Treatment Plan - A Must!

Are you trying to determine the best approach to your dental care? Has your dentist made recommendations that you are uncertain how to interpret? Did your dentist tell you what your expenses will be without written specifics? Do you know if it includes other dentists or lab fees? I get asked daily to create an estimate for patients often based on minimal patient information. Generally, patients are responding to an extensive medical treatment recommendation and/or an associated exorbitant expense that is difficult to absorb. Often patients are overwhelmed with trying to interpret the recommendations and initiate the treatment process, sometimes jeopardizing their dental health by delaying treatment. I’ve developed a comprehensive list of questions to ask your dentist about. Don’t be shy. Determine if there is an associated cost with a written treatment plan. If you are asking for an alternative consult, for example considering dental tourism, request you’re x-rays: if you have paid for them, they are yours but you may need to sign a medical release. Orthopantographic (OPG) x-rays are the best suitable for external review; they can be EM’d digitally. Regardless of age, if a thorough dental restoration is diagnosed, identify the following to thoroughly understand the proposed treatment. :Existing bone and gum status. If you require implants, your bone must be stable to secure the implants. If you require bone grafting, it is very expensive regardless of where it is done and this is important to know in the planning process. :Any required extractions, e.g. the remaining teeth - do they require extraction? :Recommended number of implants and location. Be certain the implant cost includes the a) abutment b) placement, and the type. :Any and all prosthetics which could include: a. permanent long term denture b. bridges: permanent or removable :Are there associated lab fees with the prosthetics? :If you require additional consults (with another specialist), is there a consultation fee and required repeat x-ray? For example, at Kreativ, all our dentists are onsite and you wouldn't pay for a consult if you required an examination by one of the other dentists. This is commonly referred to as a ‘curbside consult’ :Who will place the implant, and if your general dentist will place the implant, how many does he/she place a year? :If you see a specialist for the implants will they place the crown? The treatment plan should include the numbering of all teeth, the number of phases required and the healing times between treatments.

The Role of the Dental Agent in Dental Tourism

Why Travel for Dental Care?

Dental tourism means traveling out of your region or country for dental care. Why do people choose dental care outside of their healthcare community? The reasons range from dental estimates exceeding their budget to the opportunity dental tourism may provide to receive high quality and reasonably priced dental care while traveling. A Danube cruise departing from Budapest or the opportunity to experience the European Christmas Fairs are good examples of vacation destinations that offer the opportunity to receive dental care. Others may travel because the quality and price are right and the area or country is very convenient for travel. Some travel for the opportunity to visit family if they are an ex-pat. Whatever your reasons, dental travel is a very safe and viable option for higher priced dental procedures such as implants, bridges, dentures or crowns. If this is an option you are considering, the process can be challenging to locate the right dentist, country, technology and quality care - regardless of your travel experience.

You have made the decision to travel for your dental care - so what's next?

Once you have determined that dental travel is a great alternative to receive dental care, you must start the process of identifying a dental clinic that will meet your needs. I have reviewed these options in prior blog posts. Review those issues you should consider before making your decision and conduct your research carefully!

How should I proceed?

Whether your dental needs are major, such as roots canals, sinus lifts, bone grafting, bridges or implants, or minor – such as a simple crown or veneer, knowing specifically what your needs or desires are is important. A current treatment plan and estimate along with radiology films or CT scans from your dentist allows a comparable estimate to be transparent. You should expect high quality customer service from the clinic or agent, which includes direct communication or a call back/EM within twenty four hours. Outline your questions answered and keep detailed notes.

Why choose a dental agent?

Is the clinic or the dentist available to advocate for you if there is a problem? Or, does the clinic use the services of a dental agent who may be more accessible for your questions. Are there time zone issues that make communication difficult? Do they speak English? Communication is vital to maintain the confidence necessary to know you are making the right decision. Is the pricing transparent, meaning, are all procedures and costs outlined and organized in an understandable format? Are the procedures bundled? Could there be any hidden fees? Who can you ask all these myriad of questions to?

Dental agents represent the clinic or a medical/dental tourism business and coordinate dental appointments for you. The dental agent is often much more accessible than a clinic directly and can spend the time with you answering the many questions you may have, or explain the indications and timeframes recommended for certain procedures. The dental agent should be available throughout this process to aid you in making your decision, understanding the treatments you anticipate you may need and helping you with your budget. The agent will be your consumer advocate, problem solve along the way, assist with travel recommendations and be there to help you out regardless of whatever your needs or questions are. A clinic or medical tourism business or internet site that utilizes dental agents has increased credibility. Quality of care and your health maintenance are the most important decisions you can make for yourself. Remember, price is important but your health and clinical outcome are paramount. Choose wisely and make sure you have the best dental treatment possible.

