Monday, September 9, 2013

Dental tourism on the rise

For a growing number of Albertans, sitting frozen on a Mexican beach is mission accomplished.
That anesthetic numbing their jaws is a reminder why they made the trip to the sun -- for dental work whose cost back home has become prohibitive enough for them to board a plane for relief.

Earlier this year, Don Stilwell was squeezing Cancun sand between his toes, chewing through spicy Mexican fare with a new set of teeth bought at a price far easier to swallow than in his home province of Alberta.

"I needed four implants and I was looking at $16,000-$20,000 for them, which just really turned me off," said Stilwell, 59.

The Leduc resident said he began researching out-of-country alternatives, but did so with a jaundiced eye.

On the Internet, he'd become acquainted with horror stories related by those who landed in the chairs of dodgy dentists, leaving them with a mouthful of trouble that needed costly repair work once they'd returned home.

"I investigated over the last four years about the opportunities, but I was quite apprehensive to go down there," said Stilwell.

"There are bad dentists down there and from all the research I've done, there are a lot of them."

But working through an Arizona-based medical broker, Stilwell chose a Cancun dentist and became what some are saying is a growing legion of so-called Alberta dental tourists.

After two enjoyable Mayan Riviera beach jaunts, the Albertan said he received four perfectly executed implants for just under $6,000.

Even with the cost of travel figured in, Stilwell said he might have still halved the expense of his dental work.

"I haven't even come close to what it would have cost me in Canada," he said.
"I couldn't be happier -- I can chew again ... and I got to spend some weeks in Cancun."

The experience has been so positive, he said, more dental visits to Caribbean Mexico are in the cards.

"I think more and more people are going to be seeing dental work abroad is a good idea," he said.

But Alberta dentist Dr. Randall Croutze said Stilwell is one of the lucky ones treated in a country rife with dental malpractice foisted on unsuspecting Canadians.
"It's absolutely abysmal, it's really that bad," said Croutze, who says he's repeatedly seen the grim aftermath of substandard Mexican dentistry.
"Good things can happen, but they're quite rare."

Too many discount overseas dentists, he said, are opportunistic with little regard to their patients' long-term welfare.

What some are calling a gap in Canada's medical coverage system is as glaring as a toothless grin is at the root of the dental tourism phenomenon.
Because government medical insurance doesn't include dental work, that treatment is only covered by employer benefits, which varies widely in its scope.

In 1997, the province did away with a dental fee schedule, allowing practitioners to charge what they see fit, and costs throughout the province vary.

Critics of the system say that's led to some of the highest dental costs in Canada, which quickly devours employer coverage.

According to Statistics Canada, Alberta households spent the third-highest amount in Canada on dental care, closely behind only B.C. and Quebec.
In Alberta, where a single porcelain crown can take a $1,500 bite, nomadic patients can have the procedure done for $335 in Mexico.

That reality funnels many Canadian dental shoppers into a small Sonoran Desert Mexican town where the borders of that country, California and Arizona converge.

Los Algodones has become known as having more dentists per capita than anywhere else on Earth.
In a 1 sq.-mile warren of dental offices and pharmacies, 250 to 300 dentists ply a trade driven by the gringo appetite for inexpensive tooth repair.
Well-marked dental offices hover closely over border crossings, vying for a piece of the discount toothy trade.

Ron Vinluan's Phoenix-based dental brokerage company Dayo Dental runs a 3-1/2-hour van shuttle of six to 10 people a time, up to four times a month to the Yuma, Ariz. side of the border.

From there, patients walk across the frontier into a tooth care bazaar where they'll find themselves reclining and receiving anesthetic within minutes.
"We get a lot of Canadian clients -- Canada's dental work is even more expensive than in the U.S.," said Vinluan, adding 20% of his clientele are Canadians, the bulk of the rest are Americans.

Oilpatch boom Albertans, he said, are ideal customers because they have the cash to spend for travel -- to save money.

The firm's busiest time for Canadians is during the colder months, when the so-called snowbirds sitting out winter's worst in the desert queue up for discount dental work.

"You'll find entire communities of seasonal travellers and word-of-mouth travels very quickly," he said.

That same word-of-mouth has relayed disturbing tales of malpractice from some practitioners who prey on naive foreign patients, said Vinluan.
"It does happen -- people do need to be careful," he said.
"There are some practices out there who are so good at marketing to uninformed Canadians -- without doing savvy enough research they can fall into the hands of these dentists who continue to have a bad history of dentistry."

