According to the law in force in Quebec, it is mandatory to obtain the free and informed consent of a patient before any medical intervention. The Civil Code of Quebec establishes general rules regarding consent to care, which apply regardless of the location and nature of the care provided in Quebec.
Although dental care and treatment is carried out in Colombia and the Civil Code of Quebec is not applicable, it is appropriate to follow good practice in order to allow a patient to be informed of all possible risks, even if they are rare, and obtain free and informed consent before traveling to Colombia.
In other words, the dentist in Colombia, with the help of a Quebec guide, must facilitate the patient’s decision-making and respect it. It is important to remember that it is up to the dentist to ensure that the patient is aware of this consent.
Consent is based on the principle that it is up to clients to decide about their treatment. The role of the dentist is therefore to provide all the necessary information and to make recommendations that will allow patients to make free and informed choices with full knowledge of the facts.
Please therefore read the contents of this web page carefully before making your decision.
1.BENEFITS AND DESIRED RESULTS
Whatever your motivations (to have a beautiful smile, to have healthy teeth, to correct a defect, etc.), it is important that you have realistic expectations regarding the results.
Dental care and treatment are not miraculous interventions that perfectly meet all your desires. There are in fact physical limits which cannot allow certain dental interventions or which limit the result obtained.
It is important to distinguish between aesthetic results, i.e. appearance, and beneficial results, i.e. non-apparent results.
Undertaking such an intervention with the conviction, the absolute certainty that it will solve your aesthetic problems and change your life can lead to disappointment, frustration and even depression. Take the time to clearly determine your personal expectations, while being realistic.
Going to Colombia to receive dental care and treatment is not without risk and regardless of the country, you should know that the dentist in no way guarantees a result that meets the desired appearance.
Choosing to go to Colombia is often about saving money and since you have to cover transportation costs, accommodation costs and living expenses, it is important to note that these costs do not not part of the agreement between you and the dentist in Colombia.
In other words, if there is a complication once you return to your country of origin, you recognize the risks of having to assume these costs, if you have to return to Colombia to repair or replace something regarding the care or dental treatments received and that the maximum that the dentist can reimburse you is according to what was paid on the contract for the applicable treatment.
To ensure that everything goes well in Colombia, you benefit from a guide who speaks French and Spanish depending on the period chosen, and who knows the country very well having lived for several years in order to be with him during your stay.
You are aware that the guide is in no way responsible for the medical aspect, but is intended to be a spokesperson who represents you and is not a dental tourism agency.
2.THE NATURE OF DENTAL CARE AND TREATMENT
It is important to explain to the patient what the care and treatment involves, what exactly the dentist will do, and therefore the nature of the care and treatment in order to achieve the patient’s desired results. A detailed dental diagnosis is the best way to define the nature of the means to be taken as well as the possibilities for success.
This diagnosis also provides the patient with the name of the dentist, location of care, dental care and treatment, costs and dates.
The patient must understand the expected benefits of dental care and treatments as well as the aesthetic results. He must know and understand all aspects of care and treatment and the chances of achieving the desired results.
The dental diagnosis therefore remains clear proof of the nature of dental care and treatment, the possible results as well as a document allowing the patient to be informed of all other useful information required to continue the discussion in a manner informed in order to reach an agreement with the dentist without any form of pressure, obligation or fear.
3.TREATMENT OPTIONS
Often, patients may have several dental treatment options. Some options influence one’s choice because they may be more intrusive, more painful or more expensive than others.
Even if the dentist prefers a certain option, in the end it is up to the patient to decide which option is best for them. It is acceptable, however, for the dentist to explain why certain options are not recommended and, in general, the side effects, real effects and material risks of other options.
It is not acceptable to only explain the options that the dentist will treat or is able to offer. All reasonable options must be presented including those that only other dentists can offer.
