Management of Overseas Dentistry Complications

Management of overseas dentistry complications

Many patients have travelled overseas seeking to have an improved smile appearance at a fraction of the cost. Whilst some have returned home with a good result, others have ended up in disastrous situations.

Dental cost is related to

  • Qualification and experience of dentists and dental laboratory technicians
  • Use of dental materials and dental implants that are safe and approved by the Therapeutic Goods Administration (TGA)
  • Safety of dental, surgical and radiological (xray) equipment
  • Infection control and sterilisation procedures
Reconstructive Dentistry Perth - Centre for Prosthodontics

Considerations Before Venturing into Dental Tourism – Initial Treatment, Rectification and Ongoing Maintenance Cost

In Australia, general dentists and dental specialists are registered by the Dental Board of Australia based on a high set of clinical and academic standards. With regards to dental treatment performed overseas, one cannot verify the accuracy and standard of qualifications claimed.

As clinicians who primarily focus on complex dental rehabilitation, the management of the ramifications of failed dental tourism cases often ends up with us at Perth Prosthodontics. It is all too common that these patients are typically overtreated with unnecessary root canal treatment (removal of nerve pulp tissues insider teeth) and multiple substandard fitting restorations (i.e. fillings, veneers, crowns and bridges, implants and dentures) that subsequently lead to rampant decay, gum and bone (periodontal) disease with acute or chronic infections. Dental implants made with unknown metal alloy and their poor surgical placements have led to serious implications that not only requires the removal of dental implant from the jaw bone, but the loss of gum and bone tissues requiring surgical graft / anatomical structural (i.e. nasal sinus) repairs.

Unfortunately, irreversible damage caused to the teeth, gum and bone tissues, more often than not, leave the patient in a worse state – financially, biologically and psychologically – than if the treatment was properly planned and performed in the first place.

Please view our Dental Tourism Video Blog to understand the associated risks.

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Why are australians heading overseas for dental work?

From our experience, those who have opted for overseas dentistry are mostly driven by their wish to have “the same” dental treatment at a fraction of the cost. And with the cost saved, it appeared an attractive option to enjoy an overseas holiday at the same time. Of course, there are good and bad dentistry from anywhere in the world. However, there are unlucky ones who have returned with absolute dental disasters. So what is seemingly a great idea – can be highly unpredictable, and indeed it is often too good to be true.

How much of a problem/concern is it for you and your fellow dentists that australians are heading overseas for this kind of work?

From our perspective, likely shared by many of our fellow colleagues, the majority of Australians will remain home for dental treatment – accepting costs for greater certainty of treatment outcome and peace of mind.

Therefore, our concerns lie with the management of those who venture overseas and return home with dental failures, which are often extensive, leaving them in a state worse than ever before.

Worse state in the sense that:

  • Biologically – there has been damage already done to teeth, gums, bones, nerves, arteries, and sinuses – that cannot be reversed or repaired.
  • Financially – the initial low cost of overseas dental treatment – is now offset by huge costs to rectify the mistakes.
  • Psychologically – these patients are under immense distress with their situations
  • Let’s be honest – most patients are not a big fan of seeing a dentist, but with these factors all combined, one can imagine how challenging it is to care for these patients.

What kind of risks are people taking when they go abroad to places like bali for dental work?

In Australia:

  • All practicing dentists and dental specialists are held to high standards and registered by the Dental Board of Australia
  • Stringent infection control and sterilisation protocols are enforced by the Board
  • Quality and safety of dental materials and equipment approved by TGA (Therapeutic Goods Administration)
  • Radiographical equipment – i.e. x-ray, CT scans – tested and approved by the Radiological Council
  • Patient rights are protected by the Board and the Law with all dentists working under professional indemnity insurance
  • Patients are able to claim dental expenses through private health insurance

However, the level of equivalency to the aforementioned standards is unknown when compared to those in Australia.

Key concerns have been raised by dental and medical associations that:

  • The increase of antibiotic-resistant super-bugs which were rare in Australia, is now becoming more common as people return from overseas after having treatment in hospitals and clinics that do not have the same infection control and sterilisation standards.
  • High risks and complications in having extensive dental procedures done within a short amount of time – as it does not allow adequate time for healing, follow up, and ongoing care.

What’s your experience been with australians coming back from ‘dental tourism’? Where are they going and what kind of outcomes are they experiencing?

As prosthodontists, who specialise in complex dental rehabilitation, the management of failed dental tourism cases often ends up at our practice.

Even though, we have managed failed dental cases from various countries spanned across Asia and Europe; this is by no means a true representation of the overall standard of dentistry in these respective countries.

