Dental Care Away from Home

Overview

Planning a trip out of the country? It's helpful to schedule a dental checkup before you leave, especially if you'll be traveling in developing countries or remote areas without access to good dental care.

If you are thinking about a dental vacation outside the United States in an attempt to save money, which is often referred to as "dental tourism," here are some things to consider:

Education and Clinical Training of U.S. Dentists

Dentists trained in the U.S. graduate from a dental school accredited by the American Dental Association Commission on Dental Accreditation (CODA). After earning their undergraduate degree and their dental degree (eight years for most), some dentists continue their education and training to achieve certification in one of nine recognized dental specialties. In addition, dentists must pass national examinations and meet state requirements before they earn a license to practice.

Dentists are doctors specializing in oral health whose responsibilities include diagnosing oral diseases, ensuring the safe administration of anesthetics, performing oral surgical procedures and managing oral trauma. Comparable levels of training may exist in the country to which you are travelling, but this may be difficult to find out if that country does not have similar dental regulations.

Safety

The procedures, equipment and drugs used by dentists in the U.S. are held to high standards. For example, the U.S. Centers for Disease Control and Prevention (CDC) published comprehensive guidelines on infection control procedures for dental health-care settings. These guidelines exist to prevent the spread of infections, including blood borne illnesses such as hepatitis and AIDS. U.S. dentists must abide by regulations for radiation safety (X-ray equipment and its use) and for proper disposal of biomedical waste. Also, the drugs and dental instruments and materials used by dentists in the U.S. are regulated by the U.S. Food and Drug Administration to ensure that they are safe. These standards are in place for your safety and for that of dental office staff.

Travel Advisories

The U.S. Department of State issues travel alerts to disseminate information about short-term conditions, generally within a particular country, that pose imminent risks to the security of U.S. citizens. In the spring of 2009, for example, the Department of State issued a travel alert cautioning people to avoid non-essential travel to Mexico because of an outbreak of H1N1 influenza in that country that resulted in a number of deaths. In addition, the alert recommended that travelers check the department's Web site for new travel advisories as well as the Web site of the U.S. Centers for Disease Control and Prevention for any additional information or recommendations.

Insurance, Privacy and Dental Records

If you have dental insurance for dental care performed outside of the U.S., you should confirm with your insurer and/or employer that follow-up treatment is covered upon your return to the U.S. You should consider arranging follow-up care with a U.S. dentist prior to travel to ensure continuity of care upon your return. If you do not have a dentist in the U.S., you can find an ADA member dentist in your area.

In addition, you should confirm with your U.S. dentist and the dental care provider in the other country that the transfer of patient records to-and-from facilities outside of the U.S. is consistent with current U.S. privacy and security guidelines.

Flight and Vacation Activities After Certain Dental Procedures

It's important to know that many dental procedures are surgical in nature. Dental implants, for example, often require months of healing. Post treatment risks after dental surgical procedures include bleeding, pain, swelling and infection. Your body may need time to rest and recover after procedures such as wisdom tooth extraction, root canals, dental implants and gum surgery, which should be factored in to flight and vacation activity schedules. In addition, it is possible that changes in airplane cabin pressure might cause discomfort in some patients who have recently had oral surgery. Bear in mind that significant dental procedures require follow-up care to make sure everything is healing and functioning properly. Continuity of care is important and should be a consideration when making treatment decisions.

Continuity of Care

The American Dental Association (ADA) encourages you to visit a dentist on an ongoing basis to ensure continuity of care. Establishing a "dental home" provides you with comprehensive oral health care so conditions such as gum disease and tooth decay can be diagnosed at an early stage when treatment is simpler and more affordable. A dentist who knows your case history can provide you with guidance on good oral health care habits, preventive oral health services and diagnosis and treatment of dental disease based on your individual needs. One dental visit does not establish the continuity of care that is necessary for maintaining good oral health.

Questions and Considerations Prior to a Dental Vacation

• How will you determine the qualifications and experience of the dentist who will be treating you in a foreign country?
• How is payment processed?
• If you have dental insurance, will the benefits cover treatment that is performed outside the United States and if so, to what extent?
• What happens if something goes wrong during or after treatment? Would you need to return to the country where you received treatment? Can you afford that?
• If you need corrective care after you return, will that be covered by your dental insurance or will you have to pay out of pocket for another dentist to provide corrective care?
• If something goes wrong after receiving dental care in another country, what are your legal rights?

Resources

• A checklist for dental treatment abroad can be found on the Organization for Safety and Asepsis Procedures Web site.
  
  According to the OSAP, "the decision to visit another country for dental care should go beyond simply comparing prices or even evaluating the dentists' expertise. Countries differ in their standards for infection control and safety. The use of fresh gloves, sterile instruments and safe water are not standard practice in all countries. Without these precautions, patients could be infected with diseases such as hepatitis B."

• The International Association for Medical Assistance to Travelers (IAMAT) maintains a network of medical personnel, hospitals and clinics around the world that have agreed to treat IAMAT members in need of care. Visit their Web site at www.iamat.org.
  
  IAMAT is helpful in referring patients to dentists, and any traveler can belong to IAMAT. There is no membership fee, although a donation is welcome.
  
  International Association for Medical Assistance to Travelers
  1623 Military Road #279
  Niagara Falls, N.Y. 14304-1745
  Phone: 716-754-4883
  IAMAT's online form

• The American Dental Society of Europe (ADSE) members are dentists who live and work in Europe. They have completed a full time course of study at an accredited dental school in the United States or Canada. In addition, the standard of dental education in many European countries is comparable with that in the U.S.
  
  For more information, visit:
  The American Dental Society of Europe
  ADSE
  Dr. Alastair MacDonald
  2 Clifton Street, Glasgow
  G3 7LA, Scotland
  Phone: 011 44 141 331 0088
  Fax: 011 44 141 331 0084
  ADSE's online form

Prepared by the ADA Department of Public Affairs and the Division of Global Affairs and adapted from the "For the Dental Patient" section of The Journal of the American Dental Association:

Have a checkup before you travel. JADA 2004; 135(6):827. Copyright ©2004 American Dental Association. All rights reserved. 'For The Dental Patient' was prepared by the American Dental Association in cooperation with The Journal of the American Dental Association and the ADA Center for International Development and Affairs. Adapted 2009 with permission.

Dental care while traveling. JADA 2006; 137(6):928. Copyright ©2006 American Dental Association. All rights reserved. 'For The Dental Patient' was prepared by the American Dental Association in cooperation with The Journal of the American Dental Association, the Division of Communications and the ADA Council on Scientific Affairs. Adapted 2009 with permission.