Photo by Pat Mazzera

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It's two days after Christmas and I'm sprawled out on a plastic-lined chaise lounge, sipping fluoride and waiting for the blood to stop gushing from my gums so the doctors can get back to work. Beyond the noise of drills and X-ray machines I hear grunts from several other patients and the sounds of merchants outside hawking sombreros, sweetbread, bootleg Fendi bags, and pottery. Kind of strange, but I'm not worried anymore. This is my second day at Dr. Rafael Lopez's dental clinic, and I'm no longer freaked out that it's nestled among trinket stores and cantinas in a bustling bazaar in Mexico.

I also don't care that the dentists here speak hardly any English, nor I any Spanish. I mean, it's not like I'm alone. All the other patients at Dr. Lopez's office are either Canadian or American, and all the people shopping out front are too. In fact, nearly every person I've met on the streets here is Caucasian and an English speaker.

I'd heard about Dr. Lopez's clinic through a friend of my mother's, but Los Algodones, like other dental tourism destinations, was easy to find on the Web. In fact, the town's Web site, www.losalgodones.com, is actually a dental clinic referral network, with pictures of smiling clinicians and graphic before and after shots flashing across its home page. Clinics like Dr. Lopez's, which often handle 10 to 20 patients a day, are set up exclusively for foreigners. Dr. Lopez estimates that 80 percent of his customers are American and 20 percent are Canadian; most Mexicans in the area can't afford his rates. Many of them come to towns like this for big-ticket procedures like bridges and reconstructive surgery, some of which can cost more than $10,000 at home.

And they're coming in increasing numbers. According to HealthCare Tourism International, a nonprofit accreditation and information organization set up to monitor the medical tourism boom, an estimated 1 million Americans will travel abroad this year for some of sort of medical service, up from the National Coalition on Health Care's figure of about 150,000 in 2004. Of the procedures sought, 40 percent will be dental related. A recent article in the New York Times on the dental tourism phenomenon cited a boom in luxury travel packages designed around dental procedures. A root canal followed by a little fly-fishing in Costa Rica? Why not? The money you save can justify a short vacation.

ROOTS OF THE PROBLEM

Dr. Lopez's clinic is, hopefully, the end of the road for me. I've been struggling with dental problems (and the potential resulting bills) for years. With all this talk of health care reform, you'd think I would have been able to find a decent low-cost US dentist, especially in civic-minded San Francisco. But it ...