My Dental Story - A Patient Testimony

If you are considering dental tourism as an option, here is my story on choosing a dental provider. This chronicle is in hopes that you develop a system for finding a dentist. Seeking international dental care is a daunting process and one that takes work to ensure you feel comfortable making this decision. Your teeth and dental health are crucial for your appearance and long term health.

Here is my tale in hopes it will give you some guidance. I fell and chipped my front teeth when I was 10 years old. My family was unable to afford dental care so the dentist filed the bottom of my front teeth to make them even. This began a lifetime of a stifled smile and self consciousness about my appearance. I finally decided to take action in my 60’s and began searching for a dentist to fix this lifelong embarrassment. 3 dental estimates for a full upper and lower cosmetic restoration ranged from $28,000 to $48,000. One arrogant dentist in a very expensive office didn’t even provide a treatment plan. She simply told me the process would take place over 18 months and cost $42,000. The final dentist charged me $800 for the consultation, x-rays, treatment plan and post assessment review, and that wasn’t even credited to the 48K tab. I had to pick my jaw up off the floor after that one! I now decided international options were necessary. I started with an online search and was overwhelmed with websites, questions, and determination of which country should I choose. After considerable research over several months I discovered Budapest was the epicenter of EU dental education at Semmelweiss University. Hungary had also established a Code of Practice in 1998 as medical and dental tourism grew. Membership was optional however it assured a certain standard for patients evaluating a quality experience. I knew they were organized. So we planned a trip to this beautiful city only to ‘check out’ the clinic. My wife is a nurse and former medical group administrator and was wary of this path until she had a chance to evaluate the clinical practice, see the offices, take a look at the equipment – and overall, get a general feeling for the way the office functioned. Off we went to Budapest in anticipation of what I hoped was a solution to my smile. While there we also visited several offices scattered throughout the city, most of which were quite small. Reception was often friendly, the level of English varied, and it was impossible to get a feel for the offices. Most offices were very small, the equipment appeared dated, and the staff were not available so we couldn’t see behind the curtain, so to speak. I realized their websites were much more elaborate than the clinics and thorough questioning was challenging because of language differences. Then we visited Kreativ Dental. Surprised, and almost overwhelmed, we were amazed at the beautiful building that was easily accessible in the 9th district by public transportation. Entering the modern building it was clear we were in a rockin’ facility. The first floor had a beautiful aquarium that is a calming theme throughout. There is an English speaking concierge at the front door to greet you and answer any questions. Heading up to reception we walked along the ‘publicity wall’ where we saw newspapers, magazine and written testimonials (even from NASA) that spoke of the great clinic, satisfied customers, and advanced care. There was a computer to access patient satisfaction surveys. My wife saw they had a quality certification similar to those in US hospitals. This was clearly a facility of very high caliber. That was it. We’d return, and we did one year later for a consultation. Reception had staff who spoke several languages and everyone spoke English. We had a panoramic x-rays and a treatment plan at no cost and were able to consult with the dentist on any questions we had. Everyone spoke flawless English, including the dental assistant who also performed a thorough teeth cleaning at half the cost in the US. Mary Ann noted they actually gave a recommendation on hygiene she was never told, after years of twice annual teeth cleaning and meticulous dental care. Until we retired, we always had great insurance. We still had to think about it and decided to wait another year so she could have her teeth done as well. The money we saved still paid for these trips to this marvelous city, where the cost of living is drastically lower than Western Europe. Hungary’s currency is the forint and their economy has not allowed transition to the euro. It is hard to believe, but communism was only overthrown in 1989.

Finally, in 2010 we were able to have our dental work completed. The scheduling of procedures was efficient, the clinic ran on time, and a complete dental restoration (all new crowns) was completed in 10 days. Remember the expensive dentist? She said it would take 18 months! What is that about? The treatment plan pricing was completely transparent and there were no hidden charges with my final bill. The cost remained 60% less than we would have paid in the United States. While there, we were also able to tour the modern dental lab where 5 master ceramists are on staff. I realized how important it is for the lab to be within immediate proximity of the professional staff. They were able to make modifications in real time, which improved the look and fit of the crowns. My wife was overwhelmed with the quality of the practice. She has worked with Harvard University on quality medical standards, retired from the University of California and also spent a fair portion of her career in one of the finest Center’s of Excellence in the US – and found the skills, specialists on staff, equipment and education unparalleled. I was almost tired of her exclaiming ‘Wow’.

