Access and affordability of dental care can be problematic for some in Australian Community. Increasingly, some patients have been turning to treatment overseas as an option rather than accessing routine dental care in Australia. There are some benefits for accessing dental care in Australia. These include increased affordability, speedy completion of treatment plans, convenience of treatment, combination of treatment with some leisure activity or visiting family and avoidance of public waiting lists. The affordability factor is a significant issue as a procedure may be performed at a far lower financial cost compared to the amount that a patient would otherwise spend in Australia. This affordability has been made even more attractive be a recent strong Australian dollar as compared to other currencies and the ease and affordability of overseas travel. Improvements in the standard of care overseas may also play a role.

Medical or dental tourism is a term that describes seeking medical or dental treatment in another country. The necessity for travel may be the sole or primary motivation for medical or dental treatment sought. The internet and internet advertising may also be an important source for accessing and researching treatment possibilities overseas.

However, there are significant disadvantages to dental tourism. The main issue for patients undertaking dental tourism is accountability. Accountability implies the professional, moral, legal and ethical duty of the practitioner regarding the outcome of treatment. Once a patient leaves the country that they have undergoing treatment in, it may be difficult to address accountability, even if the patient returns to that country. If complications occur, review and management by the practitioner who provided treatment is almost impossible. Patients are often not covered by insurance companies and are unable to seek compensation. Therefore, clinicians in their home country may be warranted with managing complications and giving seconds opinions. There has been reluctance by local practitioners to provide medical treatment, however they are obliged to make a diagnosis and provide treatment. Other disadvantages may include differences in training and risk of nosocomical infections, particularly those that are blood-borne.

Implant dentistry is now part of dental care which is practised by both generalist and specialist alike. It could be considered as the gold standard of care for the management of the partially or fully edentate patient. However, the cost of implant treatment as a treatment option can be prohibitive and this can be the justification for seeking dental tourism. Complications related to dental implants may be related to the patient, implant or prosthetic components and these complications are seen by oral and maxillofacial surgeons in both hospital and outpatient settings. Little has been documented in the literature regarding dental tourism, particularly in reference to dental implant treatment. The aim of this paper was to document a series of cases with suboptimal outcomes related to dental implant placement in the setting of dental tourism that have presented to the Department of Oral and maxillofacial Surgery at both the Royal Melbourne Hospital and the Royal Dental Hospital of Melbourne.

DISCUSSION
The modern success rate for non-complicated dental implants is approximately 93% to 98% at five years, generally depending on the number of stages of surgery, surgical training and the timing of loading. A number of factors can influence implant failure, including, patient factors, such as poorly controlled diabetes as in case 1; implant related factors such as the implants places in case 2; and restorative factors as in case 4. Case 5 was also interesting as it demonstrated a failure in communication.

Failure in implant dentistry does occur, in Australia and overseas. Clinician training can also be quite variable where in Australia may range from company sponsored courses over period of days to periodontal or full oral and maxillofacial surgical training, including undergraduate training in dentistry and medicine. However, the benefit for patient who does not travel overseas for treatment comes from multiple levels of accountability. It is the regulation of dentistry which allows this accountability to be available to protect the patient. These levels include various state and now federal legislation, state and federal dental boards, the Australian Dental Associations (ADA), both state and federal, and compulsory clinician indemnity. In this way, if complication does occur, there are a number of mechanisms for the patient to be followed up and managed in an appropriate fashion. If the management of such complications are suboptimal, then opportunity exists through the dental boards, the ADA and the legal system to claim recompense. This may be quite difficult to undertake for treatment carried out overseas and it is this lack of accountability which is the main issue facing Australians and dental tourism.
Regulation can also be an issue affecting different countries in their practise of dentistry. This can also affect the materials used in the treatment of patients. This issue is particularly important in regards to sterilization and hygiene processes, and the risk of cross-contamination and nosocomial infections as some overseas countries may have a higher prevalence of specific infectious agents and poor cross-contamination control. Regulation is also important in defining the minimum training requirements for dentists and their scope of practise.
These cases of complications related to implant dentistry treatment illustrate some of the issues that dental tourism may experience when seeking dental implant treatment overseas. Although the patients ranged in socio-economic status, a common motive for treatment overseas was to save on cost. Some of the patients were visiting their country of origin. However, two of the patients (cases 1 and 5) were not. It is important for clinicians to educate and advocate to their patients regarding the costs or treatment, particularly in relation to dental tourism. The costs of service and running a practise, but for the provision of safe and effective dentistry where the clinician is accountable for the planning, quality and outcomes of treatment.

We hope to provide everyone with an insight into the latest techniques, technologies and developments from the dental world. In Australia, we have a very high standard of dentistry, and we would like to relay this to you, wherever you are in the world.

At City Smiles, we are leaders in affordable dental treatment and patient care. We uphold a reputation for only using world class dental products and the latest techniques.

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A common reason for root canal treatment is an infected or abscessed tooth, which may result from a deep cavity, periodontal disease, or even a fractured tooth. Sometimes trauma like a sharp blow to the mouth can result in damage to the pulp (nerve) of the tooth. Should you have symptoms such as swelling, sensitivity to hot and cold or discomfort on touching your tooth, a dentist should be consulted immediately.

Root canal treatment removes the pulp tissue, which is composed of a nerve and blood supply within the tooth. After all the material has been removed from within the root, the canal or canals (if it is a multi rooted tooth) are sterilized and sealed with a material that prevents bacteria from re-entering.

Because a root canal removes everything which feeds the tooth and keeps it alive, the tooth will become very brittle after a period of time. This time period varies from person to person. It is for this reason that the tooth should be restored as quickly as possible and your dentist might recommend that a post and a crown be placed as a final restoration. Back teeth are usually crowned or capped shortly after a root canal has been performed to prevent the tooth from shattering due to the pressure put on it by chewing.

Root canal work is not uncomfortable, and in some instances can be performed in one visit. The discomfort associated with root canal is due to the infection associated with the need for the root canal. If there is recurring pain after the root canal has been started, or after it is completed be sure to notify us as soon as possible.