own work? If you don’t believe that high-quality dental care is a worthy investment, it will be hard to convince your patients that it is.

Assuming you’re ready to have these discussions with your patients, try to help them focus on the bigger picture. Validate their concerns about the cost of treatment while also informing them of the risks of options like dental tourism and what can happen if they don’t take care of their teeth. Change won’t happen overnight, but if we all do our part in educating our patients, we’ll be able to avoid more tooth stories like this in the future.

You can gain greater confidence in providing the best possible care to your patients by checking out E-School, my online CE course for dentists! Through a targeted curriculum and personalized coaching calls, you’ll take your endodontic training to new heights so you can become more efficient, increase your profits, and achieve better outcomes.

– Sonia