Erinne Kennedy, DMD, MPH
It was the year 2017. It was my first year out of a general practice residency, and I was working in a busy community health center in Boston, Massachusetts. Collectively, our staff spoke 13 languages fluently, giving us a unique opportunity to help patients from around the globe who were seeking dental care in the United States.
I loved working Fridays, even Friday afternoons. One Friday, I was getting ready to walk into the exam room, and my dental assistant said, “Dr. Kennedy, you might want to look at these radiographs in your office.” Surprisingly, I found 28 root canals, 28 indirect restorations with open margins, and countless periapical radiolucencies. After I gathered the patient’s history, she shared that, after a serious turn of events in her life, she had treated herself to a dental tourism vacation. She had spent her whole life wanting a new smile, and as a gift to herself at age 50, she completed the treatment in another country. Unfortunately, the outcome was not what she had anticipated.
This is one of many examples of dental tourism that I have encountered as a public health dentist. The most heartbreaking aspect of this treatment mode is when a patient undergoes additional pain, procedural complications, and additional costs after receiving care through dental tourism.
As a new dentist, I look for ways to engage my patients and help them take ownership of their oral health. I started to use motivational interviewing techniques to educate my patients on treatment expectations, procedural safety, and regulations related to dental tourism to prevent complications like those described at the beginning of this article.
When patients are thinking about seeking dental treatment through dental tourism, I ask questions to help them find the care that is right for their needs.
Where are you from? Where have you received dental care before? Many patients have received dental care from all over the world, and it is important for them to be able to share where they received most of their dental care. Asking these questions will also help you learn how you can meet their needs based on their cultural expectations and past experiences in the dental chair.
Can you share a positive dental experience you have had in the past? Where was this experience? I love to hear when patients have had positive dental treatment, and it is important for them to verbalize these wonderful experiences. If most of a patient’s positive dental experiences have been in your office or perhaps another US dental office, this will help you later on in the conversation when you try to help the patient make a choice about whether dental tourism is right for his or her needs.
Can you share a negative dental experience you have had in the past? Where was this experience? Again, verbalizing these experiences is helpful for two reasons: If a patient’s negative experiences have been at your office, you will be able to address these and hopefully create a change to prevent them from happening in the future. If their experiences abroad have been negative, reminding them of this may help them make treatment decisions that incorporate many factors beyond the cost of care.
What motivates you to receive care abroad? This is important. I try to understand why the patient wants to receive care abroad. For example, if the reason is financial, I explain the financial options we have at our community health center. I also share a MouthHealthy article on travel that states, “If you’re considering travelling for dental care, remember, saving money overseas may lead to greater expense to your health and your wallet when you arrive back home.”1
Finances might not be the only reason for seeking care abroad. Perhaps the patient feels more comfortable working with someone who speaks his or her primary language or wants to see family but needs a reason to visit. For your office, this is an opportunity to use a translation service, bring in a family member to help with communication, or connect the patient with a dentist who speaks his or her primary language. Helping patients overcome the barriers to receiving safe dental care is easier when you know what motivates them.
What are some of your fears to receiving care abroad? After I ask this question, I deeply listen to patients’ fears about receiving dental care through dental tourism, and I also highlight some of the dangers, including lack of regulation for infection control, licensure, and dental products; lack of medical and dental history; operative and postoperative complications; lack of emergency care; etc. The American Dental Association and California Dental Association share a patient resource that guides patients through risks, patient rights, and questions to ask prior to participating in dental tourism.1,2 Encouraging the patient to do due diligence prior to receiving care in the US or abroad is vital to successful patient outcomes.
What motivates you to receive care in the US? Asking patients what motivates them to receive care in the US creates another opportunity to highlight the safety features they should look for in a health-care delivery system. Examples that you can share include infection control standards, dental education accreditation standards, strict licensure criteria, the use of evidence-based guidelines in dentistry, comprehensive medical records, and the list goes on. This question gives me an opportunity to point out to patients the health care that they have at their disposal. The conversation can be more practical if you discuss the importance of comprehensive care, regular follow-up, emergency care, and the overall benefit of having a dental home.
What are some of your fears about receiving care in the US? Lastly, there may be some fears that the patient has about receiving care in the US. Discussing this topic will give you an opportunity to create change or clear up a misconception.
We have to educate our patients on all aspects of their oral health care, including the prospect of dental tourism. I hope you find these questions helpful for your patients. Most importantly, I hope having open conversations empowers patients to make the best decisions for their oral health and safety.
1. Travel. American Dental Association website. https://www.mouthhealthy.org/en/az-topics/t/travel. Accessed January 28, 2019.
2. Dental Tourism. California Dental Association website. https://www.cda.org/Portals/0/pdfs/fact_sheets/dental_tourism_english.pdf. Published 2017. Accessed January 28, 2019.
Erinne Kennedy, DMD, MPH, graduated from Nova Southeastern College of Dental Medicine in 2015. She completed a one-year general practice residency at a VA hospital in 2016 and her dental public health residency in 2018. She is currently the inaugural student in a master’s in dental education program at Harvard School of Dental Medicine and serves in a local health center in Boston, Massachusetts. Contact her at firstname.lastname@example.org.