When you visit an overseas dentist, you cannot be sure what type of materials they might be using. Some may in fact do a great job, but you can’t be sure and definitely would not have the same level of recourse that you might by receiving care by the hard-working dentists right here in the USA.

A report of lead in a dental prosthesis produced in an overseas dental laboratory from an overseas dental lab got everyone’s knickers in a twist, but it is unclear how widespread this is, or if there is a real danger to consumers.

That said, most people never ask about the materials used in a dental prosthesis that they may get in the US, or even read the labels on food items that they buy. Regulation of the dental profession, plus regulation of medical devices, will vary dramatically from country to country, as will views on safety. For example, bovine growth hormone is permitted to be given to cows in the U.S. to increase milk supply (another reason to buy organic milk and dairy products), but yet is banned virtually everywhere else in the world including our neighbor Canada. The reason? Lack of evidence proving its safety, plus evidence strongly suggesting that it may not be safe. So you can’t always blindly trust products born in the U.S. either.

If it’s at all possible, you can ask about the materials being used in a dental prosthesis that you may be contemplating from an overseas dentist. They may be quite willing to give you a list, if its a reputable dentist and they feel they have nothing to hide. And then do some research, like finding out how a comparable product is made in the U.S., and take it from there.

Well, suppose being a traveling shrink might be an interesting profession. Sort of like the itinerant preachers, who set up their tents and hold revivials, and then go off on their way.

But that’s not the type of therapist I’m talking about. This is about the therapists with the words “respiratory” “occupational” “physical” and so on in front.

Apparently, travel jobs are not just for nurses. According to an article at American Traveler, therapist can take the road in much the same way that nurses do.

This is a travel professional staffing agency, so everything they say must be looked upon with that in mind. Anecdotally, some nurses have been complaining the travel assignments have dried up and I imagine that some have. But with hiring freezes and layoffs, hospitals still need staff. Some are making a big fuss and using the economic situation as an excuse to cut benefits, salary and jobs. But when they did the same thing in the early/mid 1990s, they turned around and used travelers and per diems to fill in the slots vacated by full time staff. True, it is more expensive upfront, but a lot cheaper than an employee who demands health insurance and who they may have to eventually provide with a pension.

American Traveler claims to have a lot of jobs waiting, for assorted therapists as well as nurses. I imagine the truth is somewhere in-between no jobs and abundance of jobs.

But for allied health professionals, they claim to have travel jobs for respiratory therapists, occupational therapists, surgical technicians, speech pathologists, and physical therapists. It would make sense, as these jobs can be packed up and carried around the country, much as nursing can.

Factor in all the benefits, bonuses and perks of traveling and travel therapists can make up to $110,000 per year.

Not bad, but of course, that does depend on your location, the type of therapist you are, the pay at the moment, etc. But it is something to consider, especially if you’ve been laid off and can manage to temporarily relocate.

So, teeth again. In a previous post, I discussed guidelines from the American Dental Association, when it comes to getting toothcare abroad. Sometimes overseas dental work is a matter of necessity and not choice–you’re soaking up the sun while riding a camel through the Moroccan desert, taking a swig of from your bottle of overpriced Evian water, and wham–a filling pops out. Or you’re kayaking around the Galapagos, and suddenly your jaw begins to throb. You may need to see a dentist sooner rather than later, and that can be especially difficult in a somewhat remote location. But even if you’re in a large, modern Westernized city, finding a dentist for an emergency or semi-emergency is more difficult and overwhelming than if you had pre-arranged your appointment.

Pre-arranged appointments, aka medical nomadism, is the deliberate travel to an overseas location to get your teeth whipped into shape. The defining motive is saving money, and the savings has to be enough to offset travel expenses and time spent on travel.

So Where Do I Go?

That is a good question. The ADA has some recommendations for finding a dentist abroad, which again, I describe in my other post. As for actual names and faces, well, that is a bit more difficult.

The best way is to get a word of mouth recommendation. Short of that, there are a number of agencies that have popped up, offering their services in helping you find a reputable and inexpensive dentist. If they’re reputable, they can help you navigate the system and hook you up with a dentist.

Americans have been covering the globe in search of quality and inexpensive medical and dental care. Countries on the list include Mexico, Canada, India, Thailand, Singapore, South Africa, and Eastern Europe. In particular, Costa Rica and Hungary have become particularly popular for dental care. In fact, you could say that Hungary is the new rising star, and some towns are becoming “dental meccas” and wooing tourists to come and have their teeth cleaned, filled, capped, implanted, root canaled, and whitened. And after the anesthesia wears off, you can go sail up the Danube….

Here is an interesting article in USA Today about rising dental tourism in Hungary.

