The trend for people of all ages to seek a whiter, straighter and overall fuller smile continues. Indeed, smile makeovers are nothing new with the history books showing that early dental pioneers explored various chemicals to brighten and whiten teeth. In the 17th century barber surgeons used a substance known as aqua fortis to whiten teeth – this was actually a nitric acid solution and although the person sported a whiter smile afterwards, the enamel was left porous, and more susceptible to caries and staining thereafter.
Dentistry has of course moved on considerably and with international travel being relatively straightforward, patients are prepared to travel and self-refer to dental clinics providing both straightforward and technically complex dental treatment at relatively cost-effective costs. From the simplicity of composite resin additions through to full arch implant-supported bridges, everything is on offer for those who are prepared to travel.
The term 'Turkey teeth' is often used referring to the practice of travelling to Turkey, to either the large or the small cities having been lured by glossy advertisements. While the lower cost of such dental care is tempting, it is important for patients to understand the important issues before embarking on the smile makeover journey. It does of course strike me that the term Turkey Teeth is somewhat ironic since turkeys are edentulous.
My concern with smile makeovers and dental tourism is that whilst these cosmetic dental procedures provide patients with what they may be seeking; veneers, crowns, bridges, implants, and other fixed dental prostheses, the ‘quick fix’ treatment may be unnecessarily invasive in relation to the underlying dentition, often necessitating the removal of excessive sound tooth tissue as a result. It is no surprise that the cost of private dental treatment in many parts of the western world is off-putting for patients, but there are of course other aspects for patients to consider over and above cost and instantaneous treatment which may have lifelong complications.
Turkey has become the dental tourism hotspot, attracting a significant number of international patients. It is reassuring to note that many dentists who offer such treatment have undertaken postgraduate training, are bilingual and often speak fluent English. Furthermore, they can undertake advanced restorative dentistry in a much faster turnaround time when compared to that sometimes takes weeks to be completed elsewhere in the world. The offer of an all-inclusive package covering the cost of flights, transfers, accommodation, treatment, and the potential inclusion of a mini-break to savour the history, culture, beaches and cuisine of Turkey is alluring.
However, there are a number of risks for patients to consider in relation to dental tourism and smile makeovers. Lack of consistent regulation across dental tourism hotspots is a significant concern for The Faculty of Dental Surgery at The Royal College of Surgeons of Edinburgh (RCSEd) and having written about the lack of regulation in relation to direct to consumer dentistry in a recent blog, under-regulation of dentistry in such areas allows the unscrupulous practitioner to undertake unnecessary and / or poor quality care. Patients should of course look for international accreditation of individual clinics and practitioners and where better than to look for a dentist who holds an RCSEd qualification. Due to relative under regulation, some clinics may use lower grade materials and products in an effort to reduce costs. It is well-known that inferior quality materials are less durable, are less compatible with other intra-oral tissues and materials and may result in allergy, inflammation as well as other medical problems.
Poor quality post-treatment care for complex treatment causes a number of difficulties and whilst more reputable clinics will offer after-care, this is sometimes an advice only service and of course if patients require to return to the specific clinic, further travel and accommodation costs are inevitable as well as being inconvenient. This has a knock-on effect on publicly funded dental services who are sometimes asked to pick up the tab in relation to repairing, replacing or simply remediating disasters that should never have been considered in the first place. In some parts of the world, public dental systems do not have the resources to remediate such treatment and patients end up either having to pay again for rescue treatments or are left in a parlous state.
Complications are inevitable with all treatment and it goes without saying that for a practitioner treating the dental tourist who does not have access to the patient's full medical history, or other clinical information, unexpected complications may just be the start of the unplanned and unforeseen. Finally, patients are not always fully prepared for extensive one-stop treatment and are not always fully informed of the need for recovery following surgical treatment. Flying home during the early period of recovery may also lead to other unanticipated problems such as exhaustion particularly in the presence of post-surgical swelling and infection.
Is tooth tourism always a disaster? Patients should undertake due diligence in fully assessing the risks as well as benefits of treatments, ensure adequate after-care is available, have appropriate dental insurance cover for any remediation, and discuss the proposed treatment with their general dental practitioner who will inevitably have to undertake longer-term maintenance. The challenges of dental tourism and smile makeovers are substantial, and the Faculty of Dental Surgery would recommend that all patients consider dental tourism very carefully.
Fellows and Members are welcome to contact me at dental@rcsed.ac.uk.