So how big is this whole "dental tourism" business, anyway?

It's not really mainstream, but it is growing — and that's why we should all be keeping an eye on it.

Think tank Deloitte Center for Health Solutions predicts that about 648,000 patients will take medical and dental vacations overseas this year — 20% more than in 2008. (Read the article)

According to Deloitte, this 20% growth is actually a reduction in demand. (Deloitte once predicted medical tourism would double every year, reports one website.) As many as 750,000 American sought dental tourism in 2007. The recession seems to be to blame, with patients having less money to spend on discretionary treatment.

“Barring any tempering factors, such as supply constraints, resistance from health plans, increased domestic competition or government policies, we project that outbound medical tourism could reach upwards of 1.6 million patients by 2012,” said Paul Keckley, Ph.D. and executive director of Deloitte Center for Health Solutions.

In a 2008 article on dental tourism, The New York Times stated:

"Roughly half a million Americans sought medical care abroad in 2006, of which 40 percent were dental tourists, according to the National Coalition on Health Care, an alliance of more than 70 organizations. That’s up from an estimated 150,000 in 2004…"

So it would seem that about 200,000 Americans will take a dental vacation in 2009. That's nearly 1% of our adult population!

But there might be an upside… As the dollar slides, will foreigners start visiting the US for low-cost dental care? Maybe we'll be the ones offering discount dental implants, affordable sedation dentistry, and relatively cheap dentures…

Deloitte predicts that by 2017, up to 561,000 people from other countries will visit the US for dental and medical care.

Deloitte mentions a few other juicy tidbits:

• "West Virginia and Colorado have attempted to pass legislation that would either require or incentivize insurers to incorporate medical tourism within their health benefits plans. Although both bills did not pass, they demonstrate that state legislators are paying more attention to the value of medical tourism."

• "India’s medical tourism sector is expected to grow 30 percent annually from 2009 to 2015."

Make no mistake about it: Globalization will affect dentistry just as much as every other profession.

Now one insurance company is offering UK residents "mishap insurance" should anything go wrong on their medical or dental vacation.

The managing director of the specialist travel insurer behind the Free Spirit Travel for Treatment program acknowledged, "It has taken me some time to persuade underwriters to do it. It looks pretty onerous." (AXA Insurance UK is underwriting it.)

"Free Spirit Travel for Treatment provides cover for complications occurring whilst abroad at least 48 hours and up to 31 days after treatment… It is available to UK nationals up to age 74."

Well, I can see why AXA wouldn't be eager to offer this sort of insurance, but the time limit should protect them reasonably well. It's emergency coverage only, really, and the policy says it doesn't cover any expenses incurred within patient's home country.

The long and short of it is — no one will truly insure you against the long-term risks of getting sub-par dental work in a foreign country.

The policy covers a variety of elective medical procedures, mostly cosmetic, including the following:

• Belly button surgery
• Calf implant
• Laser hair removal
• Liposuction
• Semi-permanent make-up
• Fertility treatment

In terms of dentistry, here's what the policy will cover:

• Cosmetic Dentistry
• Dental Bonding
• Dental Bridges
• Dental contouring
• Dental Crowns
• Dental Implants
• Dental laminates
• Dental recontouring
• Dental reshaping
• Dental slenderizing
• Dental stripping
• Dental Veneers
• Enameloplasty
• Gum lifts
• Invisalign®
• Odontoplasty
• Orthodontics
• Teeth Whitening

On a related note: our most recent survey asked dentists about their fee for a dental implant and crown. I thought it was a typo when one oral surgeon said he charges $500 for the dental implant and $500 for the crown, but no – just another example of low foreign prices. "I'm working in India, and hence even these charges are high for round here!" he explained.

Just a thought… at the rate the dollar is losing value against foreign currencies, I imagine the Brits and even third world patients in need will be coming to the US in droves for low-cost dental care by the end of 2010.

Visit the Free Spirit Travel for Treatment website

We received some interesting comments from dentists on the subject, and we’re still curious to hear more about what you dentists think of Americans who head south of the border to save money on dental care.