4.RISKS AND COMPLICATIONS
Your lifestyle habits, your age and your general health can affect the preparations and the smooth running of your dental care and treatment as well as your recovery. Here are the risks and complications you should consider:
a) Anesthetic risks
Dental treatments that require anesthesia should not be taken lightly. You should consider certain risks which could be:
- Nausea and vomiting;
- Feeling weak, blurred vision;
- Chills and headaches;
- Itching and discomfort;
- Bruising and pain at injection sites in the gums;
- Allergy to an injected medication;
- Temporary problems with memory and concentration.
b) Postoperative discomfort in the operated region
Regardless of the dental treatment, you cannot escape the pain and swelling in the operated area. In some cases, your sensitivity may be affected for several days. These discomforts could be:
- Discomfort and pain;
- Swelling and bruising;
- Lymphatic effusion (accumulation of fluid under the wound);
- Loosening of stitches;
- Numbness, insensitivity, increased sensitivity, etc.
c) Risks of infection
Most of the time, all means are taken to prevent microbes from penetrating the gums. However, we have all heard of an unfortunate story of bacterial infection during dental care or treatment. It is important to carefully monitor for signs of infection which could be:
- An infection which manifests itself by redness, pain, swelling of the treated area;
- An abscess (bacterial infection in the gums);
- An infected dental implant most often requires removal;
- A new dental implant cannot be replaced for several months, as there is a high risk of infection.
d) Risks linked to smoking
If you smoke, even with electronic cigarettes, you should consider stopping two weeks before and after dental implant surgery, because smoking increases the risk of postoperative complications. The most common complications are:
- Infection ;
- Damaged gum;
- Cardiovascular problems;
- Respiratory complications;
- Healing problems;
- Bone consolidation problems.
e) Special risks with dental crowns
Loosening of the crown or pivot-crown: Most loosening results in a mobile restoration in the mouth for the patient, but without fracture. For single crowns, re-cementation can generally be carried out without problem. However, before any new intervention, the dentist must analyze the causes of failure and the damage caused by the separation. If the dentist notices the presence of cavities or if the crown lacks adaptation, it will have to be redone.
Cracks or fractures of the residual tooth: The choice of an anchor as a base for a crown always constitutes a mechanical risk for the root. First, during the root arrangement procedure, then during the stresses transmitted to the root during chewing. Cases of root fracture lead, in the majority of cases, to the extraction of the tooth.
Fractures or breakage of ceramic elements: The evolution of materials and techniques makes it possible to respond effectively to certain types of repair directly in the mouth. However, aesthetics remains a real challenge, sometimes difficult to achieve.
Prolonged postoperative pain on a vital tooth: This situation requires root canal treatment. This is why if you go to Colombia to have crowns installed, our dentist very often offers a root canal treatment with a crown.
Other possible complications: Short-term postoperative tenderness. Temporary pain in the jaw, teeth and chewing muscles. Possibility of pulp necrosis (tooth death) as a result of tooth trimming.
Long-term success and survival: It is difficult to accurately establish the longevity of a crown when it comes to fixed prostheses. However, it is reasonable to think that, regardless of the quality of the initial result, one should rethink the prosthetic problem more than once during a lifetime. The patient must be warned.
f) Special risks with dental bridges
Detachment of the bridge: Most loosening results for the patient in a mobile restoration in the mouth, but without fracture. As for fixed bridges, new cementing can be done without breaking the bridge and without fracturing the supporting teeth. The detachment can be partial or total. In most cases, the abutments can be preserved and the main objective will be to limit the risks, in particular of root fracture when attempting removal in the case of partial detachment. Faced with total detachment, the bridge will be put back in place if the pillars are intact. However, before any new intervention, the dentist must analyze the causes of failure and the damage caused by the separation. If the dentist notices the presence of cavities or if the bridge is no longer satisfactory, it will have to be redone.
Cracks or fractures of abutment teeth: If, following root canal treatment, an anchor in the root had to be considered as a seat for the abutment tooth of the bridge, this type of anchor always represents a mechanical risk for the root. First, during the root arrangement procedure, then during the stresses transmitted to the root during the chewing function. Cases of root fracture lead, in the majority of cases, to the extraction of the tooth.