I love my new teeth and can’t believe I waited all these years. I needed a minor adjustment after I returned home and my own dentist had no qualms about doing. He was very impressed with the work done. So, if I have one recommendation, it is take the time to do your homework. Don’t just ask for referrals on blogs, schedule with the first clinic you contact, or go with the lowest price. Price is important but beware of hidden fees. Get the treatment plan upfront; make sure there is a quality certificate and go where there are many dentists on staff so you don’t have to be referred across town where you don’t know the dentist. Customer testimonials are important but you have to go beyond that. People can certainly tell you all the positive components of customer service but pay attention to their outcomes. I know how important that is – I was Director of Customer Service for Blue Cross in the US for ten years. It takes some time, but look beyond the office and evaluate the criteria and questions you should ask while making this decision. Take your time. Look beyond a fancy website. Ask the same questions of everyone. Cost is very important – that is the reason that often motivates us to take this path, it sure was mine. But remember how important your health is, and your teeth and bite.

Disclaimer: I am now proudly affiliated with Kreativ Dental. I hope my story tells you why. Craig Robinson

Hungarian Code of Practice - Part III in a Series on Dental Clinical Standards in Hungary

Code of Practice = Standards of Practice
Why dental Standards of Practice are important and what do they mean to patients? Part III in this series with the final 6 points in the Hungarian 12 Point Code of Practice for Quality Dental Care.

Standards of practice in any dental clinical setting should include these components, however for most of us, we blindly go to the dentist and doctor without thinking twice about how the office is structured, what is the technology being used, does ongoing training occur and how do these aspects enhance our treatment experience.

It is not enough for any clinician to graduate from an accredited university or hold advanced credentials. How and where they choose to practice provides insight into their clinical and ethical commitment to both themselves and their patients. Science today advances quickly and the capital investment in equipment and training is necessary to benefit patients by improving discrete diagnosis and therefore cost, and importantly – reduce the risk to the patient. When a dental practice commits to oversight by a 3rd party organization, you can be confident procedures are routinely reviewed to avoid non-compliance. Quality regulation is key to advanced care.

As we progress through points 7-12, consider does your dentist follow these standards? Are the clinics you are researching in your quest for dental travel consistent with these standards? If you are considering traveling to another country for dental care, established Standards of Practice must be in place. Don’t make price your goal – mandate quality.

7. The precision of diagnosis is the key factor to enhance prevention, therapy and rehabilitation, so practices must use digital intra-oral and panoramic X-ray equipment.

While panoramic equipment is basic office equipment, intra-oral is dynamic and necessary when utilized during procedures that may require further analysis of an exposed cavity, nerve status, and bone structure. Diagnosing a discrete problem improves the underlying tissue, bone and nerve adapt to restorative techniques. A CAT scan may be necessary for further diagnosis.

8. Patient safety and accountability are essential so practices must have professional indemnity/liability insurance.

This almost seems like no-brainer, but it is most definitely a consideration and basic that your provider would carry insurance. Double check wherever you are going. If they don’t have it – never consider care regardless of the cost.

9. The quality of patient care must be accredited by external experts and practices should seek to introduce an audited quality assurance plan.

This is probably the most important aspect when considering dental care in another region or country. In the United States for example, all hospitals must be accredited by the Joint Commission of Hospitals. If ambulatory care or dental practices are associated, they will also undergo review. Joint Commission International remains the standard of quality accreditation for international facilities. However, it is extremely unusual for independent dental practices in the USA, Europe or Asia to pursue a quality accreditation. The standard dental European accreditation is through the International Standards Organization (ISO) and generally covers 3 years. In fact, the American Dental Association helped create these standards, but do not recommend the same standard in the United States.

If you are indeed pursuing dental care in another country, this standard far exceeds any testimonial, referral or blind selection you may make. A quality assurance plan is the check and balance necessary to ensure the highest level of care and scrutiny of all operational components, quality education/training of staff, technology and procedures to act on error should they occur-are assessed regularly. Protect and maintain your health with quality!

10. Up-to-date knowledge is not possible without excellent international communication, so practices must employ multi-lingual staff.

Multi-lingual staff must interact with patients on a routine basis in the alternate language(s) so communication skills are maintained, interpretation is clear and thorough, and practices are well understood. If a clinic speaks multiple languages, you are likely assured they have an international reputation, invest in multi-lingual staff and the practice considers your health and communication is their priority.