These were some of the key points dentists raised:

• You get what you pay for. Overseas dental work might save money — or it might cost extra to fix the teeth after a hack dentist ruins them.
• The patients who choose to visit other countries for low-cost dental work are more likely to be "difficult" patients, so maybe you’re just as well to be rid of them.

This week, I’m going to examine it from a patient’s perspective. Let’s say my dentist just told me I’m going to need thousands of dollars of dental treatment. What will I find if I go online looking for lower-cost options?

Shopping for Low-Cost Dental Care Online

It doesn’t take long to find Mexican Dental Vacation. Though they’ve done an excellent job of positioning their dental website on Google, they’re far from the only game in town. But they’re an excellent example of the dental competitor you may not have known you had: Canadian owner, American dentist, Mexican location, and a slick English-language website geared to the US dental tourist.

"With Mexican Dental Vacation you can save up to 75%! Crowns, bridges, veneers, dental implants, now you can have the smile you only dreamed of, all done within your 1 to 2 week vacation, right on the beach in Mazatlan, Mexico! You will love your dental vacation!"

The website shows beautiful pictures of a waiting room overlooking the ocean sands.It’s hard to compete for dollars with the Mazatlan beach!

"We have streamlined our clinic to the point where we can do your dental implants in 1 week."

Dental implants in one week? You know patients will think that sounds like a great idea.

What Do Patients Have to Say?

Next it was time to dig for some dirt! What did people have to say about this organization?

Most of the online reviews were positive. Patients knew they had saved a lot of money, and most felt they had gotten good care. One patient described how his extractions were unexpectedly difficult, so the dentist sent him out to a local oral surgeon.

One woman who got her teeth whitened said they were not careful applying the bleaching gel, leaving her with painful memories of her 5-day Mexico vacation. A man said that language difficulties left him getting only root canals instead of the crowns he had also been expecting.

Some patients reported that, after paying up-front, they had little recourse if not satisfied with the results; the Internet houses a number of former patients who stay they are still awaiting refunds promised to them by Nick Konev, the company’s founder.

But What Does It Cost?!?

Curious about the dental fees they charge? Well, they’ve posted their price list online.

Some patient comments suggest that the prices charged by Mexican Dental Vacations are higher than at other Mexican dentists, though of course they’re still rock-bottom by American standards.

In fact, the Chicago Tribune recently ran a story entitled Mexico: the new dental destination.

Medical tourism in general is a growing industry. Some Americans head to Canada or Mexico for discounts on prescription drugs. Thailand has a booming business in gender reassignment surgery. Facelifts and other cosmetic surgery can be found the world over.

One of Mexico’s top destinations for dental tourists is Los Algodones. Just over the border from Yuma, Arizona, the town of 4,000 boasts some 350 dentists. (Twenty years ago there were a dozen dentists in town.)

The town itself has an English website that centers on dental tourism. “A dental vacation in Los Algodones, Baja California, Mexico will provide you with the best of both worlds – the comfort of familiar American surroundings and the famous Mexican dental prices,” it reads.

And let’s be honest: a Mexican dentist can offer prices far lower than any American dentist. Can you offer a dental crown for $150? How about gum surgery for $360? Or veneers for $350 each? (See what patients say.)

Of course those prices will grab the attention of a price-conscious consumer. Even with travel and accommodations, a lot of patients reason they can save money on dental care.

What those patients are not accounting for is risk. The less you pay, the higher your risk of getting an inferior restoration. (Remember how low-cost dental crowns from Chinese dental labs were found to contain lead?) There are obviously exceptions, but in general, you get what you pay for.

And what if you’re not satisfied? Few Americans actually file complaints with the Mexican authorities, but anecdotal reports abound of patients who spend thousands to repair damage from hack dentists charging rock-bottom prices.

How This Affects American Dentists

The patient you’re most likely to lose to a Mexican dentist is the thrifty one who has “sticker shock” when you drop the bomb about how much major restorative dentistry costs.

But all you will see will be the glazed look in their eyes. They will not say to you, “Well, Doctor, what do you think about me just going to Mexico to get it done?” They will be polite, or embarrassed, and they will end up making their decision without consulting you.