Reputable brokers like Dayo Dental, he says, diligently screen practitioners who, though they might have been initially trained in Mexico, often undergo upgrading at U.S. universities.

New dentists that receive their clients, said Vinluan, will be placed on six months' probation.

"We start by sending them one or two patients," he said.
Painful oral outcomes from dentists supplied by his company, added Vinluan "are bad for our reputation."

Albertans should be extremely cautious about seeking Mexican oral treatment, said Daren Frick, who runs referral service Holiday Dental Inc.
After canvassing numerous dental offices in the country, Frick says "97% of them, you don't want to go to."

Most prospective patients, he said, are unschooled in vetting those clinics and their operators know it.

"They'll dress up a practice to make it look good for your eyes," he said.
His own St. Albert-based firm only makes referrals to dental specialists in Mexico, said Frick, adding "we won't touch general practitioners."

But he said the pull for discount care is powerful, recalling one client who was desperate for a new set of teeth that would have set her back $40,000 at home.
"She was about to take out a mortgage on her house," said Frick.
Canadians, particularly Albertans, have steadily become a more frequent presence in Dr. Jorge Carrasco's dental chair.

Their share of the Cancun dentist's business has now reached 50% among North Americans -- level with that of Americans, said the 30-year-practitioner.
"We also have patients from Russia, Australia, New Zealand, the Russians usually stay a month," said Carrasco, 53.
There's no doubt the Mayan Riviera's numerous tropical charms are a big draw for his practice, says the dentist, who also seems to wear a tourist promoter's hat.

The lure of Mayan ruins, scuba diving, deep-sea fishing, nightlife and "beautiful beaches" all drop from his lips.
So does the demand for the most sought-after procedure among Canadians -- implants.

Carrasco said he's no stranger to dental tourists, having treated thousands of them in the country's northern states, before following the sun and beach gringos to Mexico's Yucatan.

For some of the more complicated procedures, he strictly forbids patients' smoking and drinking for several days to aid in recovery, he says.
"They tell me 'how can you say that to me -- I'm in paradise,' " says Carrasco.
He acknowledges warnings about Mexican dentistry voiced by his counterparts in Canada and the U.S.
"It's professional jealousy, it happens," he says, adding his ethics and qualifications are interchangeable with Canadian practitioners.
Besides, he says, he uses the same high-quality brand materials employed by North American dentists.
The day before speaking to the QMI Agency, Dr. Randall Croutze says he treated a patient victimized by a discount Mexican dentist.
"She had crowns placed on teeth on very small fillings, she got a deal on crowns she didn't need," said Croutze, an Edmonton-area dentist with 28 years experience.

"She brought up the fact that infection control was really poor."
The woman's is hardly the only patient he's seen sporting shoddy dental work done abroad that ultimately costs more in the end.
"I've seen people literally having pieces of meat hanging out of their mouths."
Those travelling overseas for dental salvation often have tunnel vision confined by dollar symbols, said Croutze.

Long distance care doesn't forge the close doctor-patient relationship and lacks the proximity if emergencies occur.
When malpractice occurs, those discount dentists are unaccountable, he adds.
"Here, there's a complaint mechanism, it's brought to the attention of the college and dealt with quite harshly," said Croutze, who speaks for the Alberta Dental Association and College (ADAC).

Alberta dentists can't take short cuts, he said, on expensive lab work whose quality is almost always superior to that in developing countries.
He scoffs at claims by brokers that they vet practitioners.

"It'd be impossible to screen them unless you're watching what they do, know what you're looking for and evaluate them for a long time," he said.
"It'd be like a lay person evaluating the work of a cardiologist."
Much of the underrated value local dentists ensure that foreign ones can't is a preventative focus that saves money, said Croutze.

A big reason for higher dental costs in Alberta, he said, are the ballooning costs of overhead which have gone from 55% of a dentist's revenue to as high as 80% in the past three decades.

Higher pay for Alberta dental assistants' and hygienists' also has to be figured in, say Alberta dentists.
"Dentists' pay has decreased," said Croutze.
"I haven't heard of any dentists who've gotten rich, they're not interested in making a lot of money."

Including dental care in government health insurance, he said, isn't a good idea given the challenges in sustaining the wider medical system.
Lacking a set fee schedule, he says, helps fostering competition and efficiency.
"It allows for dentists to understand their input costs, to be very cognitive of their costs," said Croutze.

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