Americans go to Mexico for a cheaper perfect smile

Americans go to Mexico for a cheaper perfect smile

By Reuters Health

February 1, 2008 -- CIUDAD JUAREZ, Mexico (Reuters) Feb. 2 It was fear of the hefty bill as much as fear of the drill that kept American musician Don Clay away from U.S. dental clinics for 30 years.

When a sorely infected tooth eventually drove him to the dentist last month, it was to a clinic in a Mexican border city better known for violent crime and drug cartels.

Shrugging off concerns about hygiene and Mexico's brutal drug war, thousands of Americans are heading to Ciudad Juarez and other Mexican border cities for cheap dental treatment.

"I had to get my teeth fixed. I need a perfect smile to make a successful career in music. Treatment in the United States is so pricey," said Clay, a Texan trying to get a record deal as a hip-hop artist.

U.S. dental treatment costs up to four times as much as in Mexico, making it tough for uninsured Americans to treat common problems such as abscessed teeth or pay for dentures.

A dental crown in the United States costs upward of $600 per tooth, compared to $190 or less in Mexico.

Aspiring Mexican dentists are moving to border cities in droves and are luring American patients away from farther flung discount destinations such as Hungary and Thailand.

Americans have long crossed the border for cheap medicines, flu vaccines, eye surgery or specialist doctors, but dentists are now in highest demand.

Dental clinics are on almost every block in central Ciudad Juarez, ranging from dingy dives to clinics that look more like posh hair salons. Getting there involves dodging prostitutes, drug pushers, and cowboy-boot sellers.

BARGAIN-HUNTING

"We've gone from a handful of patients when we started 2.5 years ago to 150 new patients a month," said Joe Andel, an American who owns the Rio Dental clinic in Ciudad Juarez with his Mexican dentist wife, Jessica.

Rio Dental, which uses U.S. labs to make its crowns, picks patients up at the airport in El Paso, Texas, across the border and has treated people from as far away as Alaska and Hawaii.

"The Internet makes this possible. It allows patients to find us and research us and shows we can do dental work of equal or superior quality to the United States," Andel said.

Internet bloggers swap stories and compare notes about Mexican dentists, but it always comes down to money.

Dentistry in the United States has become prohibitively expensive for some patients, with bills that can run to tens of thousands of dollars. Malpractice insurance premiums, operating costs that are much higher than in Mexico and dentists seeking to claw back the rising cost of their tuition all weigh.

Even among Americans who have medical insurance, many find they are not covered for treatment other than the basics, and paying on credit means high interest payments.

"I did $4,000 of dental work in the United States and put it on my credit card. Because of the interest, I only paid off $400 in three years," said a U.S. teacher from New Mexico getting treatment in Ciudad Juarez who gave his name as Bill.

Cosmetic dentistry, which insurers do not cover and which can be paid in dollars in many Mexican border clinics, is also popular, Ciudad Juarez dentist Luis Garza said.

"If you want a perfect smile, you have to pay for it, and we can do it cheaper, that's all," he grinned.

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

California dentists asked to volunteer

California dentists asked to volunteer

By Laird Harrison, Senior Editor

January 17, 2008 -- The California Dental Association (CDA) is asking its members to offer children free "assessments", because so many of the state's kids aren't getting good dental care.

This month, Children Now, a children's advocacy group, gave the state a grade of C- for oral health. And last year, the state began requiring parents to take their kids to the dentist -- or explain the reason why.

"Out of 25 states surveyed, only Arkansas ranked below California in children's oral health," said Gayle Mathe, a spokesperson for the California Dental Association, citing a 2006 report by the Dental Health Association.

For example, 70.1% of California children have tooth decay, and 28.7% have untreated decay, according to the report.

To focus attention on the problem, the state Legislature passed a law, requiring parents to take their kids to the dentist or explain why they didn't. The law, which went into effect January 1, 2007, stirred "a lot of activity" in its first year, said Gayle Mathe, a spokesperson for the California Dental Association (CDA). "It generated a lot of phone calls to our office."