Fractures or breakage of ceramic elements: The evolution of materials and techniques makes it possible to respond effectively to certain types of repair directly in the mouth. However, their aesthetic significance is questionable.
Fractures of the metal components of the bridge: This failure is attributable to a failure located at the junction of the various metal elements that were welded.
Prolonged post-operative pain on a vital tooth: This situation may require root canal treatment. This is why if you go to Colombia to have a bridge installed, our dentist very often offers root canal treatment for abutment teeth.
Other possible complications: Short-term postoperative tenderness. Temporary pain in the jaw, teeth and chewing muscles. Possibility of pulp necrosis following tooth pruning.
g) Special risks with dental veneers
Short-term considerations (30 days after placement): Particular caution must be taken in the first 72 hours after cementing the veneer since the product that binds the veneer to the tooth continues its setting reaction during this time. The patient must follow a soft diet, avoid extreme temperature variations in the mouth and refrain from consuming any food or drink that could cause tooth discoloration or discoloration (wine, coffee, etc.). After this three-day period, the patient returns to their usual diet. However, he must avoid crunching hard candy on his teeth, biting into crusty bread or even chewing meat on bones. In addition, he must follow the usual hygiene care (toothbrush and dental floss).
Long-term considerations: Concerning oral hygiene, it must be optimal in order to avoid the accumulation of plaque at the facet-tooth junction. The lifespan of veneers is five to ten years, and like any dental restoration, there is a possibility of treatment failure such as:
Fracture: It is possible for cracks to develop in the porcelain or zirconia before or at the time of cementation. These cracks can become more pronounced and appear like cracks once in the mouth. Also, it is possible that a clear fracture of the porcelain occurs during cementing of the veneer.
Lifting: It is rare for the veneer to come off completely. If this is the case, the dentist resumes the cementation. In case the veneer comes off more than once, it is suggested to replace the veneer with a dental crown. When a single piece of porcelain or zirconia is fractured, the dentist may try to glue the piece back together or fill the gap with composite resin.
Marginal infiltration: Around the edge of the veneer, at the porcelain-tooth junction, it is possible that there is an infiltration of fluid from the oral cavity, causing certain problems such as unsightly coloring, the appearance of stains, repeated takeoff.
Coloring: Generally speaking, the color of the veneer remains stable during the first three years in the mouth. Over time, color deterioration may occur. On the one hand, the infiltration of liquids at the margin of the veneer can cause the appearance of stains and, on the other hand, the cementing resin between the porcelain or zirconia and the tooth can see its color altered, thus affecting the appearance of the facet.
h) Root canal treatment
Access risks
Damage to a restoration already present in the mouth: When the dentist has to do a root canal on a tooth where a crown or other restoration rests, it is possible that the restoration (or crown) will be damaged to the point of needing to be replaced, repaired or reglued. The dam clamp can damage the crown and gum finish of the tooth it rests on.
Perforation during preparation of the access cavity: Sometimes when drilling to find the orifices of the canals, the crown is perforated on the sides or in the floor of the pulp chamber.
Fracture of the tooth: Caution is required, as the tooth may give way under the forces of chewing during treatment.
Canal not detected: Unintentionally, some canals may be left without cleaning, disinfection, mechanical preparation and obturation. This can lead to postoperative complications that may appear in the more or less long term (sensitivity, pain or infection). If this is the case, then the dentist may recommend other treatments to remedy the situation.
Risks related to instrumentation
Perforation at the root: At the middle part of the root, with a curved root, the perforation is outwards. Side perforation. Apical perforation or deviation of the apical foramen is a situation that occurs when overly rigid instruments are brought to the curved end of a canal, thereby causing unnecessary enlargement of the orifice. The canal is then more difficult to seal.
Instrument breakage in the canal: Since some endodontic instruments are fragile and the size of the canals of the majority of teeth is very small, it is possible that an instrument breaks inside one of the canals of the tooth during processing. This could affect the prognosis of root canal treatment.
