It's becoming increasingly common for patients to seek dental treatment overseas. Media stories about 'Turkey teeth' aren't uncommon, and patients might be motivated by both possible savings and the allure of combining a holiday in the sun with a quick dental makeover.

Unfortunately, before embarking on treatment abroad, these same patients may not have considered that it might be difficult for them to return to the overseas provider if acute complications arise. They may also not have considered whether their local dental provider will be suitably trained and competent to provide any necessary maintenance or remedial care.

If patients ask your advice about going abroad for dental care, you might find it helpful to signpost them to some of the potential risks and pitfalls, which could help them make an informed decision before they make arrangements.

Members often come to us with questions around the topic of dental tourism. Here are some of our answers.

Must I see a patient who is experiencing complications arising from dental treatment received abroad?

The short answer is that dealing with a patient who has been treated abroad is no different to a patient who has previously received care anywhere else.

The GDC would expect any registrant to act in a patient's best interests, and shouldn't decline to treat someone simply because they have received treatment abroad, particularly if there are urgent treatment needs.

Even if we think a patient's decision to undergo treatment overseas is unwise, declining to see them simply because they've had treatment elsewhere could give rise to complaints, including possible allegations of discrimination.

What can I provide for a patient who has returned after having dental treatment abroad?

As with any patient, an appropriate assessment along with any special tests and investigations should be carried out so that enough information can be given about your findings, and the relevant treatment options, risks, benefits and costs discussed.

You should only provide care for which you are trained, competent and indemnified to provide. If patients present with treatment needs that fall outside your training, competency or scope of practice, you should make appropriate alternative arrangements, including any necessary onward referral.

It's important that patients understand the rationale and process for any referral, as this might reduce the risk of complaints about your decision not to personally provide care.

What about when the patient's urgent care needs have been addressed and the patient's health is stabilised?

After stabilisation, you'll need to decide whether any further necessary care can be provided. This will depend on your training and competency, familiarity with the materials and techniques used by the overseas provider, and the complexity of care needed.

The CDO's policy also explains how any further necessary care the patient might require should be managed within the NHS framework:

"Any treatment beyond stabilisation should be assessed based on complexity and need and should be provided at the appropriate care setting, subject to existing NHS acceptance criteria as laid out in The National Health Service (General Dental Services Contracts) Regulations 2005.

Self-funded care that the NHS would not routinely fund would not usually be offered or replaced as NHS items of treatment once stabilisation has been achieved."

For clinicians providing NHS care in England, the NHS Business Services Authority also offers information about how patients returning from overseas should be managed under an NHS GDS contract.

If the patient is accepted for 'non-urgent' treatment under the NHS, following an examination of that patient, any treatment (appropriate to mandatory services) identified as clinically necessary should be provided, subject to the patient's consent, or that of their representative.

Where the original treatment was not provided by the current contract provider, 'Further treatment within 2 months', 'Free repair / replacement' and 'Regulation 11(replacement appliance)' arrangements will not apply.

Will I become responsible for treatment the patient had performed overseas if I try to help them?

Colleagues are often fearful that they might become responsible for treatment previously provided overseas. However, with good baseline records, it should be clear which part of the care was provided by whom, and what the pre-existing findings were at the point where each dentist became involved with the patient.

You are responsible for advice and care you personally provide, and not for treatment provided by other people.

Conclusion

Just because a patient has had treatment abroad, it does not mean this should in and of itself be a barrier to treating them - except perhaps where they have acted directly contrary to your advice, to the extent that this demonstrates a lack of trust and confidence indicative of a breakdown in the professional relationship.

Generally, with careful record keeping, good communication and working within your capabilities, it is perfectly permissible to offer care and solutions for patients - who are often greatly appreciative.