“I think there's a shortage of certain kinds of dentists.”
— Kelly Hardy, associate director for
     health, Children Now

She notes that some other states, including Pennsylvania, Rhode Island, and Illinois, have similar programs in place, and that many others are considering them.

Under the law, parents of public school kids must submit a form by May 31 of the year after the child first enters the public school system. The first part of the form must be signed by a dentist or hygienist.

The second part of the form is a waiver that excuses parents for not getting the first part completed. Parents can simply check a box saying that they didn't want to take their kid to the dentist or a box saying that they couldn't find a dental office where their insurance was accepted. They are also asked to indicate which type of insurance or state benefit dentists rejected.

The legislation provided funds for schools to distribute the forms, collect them, and report the data. "We're trying to get specifics on barriers," Mathe said. Some hint of what the numbers might reveal can be found in the 2006 Dental Health Association report, which stated that 16% of those surveyed had trouble getting access to care, primarily because of poverty or lack of insurance.

To help bridge that gap, the CDA is asking dentists to conduct the dental assessments for free for those patients who can't afford to pay. According to the organization's Web site, an "assessment" can fall short of a full examination. It's simply a matter of noting whether there are visible caries or fillings, or any problem that requires urgent treatment. The CDA says parents requesting an assessment -- rather than a standard examination -- should fill out a consent form, available on the organization's Web site, making it clear that their child didn't get thorough inspection.

But dentists shouldn't leave it at that. "You and your office staff have a unique opportunity to educate the parent on the importance of oral health and begin the process of establishing a dental home for this child," the CDA states on its Web site.

Kelly Hardy, associate director for health at Children Now, thinks cost isn't the only reason why kids aren't getting to the dentist: "I think there's a shortage," she said. "Some counties don't have any pediatric dentists."

While she applauds the new legislation as a "first step," she argues that more should be done, including more money for dental care and efforts to get even younger kids to the dentist.

In a separate report, Children Now cited a survey finding that 58 counties in California reported a shortage of dentists.

There is some good news, though. California children's teeth actually improved between 1994 and 2005, according to the Dental Health Foundation.

Copyright © 2008 DrBicuspid.com

Is Invisalign dangerous for generalists?

Is Invisalign dangerous for generalists?

By Laird Harrison, Senior Editor

December 5, 2007 -- So you've taken a course on Invisalign and now you think you can straighten teeth. Maybe so. But watch out. These high-tech plastic aligners may not work as well as old-fashioned braces...in which case there could be a lawyer in your future.

That's the word from Daniel Kuncio, D.D.S., a New York orthodontist, and his colleagues at the Montefiore Medical Center in the Bronx. The team compared the teeth of 11 patients treated with Invisalign to 11 treated with conventional braces three years after the two groups had finished their treatments. They found that the Invisalign patients' teeth had relapsed significantly more than the patients using traditional braces.

"The take-home message is that you have to be very careful with this product," says Dr. Kuncio, whose study was published in the September issue of Angle Orthodontics. "It's easy to get into trouble." Kuncio should know. He was called as an expert witness in the malpractice trial of a general dentist accused of botching an orthodontic treatment with Invisalign. He warns that many such lawsuits could crop up soon as more and more general dentists begin using Invisalign.

"The take-home message: be very careful with this product"

Introduced in 1999, the system caught on fast, partly because it requires less expertise and less training than conventional braces, opening the world of orthodontics a bit to general dentists. Dentists simply make impressions of their patients' teeth, then send them to Invisalign's creator, Align Technology of Santa Clara, Calif. Technicians at the company use computer modeling to create a set of clear plastic aligners, each designed to move teeth a little bit farther in the desired direction.

Invisalign is popular among patients because the transparent, removable aligners are much less noticeable and more comfortable than conventional braces, says Robert L. Boyd, D.D.S., M.Ed. chair of orthodontics at the University of the Pacific in San Francisco. Hundreds of thousands of patients have received Invisalign treatment, and because of its appeal, the technique is expanding the market for elective orthodontic treatment, he says.