Canal blockage: This occurs when debris forms a solid mass in the canal or when fibrous pulp tissue is compacted against the canal walls.
Obturation-related complications
Underfilling: This is a situation where the filling material does not reach the apical foramen. If this situation prevents healing of a pre-existing infection and/or is combined with postoperative symptoms originating from the canals of the treated tooth, a revision of the root canal treatment (endodontic retreatment) or apical surgery with retrograde obturation may be indicated.
Over-filling: The canal filling material is located outside the canal, in contact with the tissues surrounding the root of the tooth. This may cause delayed healing, prevent healing of a pre-existing infection, or lead to postoperative symptoms related to endodontic treatment. If this is the case, the dentist may recommend other treatments to remedy the situation.
Other complications
Post-operative awakening: Pain following a root canal treatment appointment, some pain may be felt when touching the tooth. The dentist will prescribe painkillers, and this pain will gradually fade after 72 hours. Swelling In the case of a previously infected tooth, swelling may occur, which can be controlled by taking an appropriate antibiotic.
If the infection persists, the possible interventions are: Canal retreatment, apical surgery with retrograde obturation, extraction and orthodontic replacement of the edentulous space.
Here are the difficulties that may arise during your root canal treatment:
- Curvatures
- Interferences, calcification
- Difficult access
- Accessory channels
- Dual Channels
- Resorption
- Infection or other associated injury
- Patient’s medical condition
i) Extraction of wisdom tooth or impacted tooth
Damage to adjacent nerve structures: Trauma to a sensory nerve, whether the inferior dental nerve or the lingual nerve, can lead to paresthesia, which is defined as a loss of sensation in the chin, lip or tongue, the duration of which is variable. Usually the numbness is temporary but, on rare occasions, it can be permanent.
Damage to the upper maxillary sinus: The maxillary sinus is a pneumatic cavity located in the upper jaw. If the sinus is oversized, it can extend around the apices (tips) of the roots and thus enlarge, and a bone fracture, as well as a communication between the sinus and the oral cavity, can be created.
Damage to neighboring teeth: This may consist of a coronal fracture.
Risk of root fracture: If the shape of the roots is not favorable for this procedure, the risk can be high. In these cases, a partial odontectomy may be considered.
Mandibular fracture risk: A fracture of the lower jaw bone may occur.
Risk of infection: This can occur following extraction. In some cases, crushing food, the presence of a residual tooth fragment or a foreign body can be the cause.
Risk of alveolitis: This is the most common postoperative complication, which is defined by the premature loss of the blood clot from the alveolus, causing superficial osteonecrosis of the alveolar bone. This can occur three to five days after the extraction and is manifested by very sharp pain that can radiate to the ear and bad breath.
Other disadvantages: Pain and discomfort, trismus (limited opening of the mouth), bleeding (hemorrhage), myofascial pain, edema (swelling), temporomandibular joint disorder.
j) Dental implant and fixed prostheses
Failure of the implant: In the short term, it is the non-osseointegration of the implant, that is to say the absence of fusion between the bone and the implant. In the medium and long term, there is rejection of the implant caused by the creation of a poorly balanced prosthesis leading to slow resorption (destruction) of the bone around the implant.
Complications: They can appear at all stages of treatment and represent a significant part of all
complications observed in implantology. They essentially consist of fracture of the implant, a major complication requiring its removal and replacement with an implant of larger diameter, which fortunately is rare. From unscrewing one or more tightening screws of the prosthesis or abutment screws, sometimes going as far as breaking these screws, the removal of which can sometimes prove difficult. Breakage of the prosthesis and other breakage associated with the retention parts which may appear, thus resulting in additional costs.
Hygiene: Issues regarding maintaining good gingival health are essential to the durability of implants. The patient’s lack of hygiene and an accumulation of bacterial plaque quickly induce infiltration under the gums and cratering around the implant. The gingival pathologies that we encounter are, in general, of late onset and are modeled on the gingivitis and periodontitis observed around natural teeth.
