Guest Editorial: The Growing Popularity of Dental Tourism

Due to rising dental costs in the United States, the number of American citizens traveling abroad to obtain oral health services has drastically increased. This trend has been coined “dental tourism.” And while it’s not new, dental tourism continues to gain traction. The top locations for dental tourism depend on the patient’s location and/or country of origin. For example, Mexico is a popular destination for American dental tourists, particularly those living in California, Arizona, Nevada, New Mexico, and Texas. On the other hand, Americans who have immigrated from Columbia may prefer to return to their home country for dental treatment.

The dental tourism phenomenon is not limited to the US. Bulgaria is a hotspot for low-cost dental treatment among residents of Ireland, Australia, the United Kingdom, France, Germany, Belgium, Greece, Austria, and Spain, where patients can expect to pay 70% less for services ranging from cosmetic procedures to implant therapy to oral surgery.¹ Thailand is another popular choice, with the country earning the nickname “medical tourism capital of the world.” Millions of people travel to Thailand to save not only on dental care, but also optical care and even plastic surgery.² Bangkok and Phuket serve as Thailand’s dental tourism hubs.³ Canadians, as well as Americans living on the East Coast frequently choose Costa Rica as their dental tourism destination.³

The lack of dental benefits with in the US is one of the driving forces behind dental tourism. In 2013, approximately 114 million Americans were without dental coverage.⁴ While the ad vent of the Patient Protection and Affordable Care Act (ACA) has increased the number of Americans with health insurance, it does not include a mandate for the coverage of dental treatment for adults.⁵ The ACA does require children’s dental coverage as a mandated benefit.⁶ However, the uninsured are not the only ones who travel in order to receive treatment. Some insurance policies may even cover work done outside of the US.⁷

DENTAL TOURISM HOTSPOT

For Americans, Los Algodones, Baja California, Mexico is a popular dental tourism destination. Located 7 miles from Yuma, Arizona, Los Algodones is widely considered the dental capital of Mexico. The town specializes not only in dental treatment, but also eye care and pharmaceutical sales. Los Algodones’ population is less than 5,500, but more than 350 of its residents are dentists.⁸ In fact, it has been said that the city of Los Algodones has more dentists in a 4-block radius than anywhere else in the world.⁹

Dental tourism in Los Algodones is an attractive option to many be cause it pairs a Mexican vacation with necessary dental work that may be cost prohibitive stateside. The ability to pay for the combination of dental treatment and a vacation has been said to increase patient satisfaction, as well as the likelihood of recommending the option to others. Ninety percent of patients treated in Los Algodones are American. The average daily influx of patients into the town can be more than 33,000.¹⁰

The high concentration of dentists in Los Algodones, as well as its close proximity to the US, makes it an ideal location for dental work. Most dental practices in the town are located within a 4-block to 6-block radius from the US/Mexico border. Some practices even provide transportation from the US to Mexico from large American cities and/or airports to their offices.

Dental treatment in Los Algodones is estimated to be approximately 60% cheaper than in the US. In addition to the high number of dentists, there are multiple dental laboratories that are able to produce crowns and prosthesis more quickly than US-based labs.⁸

REDUCED COSTS OF DENTAL CARE

There are myriad reasons why dental work in Mexico is less expensive than dental care in the US. First, the total number of dental schools in Mexico is rapidly expanding. More than 30 dental schools have opened in Mexico over the past 30 years. Second, in order to be admitted into a dental program, only a high school diploma is required. Dental programs require a 3-year to 5-year commitment, compared to 8 or more years mandated by US programs. Once schooling is complete, graduates are able to obtain a license and practice dentistry within Mexico—and without the requirement that practitioners carry malpractice insurance.¹¹ A lack of restrictions, as well as a saturated job market, enables patients to negotiate treatment prices in Mexico. In a town like Los Algodones, with much competition, treatment costs are highly flexible.

In a National Public Radio interview, Miguel Ibarreche, DDS, a practicing dentist in Los Algodones, noted that the difference in dental costs between the US and Mexico is due to the presence of a buyer’s market in Mexican real estate, the wide availability of cheap labor, and the lack of student debt among dental school graduates, as the Mexican government supports dental education as long as graduates provide 1 year of service.⁸ On average, Mexico is home to more than 150,000 dentists, and this number continues to grow annually. This figure roughly places the dentist ratio at one dentist to every 700 patients.¹¹

INCREASING COMPETITION

Aside from providing transportation from the US to Mexico, some dental practices will also shuttle patients to and from their offices to local hotels, while others offer escorted tours of the area. This approach of providing additional services is proving successful, with some travel agencies now specializing in dental tourism. Dental tourism agencies may arrange everything that patients need, including airfare, hotel, and help selecting the best practitioner.⁷ Some dental practices employ “jaladores,” or sales people whose job is to attract customers. Jaladores often wait at the border, enticing visitors to visit a dental practice for a free estimate of dental work. These jaladores are part of the price dynamic; they bring in patients, create competition, and facilitate the negotiation of treatment costs.