But how effective is it? While no one disputes that the aligners can move teeth, experts debate which kinds of problems it can fix and which kinds should be treated using conventional techniques. Dr. Boyd, a paid board member and shareholder in Align, has published several studies describing the advantages of Align over traditional orthodontics. For example, he points to unpublished research showing that Invisalign patients experience less root resorption than conventional orthodontics patients.

And Dr. Boyd argues that general dentists can and should be using Invisalign -- in fact, his school is teaching the procedure to general dentistry students. He has also published research suggesting orthodontists can use it for fairly complex procedures.

But independent researchers have found Invisalign wanting. A review of Invisalign studies published in the April 2007 Journal of the Canadian Dental Association concluded, "Achieving similar results to those of more conventional fixed appliances may be difficult."

The only two clinical trials comparing Invisalign to traditional braces reached similar conclusions. First came a Sept. 2005 retrospective study in the American Journal of Orthodontics & Dentofacial Orthopedics. The investigators compared 48 patients immediately after treatment with Invisalign to 48 patients immediately after treatment with braces, using American Board of Orthodontics (ABO) Phase III examination criteria. Twenty-seven percent fewer Invisalign patients had passing scores.

Now comes Dr. Kuncio's work using the ABO system to score the teeth after three years. "What I saw in my research was that Invisalign relapsed more," he says.

Dr. Boyd dismisses these results. "There is a bit of negativity out there," he says. "Whenever you get into something new, there is at least a third of the old guard who will hate it just because it's new." He calls Dr. Kuncio's study "biased," arguing that the investigators just didn't like Invisalign. And he says the study was "poorly done" because the orthodontist treating the two groups of patients, Clarence E. Shelton, Jr., was much more experienced with braces than with Invisalign.

Dr. Kuncio responds that he and his colleagues do like Invisalign. "I use it everyday," he says. He also acknowledged that it would have been more ideal to compare patients treated by an orthodontist equally well-practiced in both techniques. But he points out that the two groups had equivalent ABO scores immediately post treatment.

He argues that Align should market Invisalign to orthodontists rather than general dentists because general dentists don't know what to do if they get into trouble. Orthodontists, by contrast, can fall back on conventional techniques. For those general dentists who do want to try Invisalign, he recommends extreme caution. "Start slow with simple cases," he says.

And in the end, that's where the two experts agreed. "Don't start with anything but the simplest cases," echoes Dr. Boyd. He also advises treating only patients over 14 and only those patients who are truly motivated. "Cooperation is the number one issue," he says.

Dental care? What, me worry?

Dental care? What, me worry?

By DrBicuspid Staff

December 5, 2007 -- Nearly 40 million adults in the U.S. report that they lack access to adequate healthcare. Almost 20 percent say they cannot afford dental care, prescription medicines, mental health care, or eyeglasses. No, this isn't from the script for a "Sicko" sequel. Rather, these are sobering statistics gleaned from "Health, United States, 2007," the annual report on the nation's health released by the Centers for Disease Control and Prevention (CDC).

"There has been important progress made in many areas of health such as increased life expectancy and decreases in deaths from leading killers such as heart disease and cancer," said CDC Director Julie Gerberding, M.D., M.P.H in a press release. "But this report shows that access to health care is still an issue where we need improvement."

Some notable highlights about Americans' dental health:

• In 2005, 25 million adults did not get dental care because they could not afford it.

• One-fourth of children between the ages of 2-17 did not visit the dentist in 2005. Of these children, those living below the poverty line were more likely to lack dental care.

• In the same year, about one-half of adults living below the poverty line did not make a single visit to the dentist.

• In some good news, the report noted that, "between 1988-1994 and 2001-2004, approximately one-quarter of adults 20-64 years of age had untreated dental caries, down from nearly one-half in 1971-1974."

The report cites cost of care, difficulty in navigating government assistance programs, finding a local dentist who accepts Medicaid, language/cultural barriers, and lack of insurance as some of the problems associated with accessing proper dental care.

Copyright © 2007 DrBicuspid.com