Dental Care US is a company that specializes in finding you a Hungarian dentist. Their website says that they arrange every detail, from the initial consultation, review of any x-rays and records, organizing the travel plans and accommodations, providing the services, and are available for any customer service need that arises. I don’t know anything about them, but they do appear to be a legitimate company (with a real address!), and what I like is that they give you a full breakdown of what every type of procedure will cost you. Since they are located in the UK, they compare the cost to what it would be over there, but you can get the idea as it compares to US dental rates (hint–a lot lower).

Not sure about Hungary. Well, try dental care in Bulgaria. It’s in the same neighborhood, and you can get a root canal done for 53 Euros, which is roughly about $40. This is through Dentist-Bulgaria, and they list prices, the type of equipment used, the procedures they perform and even accommodations on their website.

Looking for a warmer locale and some cosmetic work? Try Bangalore, India. I found this very nice and polished website for a cosmetic dental clinic in Bangalore, which is also the high tech capitol of India. They say that they are “a premier ‘Cosmetic and Restorative Dentistry Practice’ in Bangalore, India. Our services include providing excellent dental care to our patients from all over the world. We are apt at providing you simple cosmetic filling or more sophisticated smile designing and complete smile makeover. We offer the latest in contemporary dentistry including porcelain veneers, all porcelain crowns, teeth whitening, crowns etc.” It is interesting to note that all of the models on the website are fair skinned and European looking, not Indian. So you can take a guess who this is directed at.

These are a few samples. I am planning to put together an e-book about dental nomadism, which will have an extensive list of websites and clinics (I’m not endorsing any, just providing the information out there in one easy place to find it), plus other important information if you plan to go overseas.

Take Responsibility

But as with anything, we all have to take responsibility for what we’re doing. Prior to taking any kind of dental related journey to a far off land, it’s important that you do your research thoroughly–even if you are working with an agency.

• Get your price quotes and estimates up front (most important!). You do not want to be shocked after the fact, and get into a haggling war.
• Ask about mode of payment–cash, check or credit card.
• Get details about the procedure. For example, does the dentist use local anesthetic, or are you going to be into la-la land? How soon will you be able to travel? How many days do you need to plan to be there?
• If you do not speak the local language, make sure that someone in the office speaks English. You want to be able to communicate any questions or concerns while there. It may sound silly, but this is something that you want to be sure of. Would you go see a dentist in the US if you couldn’t communicate?

Photo courtesy of the U.S. National Library of Medicine

The subject of medical nomadism stirs up a lot of debris, anyway you look at it. You have the critics muttering about all of the risks that a person takes by heading overseas to find quality care at an affordable price, and they can always dig up a horror story to illustrate their point.

On the other hand, you have the patients who might otherwise have to mortgage their house or sell their kids, in order to afford the same care here in the U.S. And these are often people with health insurance, but the insurer finds a convenient glitch in the policy so they don’t have to pay for the procedure, or the copay is beyond the means of the patient, and so on.

And as far as medical disasters, well, you don’t have to go far from home to find those.

The bottom line is the medical tourism exists because there is no acceptable alternative.  It would not have grown to this capactity if most patients had a viable alternative. The critics often criticize, but I’ve yet to see them offer a reasonable alternative, other than “we must reform health care.” Well, I can’t argue with that, except it doesn’t do much for someone who needs help right now.

Teeth, Anyone?

I thought I’d write about teeth, since I did post an article yesterday about a woman who went to Costa Rica to find a dentist. Teeth are an interesting topic because dental care tends not to be a top priority for many. It could be because of the pain associated with the dentist’s office, and many people (including myself) avoid dentists as much as possible due to traumatic childhood memories, but dental care is also expensive and poorly covered by insurance.

So if you decide to venture beyond US shores, how do you find a dentist? Well, the best way is the same way that you would go about it for any type of healthcare professional–a reference from someone you trust (and has nice teeth to show for it). But if you don’t know anyone who has actually gone abroad for dental work, or any other medical care, the only other way is to do some sleuthing.

So let’s stick with dentistry for now.  The American Dental Association has not offered a statement on medical tourism, but they do offer some guidelines:

– Check with the appropriate government agency in the destination country about its national dentistry guidelines.

– Find out what recourse is available if something goes wrong.

– At the dental office, look for infection-control procedures, including instrument sterilization and use of protective gloves, mask and eyewear.

– A traveler’s guide to dental care is available through the Organization for Safety and Asepsis Procedures at www.osap.org.

But Where Do I Find My Dentist?

While these are great tips, they still don’t tell you how to find a dentist. Well, there are a number of ways of doing that, and of course, no guarantees that you’re going to land one you love.  But for starters, the American Dental Association offers some practical tips on finding a dentist:

The International Association for Medical Assistance to Travellers, (IAMAT), maintains a network of medical personnel, hospitals and clinics around the world that have agreed to treat IAMAT members in need of care. IAMAT is helpful in referring patients to dentists. Any traveler can belong to IAMAT. There is no membership fee, although a donation is welcome.