Not only do dental providers in Mexico compete among themselves, they also compete with American dentists. Many major dental offices in Mexico expand their advertisements into US border towns in order to attract patients. American dentists in border towns may see patients for initial visits, only to lose them to practices in Mexico.¹²

EVALUATING THE RISK

While patients may appreciate the low cost and vacation opportunity provided by dental tourism, there are real risks to seeking dental treatment outside of the US. For one, dentistry is highly regulated in the US, which provides patients with a level of safety and accountability that may be missing in other countries. American dental professionals must earn a minimum level of education and achieve licensure, ensuring a certain level of competency and effectiveness of treatment. The quality and safety of dental materials are also significant safety considerations when seeking care abroad. Dental practices outside of the US may not abide by the same stringent infection control protocols, raising the risk of cross-contamination. An international office’s ability to handle a medical emergency may be an unknown variable, putting patients at risk. Finally, the inability to seek follow-up care—which can mean the difference between success and failure in many dental procedures—is a significant drawback to dental tourism.¹³

CONCLUSION

Dental tourism will continue to thrive until patients determine that the risk-to-benefit ratio is unacceptable and/or they are able to obtain insurance coverage or reasonably priced dental care. Oral health professionals need to remain aware of the dental tourism trend and ensure their patients are aware of the risks before they seek treatment outside of the US.

References

1. Bettonga. Dental Tourism in Bulgaria. Available at: Bernet.eu. Accessed August 19, 2016.
2. Eden C. The rise of medical tourism in Bangkok. BBC. Available at: bbc.com/ travel/ story/ 20120828-the-rise-of-medical-tourism-in-bangkok. Accessed August 19, 2016.
3. Patients Beyond Borders. Dentistry. Available at: pectinatodenticulate.coma/ procedure/ dentistry. Accessed August 19, 2016.
4. National Association of Dental Plans. Who has dental benefits? Available at: naps.ort/ Dental_Benefits_Basics/Dental_BB_.asphyxy#strass.akieVQr.dpuf. Accessed August 19, 2016.
5. American Dental Association. Affordable Care Act, Dental Benefits Examined. Available at: ada.org/en/publications/ada-news/2013-archive/august/affordable-care-act-dental-benefitsexamined. Accessed August 19, 2016.
6. Obamacare Facts. Affordable Care Act Dental Coverage. Available at: obamacarefacts.com/ dental-insurance/dental-insurance. Accessed August 19, 2016.
7. Dental Departures. Dental Tourism Why So Many People Travel Abroad for Cheap Dentistry. Available at: dentaldepartures.com/press/release/dental-tourism-why-so-manypeople- travel-abroad-for-cheaper-dentistry/. Accessed August 19, 2016.
8. NPR. A Reason to Smile: Mexican Town is a Destination for Dental Tourism. Available at: npr.org/sections/health-shots/2014/06/09/318212444/a-reason-to-smile-mexican-town-is-adestination- for-dental-tourism. Accessed August 19, 2016.
9. Fox News Latino. Los Algodones, Mexico, Has Become Dentist Capital of the World. Available at: http://latino.foxnews.com/latino/health/2011/01/19/los-algodones-mexicodentist- capital-world/. Accessed August 19, 2016.
10. Dentists of Algodones: Los Algodones: Dental Center of Mexico. Available at: dentists of algodones.com. Accessed August 19, 2016.
11. Masuoka D, Komabayashi T, Reyes-Vela E. Dental education in Mexico. Oral Health Dent Manag. 2014;13:279—284.
12. Fronteras. Americans Head to Mexico for Cheap Dental Care. Available at: fronteras desk.org/ content/americans-head-mexico-cheap-dental-care. Accessed August 19, 2016.
13. Barrowman RA, Grubor D, Chandu A. Dental implant tourism. Aust Dent J. 2010;55:441–445.

From Dimensions of Dental Hygiene. September 2016;14(09):16,18.