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Dental tourism – knowing the risks

08 July 2019

As the cost of health insurance escalates, many patients may consider whether they are getting value for money, or whether they would be better off seeking treatment abroad. Dr Annalene Weston, dentolegal adviser at Dental Protection, considers the potential implications of providing treatment on teeth that have previously been treated abroad, and asks the question: “If I do this, will I be liable if it fails?”

Most of us like to get the best possible deal, and getting value for money is considerably more important to consumers in lean fiscal times. Many people have a limited disposable income, and treatment costs are a well-reported barrier to care. Enter the ‘dental holiday’: a chance to have beaches and bridgework, explore new cultures while having extractions, and have an adventure with a side order of amalgam.

If it is positioned correctly to a patient, why wouldn’t they take this option? We have all had patients tell us that they can take their family to a top class resort, have all of their treatment and live like kings for half of the cost of our proposed treatment plan. When you think about it pragmatically, it is easy to see why a patient would consider this a ‘no-brainer’.

But what about the other costs? Are there any? And what about the ‘morning after’? Will the patient return with sunburn and a superbug, or will everything be just fine? The honest answer is that we simply cannot be sure.

A ticking time bomb

There are well-reported patient risks of dental tourism, such as having ‘too much treatment’ at one time – with no recovery or review factored in – to the failure of complex work that was neither planned nor performed appropriately. It can be devastating to us as practitioners when a patient attends with their shiny new teeth, and ‘a bit of a niggle’ that, under scrutiny, proves to be a ticking time bomb. Naturally, this can then lead to a much greater expense for the patient to undo the damage, and retrieval work carries with it greater risks. Of greater concern are the horror stories of poor infection control and superbug infections.

It would seem, however, that we as the healthcare providers are more fearful of this than patients. A quick Google search will reveal numerous modern and clean dental clinics, many manned by Australian trained dental practitioners, and bringing the risks to the patient’s attention can sound like sour grapes. If a patient wishes to discuss dental tourism, take the opportunity to advise them of the issues that can occur, and direct them to meaningful resources to read, such as those on the ADA webpage. They may choose to read the Google reviews only, and we would suggest practitioners caution them about this, as while the short-term satisfaction regarding the outcome (and price) may be high, the longevity of the work and real cost will not be known for some time.

It may also be worth suggesting to the patient that they need to consider the long-term maintenance of the work, which may be best performed by the practitioner who provided the treatment, particularly if they have used materials or systems that are not compatible with our own. It is crucial that you document these discussions with the patient.

If you know your patient is going to take the plunge, one thing that can be helpful is if they bring home a copy of the records from the treating practitioner overseas. These can prove invaluable if the patient has a hypersensitivity reaction and implant screw failure, or any complication where the specific type or brand of material needs to be known.

Taking over treatment

Following the triumphant return home, when the patient proudly presents their beautiful new smile to you – what then? If we are honest with ourselves, the desire to disown the patient is strong at this point. We fear ‘taking over’ this treatment, as we know the basic rule of thumb that “the hands on the mouth own the treatment”. We know the risk of placing a crown on another practitioner’s root canal, and we know how dissatisfied patients who have repeated problems can be. We do not want that dissatisfaction directed at us.

The reality of the situation is that it is impractical and morally questionable to decline to see every patient who has completed a course of treatment overseas. It is also unreasonable to assume that the work placed will be subpar because it wasn’t placed by us. How then do we proceed?

Firstly, retake your baseline charting. Treat the patient as if they are new to you, and check and chart their restorations and their periodontal condition. Take a sensible array of radiographs and, if possible, intraoral photographs to fully assess and document the work provided. Identify any issues or concerns that you have at this point – whether it be questionable treatment, unfamiliar materials or an unusual treatment plan. Notify the patient of your findings and concerns, and advise them of any limitations of treatment moving forwards.

Avoid the temptation to be critical of any colleague, regardless of where they are situated on the globe, as we are not privy to what the patient gave consent for, nor any issues that arose during the treatment itself. Overt criticism may come across as petty, and may influence the patient’s opinion of you, and your ongoing relationship. Consider referring the patient to a specialist if you are unsure if you can manage and maintain the work. And of course, document all of your findings and discussions with the patient.

Dental tourism need not be the end of your relationship with the patient, but it may change the parameters. Open and honest conversations about what you can and cannot do are key to minimising your risk, and providing optimum patient care.

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DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. Dental Protection Limited (“DPL”) is registered in England (No. 2374160) and along with DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 36142). Both DPL and MPS have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. DPL serves and supports the dental members of MPS. All the benefits of MPS membership are discretionary, as set out in MPS’s Memorandum and Articles of Association.
“Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADAWA”).
Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDANI”), ABN 56 058 271 417, AFS Licence No. 238073. MDANI is a wholly-owned subsidiary of MDA National Limited, ABN 67 055 801 771. DPLA is a Corporate Authorised Representative of MDANI with CAR No. 326134. For such Dental Protection members, by agreement with MDANI, DPLA provides point-of-contact member services, case management and colleague-to-colleague support.
Dental Protection members who are also ADAWA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDANI, which is available in accordance with the provisions of ADAWA membership.
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