For more information visit:

• www.iamat.org
  IAMAT
  1623 Military Rd. #279
  Niagara Falls, NY 14304-1745
  Phone: 716-754-4883
  info@iamat.org

If you are traveling in Europe, contact the American Dental Society of Europe (ADSE). The Society’s members–dentists who live and work in Europe–have completed a full-time course of study at a recognized dental school in the United States or Canada.

For more information visit:

• www.adse.co.uk
  The American Dental Society of Europe
  Dr. Alastair MacDonald
  62 Highburgh Road, Glasgow
  G12 9EJ Scotlan
  Phone: 011 44 141 331 0088
  Fax: 011 44 141 338 8109

Many countries have dental associations that can provide referrals. Here is a list of International Dental Associations.

A dental school in another country may also be an option. Check the FDI World Dental Federation Web site:

• www.fdiworldental.org

Dental referrals may be available from a hotel concierge, the American Consulate, or the American Embassy in the country you are visiting.

More tomorrow on dentists abroad…

Photo courtesy of Stock.xchng

You may have reason to smile if you can get dental care done for a fraction of the price that it might otherwise cost you. As most of us know, dental insurance for the most part, well, sucks. I’ve had dental insurance in the past, and its not worth the premiums for the pissy coverage.  And many people do not have any dental insurance at all, and have to pay out of pocket to fix teeth.

But if you’re an adventurous health nomad, you may find that affordable and good quality dental care can be had south of the border. And what’s more, some employers now offer insurance that transcends borders.

This is from the State.com:

Sheila Liner spent years suffering from piecemeal dental work that led to sinus infections and a swollen face. But she didn’t have the money – an estimated $14,000 after insurance – for the nine crowns, three root canals, deep cleaning and partial dentures she ultimately needed.

At her boss’ suggestion, the 49-year-old customer service representative got in touch with a subsidiary of her insurance company and traveled to Costa Rica, where the work cost her $3,600 out-of-pocket. Even after spending $1,700 on the nine-day trip, including hotel, meals and sightseeing, she still came out $9,000 ahead.

And of course there are critics who point out all the potential problems, but then, healthcare isn’t risk free in the U.S. either. And critics tend to skim over the most important factor–why the patient went overseas in the first place. Liner wasn’t looking for sun and fun, but for a way to fix her teeth. If healthcare in the US was more affordable and if people had better insurance, medical nomadism wouldn’t even be an issue.  And that’s the bottom line. People are willing to take the risk.

The research firm Deloitte Center for Health Solutions reported that 750,000 Americans traveled abroad in 2007 for some form of medical care. Deloitte analysts estimated that number could increase to 6 million next year and projects the number will continue increasing. Other experts say the trend is growing, but perhaps not as rapidly.

The draw for patients seeking dental work, surgery and joint replacements are the discount prices for those who have high-deductible insurance plans, make flat-rate payments, like Liner, or have no coverage at all.

That’s a lot of people. I tend to think that 6 million may be an overestimate, but then again, with people losing jobs and insurance, it may be the only way to get needed healthcare. On the other hand, if Barack (yes, we are on a first name basis!) does something quickly about healthcare, it may become more accessible and affordable sooner rather than later, and health nomads may decide to opt for staying home.

Photo courtesy of Stock.xchng

This is the first post for my new nomad section. Nomads can be either patients or healthcare professionals, who wander far from home in search of care or a job. The trend is becoming more common than people think, especially on the patient side of the equation. The search for affordable medical care in foreign lands is only going to grow, unless something changes dramatically in the U.S.

For cosmetic surgery, the world beckons. Why pay zillions to a fancy New York plastic surgeon, when you can slash that cost by 50% by heading to Argentina. This was an ad that I across:

Cosmetic Surgery – 50% less than in the United States.
Argentina provides highly skilled physicians and medical facilities equipped with the most modern technology. Argentina has the needed infrastructure and the professional qualifications for offering high quality cosmetic surgery to patients from the United States and other countries.

Cosmetic surgeons operating in South America, particularly Brazil and Argentina, do have quite a brisk business. And what I heard from a plastic surgeon living in California, who was heading down to a conference in Brazil, is that they perform techniques that aren’t quite available North of the border. Good or bad, hard to say, but a lot of innovation is stifled here, without really improving safety.

I thought that this ad was interesting because it shows how this practice of nomadic medicine has evolved. The website has a form to fill out, and you can receive a travel quote and free consultation. Just 30 seconds to  fill out and voila, you’re on your way.

Photo courtesy of National Library of Medicine

New year, new site.

Finally, the long awaited revamp. As you can see, it looks a little different and there are all of these strange little tabs on top, and new sections, and the style is slightly different. The reason for the revamp was to make the blog more focused, and easier to locate different topics.

Every article that has ever appeared on this site is still here, and can be found under “All Topics.” Some of them will have to be sorted out further and tagged, but for now, everything that doesn’t fall under the tabs above is just designated under the more generic All Topics.