Though, for the cases that we have managed – presentations have ranged from:

  • Grossly unsatisfactory root canal treatments with residual infections,
  • Poorly fitted veneers and crown and bridgework in multiple teeth with extensive gum and bone infections,
  • Dental implant placements into nerve and arterial supply of the jaw, nasal sinuses, and even the base of eye socket
  • And failure of full mouth implant bridge cases with multiple attempts in implant placements and removal resulting in extensive loss in jaw bone.

What kind of problems/complications have you encountered? Why are people experiencing these problems – is it because of over-zealous practitioners over-servicing their clients because it’s seen as a one-off job? Or is it because of the tools/products being used? Is it because these dentists are giving people what they want rather than what they need?

For patients seeking bright smile, at a low cost, within a short overseas holiday, they are often promised with:

  • Treatment that may involve full mouth crown and bridgework; or
  • The removal of all their teeth and replacement with dental implants.

From our experience, these patients often proceed without much understanding of the processes involved, risks, complications, and long-term consequences.

For those who end up with full mouth crown and bridgework of their natural teeth, it appears that:

  • In order to avoid complaints of tooth sensitivity/pain and discomfort, unnecessary root canal treatment involving the removal of nerve and arterial tissues are often/routinely performed, followed with poorly fitted dental restorations (including fillings, veneers, crowns and bridges) that are constructed in rushed time with poor bite arrangements and smile aesthetics.
  • Ultimately, this gives rise to bacterial and food traps, decay, gum and bone disease, acute or chronic infections, jaw and muscle dysfunction – and hence needing full mouth retreatment involving every single tooth for rectification.

For those who have received dental implants, the nightmare begins… when implants used are:


  • Made of unknown alloy resulting in allergic reactions, infections, associated bone and gum loss.
  • Not documented in clear clinical records, or of unknown origin, or from small scale companies with catalogue in foreign languages that may close down after a few years – so we can never source for implant parts and components for future retreatment needs. Even if we could attain clinical records and identify the implant company and decipher a catalogue written in foreign languages – we will have to apply for special TGA approval to import implant parts and components for medical/dental use in Australia.
  • Then there is the worst situation – which is when implants are poorly placed or have failed, they will need to be removed, leaving patients toothless resort to removable dentures if extensive damage is beyond surgical.

What can australian dentists do to prevent this from happening? Is there anything that is being done to stop it from happening?

With globalisation, overseas travel for dental care seems inevitable. Australian Dental Association have released position statements to urge the public to seek dental care in Australia given risk of adverse oral and general health outcomes, difficulties and extensive costs to resolve problems from overseas dental treatment. Professional indemnity insurance companies have cautioned dentists in handling dental tourism cases, and have given guidelines to us given an understandable fear of liability when providing treatment for those previously treated abroad. As dental practitioners, our role involves conveying the perspectives of the ADA and the advice provided by our professional indemnity insurance. We aim to alert patients to the risks and complications based on our experience, urging them to be careful in their decision-making process.

Many australians are rejecting the high costs of australian dentistry for the cheaper retail dentistry being offered overseas – what does this say about the perception of dentistry amongst the broader australian public and the misconceptions that we have here about the value of good-quality of dental healthcare?

Australia has consistently held its reputation as a leading country for Dental Education on a global scale. However, we’ve come to consider this high standard as the norm rather than an exceptional achievement. While this value is acknowledged by a significant number of Australians who opt to receive dental treatment at home, the emergence of dental tourism highlights the necessity to build confidence in this sector of our population. Targeted awareness campaigns may be considered with the aim of dispelling misconceptions that lower-cost dentistry overseas is guaranteed to provide equivalent value. Undoubtedly, the expense of dental procedures often mirrors their quality. We are aware that our colleagues, who are prosthodontists trained in the United States and practice in Thailand, charge comparable fees for treatments of the same calibre as those provided by us in Australia. In essence, you get what you paid for.

What do you think makes the australian dental industry more trustworthy or reliable than say the indonesian one?

As said, there is good and bad dentistry from anywhere around the world. We don’t believe that a blanket statement should be applied as to the trustworthiness of dental industry of one country to another. Rather, every country has a different set of standards and guidelines regulating dentist education, registration, material and equipment health and safety, infection control, and sterilisation protocols – as enforced by respective authoritative governing bodies. With greater familiarity of the Australian dental industry, we can only comment on the stringent and high standards we are held up to.

What would you say to australians who believe the australian dental industry is too expensive? How can we make australians understand the cost/value of dentistry?

The cost of dental care in Australia is intricately linked to the quality and standards upheld in education, qualifications, experience, dentist registration, material and equipment health and safety, as well as infection control and sterilisation protocols, all strictly governed by authoritative bodies. The value of dental treatment planned and performed under these firmly established core principles lies in the confidence of a successful long term outcome. With good patient compliance, this will decrease long term dental cost as there will be a reduced need for extensive rectification


While you can access our services without a referral, we strongly suggest you speak to your dentist first. Our team are available to help discuss your options.