11. Good administration is the foundation of high quality patient care and this includes post-treatment follow ups. Practices must have a team of patient co-coordinators and custom care staff.

Not only should the office be high quality, you must be assured all your questions are answered throughout the investigatory and treatment care phase. If you are working with a clinic that utilizes representative agents, is their communications prompt, thorough, and are all your questions answered comprehensively? After dental work is concluded, clinical follow up should be done to answer any patient questions, alleviate any anxieties, and check the status of the dental work completed and verify your satisfaction. Are you aware patient satisfaction surveys are standard?

12. It is very important to create a safe environment for foreign patients during their stay, so there should be a transfer service to airports and hotels.


This basic standard is customary, there should be no associated fees, and their availability will diminish any fears you have on arrival. Your immediate confidence will improve your outcome.

This series is very comprehensive. Review all 3 articles and apply what you have learned when you are researching your dental travel. Remember, you are investing in yourself. Aren’t you worth the best? Change your smile, change your life!






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Code of Practice = Standards of Practice

Why dental Standards of Practice are important and what do they mean to patients? Part II in this series on the Hungarian Code of Practice for Quality Patient Care.

In the last article introducing the Association of Leading Hungarian Dental Clinics, the Code of Practice was identified as a quality standard developed to focus on an emerging industry impacting global health and medical tourism. Patients traveling for extensive procedures such as implants, dentures, bridges, cosmetic restoration and periodontal treatment must feel confident their chosen dentist practices at the highest level possible.

Clinical standards of practice are introduced during the educational process of dentists and physicians. The standards and protocols are the basis of quality assurance indicating a commitment to excellence, ethics, and education. It is incumbent on dentists as they develop their practices to continue to hold these standards high in their commitment to patients and their peers. Ongoing commitment is represented by membership in organizations holding these standards and undergoing an accreditation process.

The Hungarian 12 Point Code of Practice mandates members abide by these standards. As a consumer, you can be assured this standard of practice includes the oversight necessary to ensure you are receiving the highest level of care maximizing optimal dental health. If you are considering dental tourism, does the dentist you are considering meet these standards? Are the dentists in a comprehensive group practice including specialists practicing at this higher level? Don’t be afraid to ask!

1. To provide the possible highest standard of remedy a team of specialized dentists is essential. The practice must employ a minimum of ten dentists/oral surgeons with a specialist diploma.

A group practice of this size can reduce error, facilitate increased diagnosis by what is referred to as a ‘curbside consult’, meaning peer review is readily available often at no cost unless their services are indicated - reducing patient expense and time – while simultaneously reducing patient morbidity. This scientific term simply means in complex medical procedures anesthetic time and open exposure of the oral cavity is lessened thereby reducing both risk of infection and improving healing Dentists with advanced credentials via education and licensing generally perform the number of procedures necessary to heighten skill.

2. For patient safety, practices must have at least 5 modern dental medical and operating units and prepare at least 1,500 units of aesthetic tooth replacements a year.

An office of this size ensures the financial commitment to capital equipment, technology and training. As noted above, volume and specialization are Center of Excellence mandates in the USA. Does the country you are considering for dental travel have the same standard?

3. Modern dental technology demands an adequate medical experience so practices must do a minimum of 1000 implants a year.

Dental implants are a precise procedure. Implant insertion including abutment and crown placement is considered invasive, that is, the tissue is opened exposing the patient for a period of time. In medicine and dentistry, qualified clinicians must have superb diagnostic skills, proceed efficiently and skillfully (to reduce risk of infection) and perform the requisite number of procedures to maintain their credentials. In the USA, the same standard board certifies the clinician.

4. Computer technology is vital for patient safety and satisfaction so practices must use cutting edge technology and pre-implantation surgery planning methods on a daily basis.

Computers to our world are essential. In dentistry, use of panoramic (OPG) x-rays and CT scans allow the dentist to more acutely diagnose bone health, thus receptivity to implants. All dental operating units and prosthetic labs must have access to patient information immediately and this technology is critical to contemporary and advanced patient care. Each work station must be fully equipped with monitors, software and include remote operation.

5. The quality of treatment depends on the quality of equipment; so all materials and instruments must be of the highest quality.

Science evolves quickly producing equipment that maximizes patient diagnosis. The practice must be committed to the investment necessary to treat patients who travel for their care. Materials should meet international standards with component details.

6. Practices must work within industry recognized protocols, including clinical governance and undergo regular internal clinical audits and assessment. This includes ongoing dental and hygienist clinical education and professional development courses.

