Dr. Alma Renteria, left, and Laura Arvizu, a dental assistant, perform a cleaning Jan. 5 on Octavio Garcia-Von Borstel, the mayor of Nogales, Ariz., a regular patient of Renteria's. (Marissa Lang/NYTI)
“I like to count the number of Anglos I see walking by,” said Sonia Knodt, a white-haired, blue-eyed retiree. She’s watched the Nogales area transform, she said, most noticeably in the past few years: As the economy went south, so did hundreds of Americans seeking more affordable dental care.
For the millions without dental insurance, and for those with limited coverage, dental care in the United States is simply too expensive. Many go without.
The U.S. Centers for Disease Control and Prevention reports that about 53 million children and adults have untreated tooth decay in their permanent teeth. More than 100 million Americans lack dental coverage — nearly three times the number without health insurance, according to a 2006 analysis by the Kaiser Family Foundation.
Although Mexican officials don’t track how many Americans receive dental care in border towns, Dr. Jose Saturno, a dentist in Nogales, reported having close to 900 patients from the United States, including the Knodts.
Dr. Ernesto Quiroga, who runs Dental Laser in Nogales, said he treated about 80 American patients every week in his two dental clinics.
Some patients said even if the U.S. government backed universal health care legislation that included dental coverage, they would still make the trek south of the border.
“We found ourselves needing dental care, and it’s quite expensive in the U.S.,” Sonia Knodt said after receiving a free consultation last Tuesday morning at Border Dental, where she and her husband have been receiving dental care for the last two years. “When we go to American dentists, we always feel like we’re being ripped off. Here, we pay a third to a half of the U.S. price for any procedure.”
While American dentists and dental health organizations recognize the cost discrepancy between one side of the border and the other, the American Dental Association and its members say going to Mexico for dental work is a risk they would discourage Americans from taking.
Many Arizona dentists have reported a significant drop in business since the economic downturn, according to the Arizona Dental Association. Business in Mexico is going well, some Nogales dentists said — despite reports of violence and warnings from U.S. dental providers and organizations.
Saturno, who is from Panama, runs Border Dental with his wife, Dr. Alma Renteria, who is also a dentist. These days, he said, about 90 percent of his clients are American.
“We’re in a good position,” Saturno said. “I have U.S. Border Patrol patients, U.S. Customs patients, Nogales police. Here, everybody is binational.”
One regular patient at Border Dental is Octavio Garcia-Von Borstel, the mayor of Nogales, Ariz., who said while getting a cleaning recently that he’s happy to “receive care from first-class dentists” just south of the U.S.-Mexico border.
In Nogales, Mexico, most dentists try to ensure their practices are seen as “binational,” allowing them to accommodate both their Mexican and American clientele.
“Border Dental, buenas tardes,” Yadiera Marquez, a receptionist, said when she answered the phone at Saturno’s office. She then switched seamlessly to English. “Oh, hi, Allen, I was just calling to remind you of your appointment tomorrow.”
For most Nogales dentists, English is a necessity. American magazines line the waiting rooms, and American channels are broadcast on office TV sets. The dentists say they go the extra mile to make their customers feel as comfortable as possible, because many of their patients cannot speak or understand Spanish.
“I can never say his last name — Santaro or whatever it is,” Sonia Knodt said of her dentist. “He speaks English so well. We just love him.”
For the more than 30 dental practices in Nogales, more Americans means more competition among businesses. The desire to attract American patients, some critics say, can lead to misrepresentation and shady practices used to cut corners in a relatively unregulated field.
About 30 dentists are listed on the Nogales Dental Association’s Web site. Of the 30, seven advertise that they are members of the American Dental Association. Affiliate membership is granted to international dentists who pay dues and provide the ADA with proof of graduation from a recognized dental school, but none of the seven claiming to be affiliate members actually are, said Fred Peterson, an ADA spokesman.
Kevin Earle, executive director of the Arizona Dental Association, said, “Some practices could have all the trappings of a perfect dental office but not be properly cleaned or sanitized, and you would have no idea of what goes on behind the scenes.”
Dentists on the Arizona side of the border must renew their license every three years, which requires that they take 72 hours of continuing education classes and pass regular government sanitation inspections. Mexican dentists are required to renew their licenses every five years, which also requires continuing education.
Earle said that in the United States, patients are not just paying for dental care — they’re paying for accountability.
“If you go to Mexico for a vacation and are afraid to drink the water, why would you go to a dentist that’s going to spray that water into your mouth while your gums are bleeding?” Earle said. “If someone commits gross malpractice” in the United States, he said, “they could have their license revoked.”
But Mexican dentists, who said they used only bottled or treated water, or water from the United States, insisted that their facilities were as good as those north of the border. Dentists in Nogales said the equipment they used was American-made, and the labs they used were often in the United States.
“Most people don’t associate the border with good dental care,” Quiroga, of Dental Laser, said in Spanish. “But the quality is equal as in the United States.”
While some dentists and patients acknowledged that a few dentists ran their practices like “maquilas,” or assembly-line factories, they said most operated familylike practices and relied on a personal, small-town feel to attract more patients.
Renteria, of Border Dental, even drives patients from the U.S. side of the border to her office in Mexico whenever Americans are uncomfortable crossing alone. Once the patients are at the office — a modestly decorated establishment with two examination rooms and thin walls — Saturno makes sure to say hello and explain the plan for treatment to each person, he said. He doesn’t like to rush.
“American patients like the personalized service, especially the older people,” Saturno said. “I get most of my business through referrals.”
That’s how the Knodts heard about Border Dental, said John Knodt, a retired history professor. When they return to their retirement community, Tucson Estates, at the base of the Tucson Mountain Park preserve, they are always sure to bring Saturno’s business cards to hand out.
“We know at least half a dozen other couples from T.E. who come down here for dental work,” John Knodt said. “In this economy, you never pay more than you have to.”
Nationally, Americans spent an average of $2,914 on health care, including dental, in 2008, according to the U.S. Bureau of Labor Statistics. Of that, the average insured person spent roughly $300 on dental services. Last April, the American Dental Association urged President Barack Obama to include affordable oral health coverage in health care reform.
Some dental practices in Nogales, Mexico, accept American insurance. But whether treatment is paid for by insurance or individuals, patients pay significantly less than they would in the states. A typical examination, which includes a cleaning, X-ray and consultation, costs about $50 in Mexico; in the United States, the same treatment could run from $90 to almost $200.
For John Knodt, even universal dental insurance wouldn’t convince him to seek medical attention in the States. “Why are we charging so much for dental care in America?” he said.
“If health care passed, we’d still go to Nogales,” Knodt said, adding that the only thing he’s worried about is legislation that could make it harder for Americans to take their business out of the country.
As for the issue of quality, Saturno said that in Mexico, there’s a saying: “En todos lados se cuecen habas.” It means everyone can make mistakes.
“I have seen very bad procedures from doctors in the U.S., and I have heard about bad experiences with doctors here in Nogales. Seems like in each country, inexperienced doctors are going to make mistakes,” Saturno said. “But people are still coming down here, no matter what people hear or think. That must mean something.”
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A version of this article appeared in print on page 1 of the Tucson 2010 edition of The New York Times Student Journalism Institute.