Follow-up: As with all other treatments, we must ensure good follow-up after the end of the treatment. The absence or neglect of regular check-ups can lead to complications or even failure of prosthetic treatment. The fixed implant prosthesis must be checked by the dentist and must be changed if necessary, because it undergoes wear and aging like a conventional prosthesis.
5. FOLLOW-UP AFTER TREATMENTS
A few days after dental care or treatment, a consultation is required to check the patient’s condition, to ensure that everything is done correctly and does not involve any risk of travel.
One of the important elements when you go to another country for dental treatment is that of follow-ups once you return to your country. You must send the dentist images of the area of your treatments to allow him to monitor the progress of the results and your healing.
Additionally, inform them immediately of any pain, infection, swelling, fever or other symptoms. On request, he will send your medical file to your family doctor if emergencies arise.
6. RESPONSIBILITIES
From a medical point of view, only the dentist can be held responsible.
You acknowledge that you are aware that the person who translates the surgeon’s information and who accompanies you to Colombia has no medical responsibility.
The patient’s responsibility is to provide the information requested by the dentist and to pay the costs indicated on the contract.
7. GUARANTEES
The notion of an unsatisfactory result involves a significant amount of subjectivity. It is therefore based on the opinion of experts in cosmetic dentistry and mutual good faith. Our warranty is valid for 5 years for crowns, bridges and dental veneers as well as a lifetime warranty for dental implants. Permanent fixed complete dentures on implants have a 1-year guarantee.
Remember that the dentist has the choice to repair, replace or reimburse the services or products and that the reimbursement cannot exceed the amount the patient pays for dental treatment.
In the event of a proven complication:
- If the patient has a complication during and after the procedure while in Colombia, all treatment is done on site at the dentist’s expense.
- If the patient has a complication when he has already returned to his country of origin and has complied with the recommendations and this is still under warranty, the dentist in Colombia takes care of the new treatment. The evaluation will be made by photos. If the insufficient result is noted by the dentist in Colombia, the entire cost of a new intervention in Colombia is the responsibility of the dentist in Colombia, but the transport, accommodation and subsistence costs are not covered by this guarantee.
- The dentist in Colombia will do everything possible to arrive at a practical solution if the patient does not wish to return to Colombia for the new treatment. He will ask the patient to make an appointment with a dentist suggested by the Colombia dentist in order to receive the appropriate care or treatment. The dentist in Colombia undertakes to provide the patient’s medical file upon request and in French.
In case of unsatisfactory result:
The evaluation of the results is done after the intervention on the basis of before and after images sent by the patient. It nevertheless remains subjective and the reason why two situations are considered:
- If the unsatisfactory finding is shared by the dentist in Colombia, then he will cover the costs of the new intervention. The patient must come to Colombia at their own expense.
- If the unsatisfactory finding is not shared by the dentist in Colombia, the arbitration will be done by a cosmetic dentist at the patient’s choice and at the patient’s expense. The dentist in Colombia will comply with the established report and undertakes to cover the costs of the new treatment. The patient must come to Colombia at their own expense.
Legally, in all countries of the world, the dentist has a contract of means and not of results. This obligation does not require the dentist to guarantee a result, but to take all reasonable means to obtain the desired result. This means that if the result is unsatisfactory, but there is no medical error, no legal action can be taken.
8. LEGAL REMEDIES
The patient acknowledges that in the event of medical malpractice in Colombia, the dentist in Colombia is not subject to Canadian or Quebec laws, but to the civil code of Colombia where the dental care and treatment took place.
Furthermore, since dentistry is not a commercial good, financial compensation cannot be requested for an unsatisfactory result.
You can seek legal redress if there is a fault or technical error. However, the patient must provide proof of this error and travel to Colombia to begin legal proceedings.
To establish fault, the question to ask is: Was the dentist’s behavior reasonably prudent, diligent and competent? In other words, would another dentist in the same circumstances have acted in the same way?