Accreditation standards are equal to quality assurance. Skills and knowledge must be updated to learn the latest techniques. Scrutiny of office procedures including clinical and administrative at all operational levels is paramount to the oversight necessary to protect and maximize the patient care experience. This forces a healthy competitive edge necessary in science. Don’t you want the best for your health?

In the next article we will focus on 6 through 12 of the Hungarian Code of Practice. Kreativ Dental developed dental tourism and led the path to the formulation of these standards. They have an unsurpassed level of commitment to quality, their staff, their clinicians, and their patients. They are the Center of Excellence for dental care for the European Union. Affordability is important but quality is critical to your overall health and well being.

Dental Travel – Code of Practice

The growth in dental travel mandates oversight and regulation.

There are many reasons for seeking dental care outside of your region or country. Crowns, implants, bridges, dentures and root canals are those dental procedures most sought after because of their high cost and lack of insurance reimbursement. Dentists advertising themselves to potential patients across the internet should establish their credibility beyond an attractive and flashy website. Your evaluation process must be rigorous.

The competition for dental tourism patients continues to grow as more countries in the European Union and Asia enter the market. It has become a real challenge for the consumer to differentiate between quality, experience and affordability. Seeking a dentist away from home exceeds a simple price quote and a treatment plan. Remember – there are two dentists offices. There is the online clinic and the physical office where dentistry is actually conducted. How do you determine if the two match and where do you start? Quality can be deceiving and though there are a multitude of questions you should ask some basic queries will send you in the right direction. Transparency is key.

A mature and qualified dental practice participating in dental travel and receiving patients from many parts of the world has significant responsibility. In today’s global economy, medical and dental care that interfaces with patients from multiple countries should compete at the highest level. As a consumer, your dental options are many so evaluate and choose wisely.

Hungary is the Gold Standard
Hungary has long been considered an epicenter of dental training and practice for the European Union. As dental tourism rapidly grew, a formal group comprised of dentists and government officials was established who jointly identified a standard code of professional conduct and practice for dentists. The Association of Leading Hungarian Dental Clinics was established in the 1990’mandating a high standard of ethics and quality is paramount in leading to be best outcome for consumers. Think of this assembly as the Better Business Bureau with consumer rights and patient quality as the objective. Kreativ Dental, Budapest, is a founding member. Dental and laboratory procedures, clinicians and clinic operations oversight have been established in setting criteria for patient satisfaction and quality delivery of care. This style of peer review, or group oversight in following a basic Code of Practice assures the consumer the highest quality of medical and tourist visit.

Dental Fee Madness

Is dental care a basic health right? How can treatment plan fees be so astronomical?

I talked to two clients this week who were completely astounded with their pricing estimate on their dental treatment plan. Both were highly educated executives with international exposure and had excellent dental care throughout their life. Each client was healthy, maintained a good diet and exercise. One individiual was a UK ex-pat who had grown up in the National Health System in Great Britain and wondered what do people in the US do without a safety net. Medicaid has supported millions but those cuts loom on the horizon however even that benefit was primarily for the indigent. The middle class which is barely hanging on to that title generally has to pay cash and it is anyone's guess how dental care was prioritized during the recession. Patient #2 had premier dental insurance throughout his life, which proves even great dental care cannot deny genetics if your teeth are predisposed to failure, stress, accident or peridontal disease. Unfortunately, the needs each expressed included treatment of implants,crowns, dentures and / or bridges that regardless of dental insurance is barely covered - if at all. The fee estimates were astronomical and many poor families could finance their retirement on one alone. I know firsthand the overhead in medicine and dentistry in the US but there are complementary services such as in prosthetics where extreme profit margins are made. Economies of scale exist in dentistry just as they were discussed during the recent health care imbroglio. And yes, the insurance industry drastically needs reform.

The feeling and frustration each patient expressed going through this process was the total lack of empathy and understanding that was delivered along with the plan. The arrogance and ease of the dentists who felt more than comfortable their clients could pay and payment plans were not an option. Medicine cannot be an incentive based business.

The United States has made significant strides in oral and dental health over the last 50 years. Dental care, fluoride and the general fiscal improvement in society regardless of class has led to these advances. But, they are going to rapidly deteriorate until dental and medical health are seen as basic rights and made more affordable regardless of socioeconomic status.

Know that you have an alternative and it can be found in dental tourism. See kdana.com and the FAQ to help guide you. I have guided you in the past with your rights as a consumer. Know them. Practice them and negotiate. Your dentist needs you as much as you need them. And speak up - your dental health is paramount to those with chronic disease, longevity, and overall well being.