Why? Three reasons. The first seems to be computers and access to the Internet and the information that a web site(s) provides. Many people have learned, or are learning, that this powerful and increasingly popular source for information is an incomparable method for research. A well-done web site is educational and informative and causes a person to become knowledgeable and informed.

The second reason is money. Given the state of the weak Canadian dollar, $1.00 US is currently worth approximately $1.50 in Canada. Many medical and dental services and procedures are comparably priced in the United States and Canada, so that in Canadian funds a patient can anticipate saving anywhere from 30 – 50 percent.

And the third reason, which is the most qualified and beneficial reason, is the level of experience and expertise achieved by Physicians, clinics and hospitals in Toronto.

For example, The Studio for Aesthetic Dentistry in Toronto is the only one of its’ kind in North America, and the Shouldice Hospital, which performs only hernia procedures, is recognized worldwide for the procedure developed some 58 years ago, and at the Bochner Eye Institute, patients come from as far away as Texas and California as a result of the Canadian approved equipment utilized to perform laser eye surgery.

Toronto is recognized worldwide as a medical centre mecca for various disciplines, and teaching facilities. Many Doctors, medical researchers, Dentists and other health care specialists are frequently invited to lecture in the United States and around the world. The reputation of certain facilities and Physicians is such that American patients are often referred by their personal physicians for treatment in Toronto, and U.S. Doctors have been known themselves to come to Toronto for certain treatments.

As a result, hundreds of Americans come to Toronto annually for numerous medical and cosmetic services, which often results in satisfied patients referring friends and relatives for the same or similar procedures.

Following is a brief profile of some facilities in Toronto which have, and are, currently treating American patients:

The Institute of Cosmetic Surgery
Since commencing his practice in 1978, Dr. Lome Tarshis has become one of the most respected and popular cosmetic surgeons in the city. Trained in Toronto, and Beverly Hills at Cedars Sinai Hospital, Dr. Tarshis has had additional training and worked with some of the most renowned plastic surgeons in the US, Brazil, Italy and France. It is important to note that Dr. Tarshis is a Board Certified Fellow of the American College of Surgeons. Dr. Tarshis has become a recognized authority in his field and attends national and international symposia, either to lecture or participate in a professional exchange of information.

Dr. Tarshis has performed various procedures for over 500 American patients, one of the most recent having travelled from Missouri to Toronto. In addition to the Doctors’ skills and expertise the cost of having procedures performed in Toronto, in Canadian funds, justifies the travel expenses.

An indication of how well some people research a cosmetic surgical procedure is how often The Institutes web site is accessed – 200 times a day and from across the U.S. and as far away as England. The Institute receives 5 -10 qualified email inquires everyday.

Several new patients are referred to The Institute by former patients, some who have returned for second and third procedures. Contact The Institute of Cosmetic Surgery at 1 888 926-8122 or (416)

926-8122. The web site address is www.cosmeticscanada.com

Shouldice Hospital
This hospital, having gained a worldwide reputation for the technique of repairing hernias, (the method having been developed some 50 years ago), has treated 400 – 500 American patients a year! and many more that come from around the world. Such is the experience of the medical staff and the highly developed skills and procedure that this method of hernia repair has come to be known as "the Shouldice technique"

In fact, one of every seventy patients is a medical doctor, and of the thousands of patients treated at Shouldice every year, 57% are referred by former patients. The internet being the source of information it has become, an astounding 11% of patients come to Shouldice as a result of the comprehensive website: www.shouldice.com.

The Hospital has prepared a comprehensive and informative VHS video which a potential patient can request.

Most U.S. managed care plans such as Aetna/U.S. Health Care, Multiplan and Blue Cross/Blue Shield, will cover the cost of the procedure, which is approximately $2200.00 US, and for patients that qualify Shouldice Hospital offers a $300.00 Cdn. travel allowance. The same procedure in the United States is approximately $4500.00 US for outpatient care. Included in the fee at Shouldice is 72 hours post op care, again specifically developed for hernia patients.

It is important to note that surgeons at Shouldice are U.S. Board certified.

Statistically, the repair and failure results in Great Britain are as high as 30%, in the United States 10 – 15% and at Shouldice over the last fifty years, the rate is less than 1%.

Shouldice Hospital is so well respected and appreciated by patients for facilities provided and especially the caring staff that a patient reunion is held annually at the Royal York Hotel where some 1500 previous patients attend – and some have attended every year for the last fifty two years!

For information you can contact the Hospital at 1 800 291-7750 or (905) 889-1125, or see the website: www.shouldice.com

The Studio for Aesthetic Dentistry
This is not your typical Dentists’ office.

This is a studio designed specifically for cosmetic dentistry; in fact the only one of its’ kind in North America. The Studio is operated by Dr. Edward Philips who is also the Course Director for Cosmetic Dentistry at the University of Toronto. Dr. Philips also lectures in Canada and the United States and is an information resource for several radio and print media.

This ultra-modern, very state- of-the-art studio literally makes clients smile.. better. The purpose, and function of the studio, is to correct and improve a persons’ smile by performing any number of procedures such as bonding, capping, crowning, teeth restoration and onlays.

No appointment is necessary to stop in. In fact, the Studio encourages potential clients to visit and spend some time at a nine-screen information centre which is informative and educational. Or visit the Studios’ website which has become a popular source for information.

In the last year Dr. Philips has seen more than 50 patients from the United States, most being from the Buffalo/Cleveland/Detroit areas, and even a patient from New York City. Several patients are referred by Toronto cosmetic surgeons, or are referred by their U.S. Physicians.

An impressive fact is that Dr. Philips sees only two patients each day, which means that a patient has the Doctors’ undivided attention.

Costs of course vary, depending on the procedures required, but as rates are often higher for similar procedures in the United States, and considering the very favourable exchange rates, it is estimated that a patient can save 40 – 60% less. An average cosmetic smile improvement costs approximately $5000.00 Cdn.

The Studio for Aesthetic Dentistry is located at University and College and can be contacted at 1 888 764-5354 or (416) 597 6453 . The website address is: www.cosmeticdentistryto.com

Bochner Eye Institute
Laser eye surgery seems to be growing in popularity and the laser technology being developed and in use in Canada today is distinctly different from the first or second generation of lasers used in the U.S. The Canadian government has approved for use advanced laser technology equipment and procedures that the FDA has not as yet certified.

The Bochner Eye Institute uses the Nidek 5000 laser, developed in Japan, and as a result of performing this procedure since 1991, is now seeing 100- 150 American patients annually.

Many patients are referred by their eye care doctors or even their physicians, and have come from as far as Texas and California, (you may recognize some names) although most patients coming from the U.S. are from the border States.

The procedure takes a few hours and usually by the next day the recovery period is over. Follow up care is provided by the patients own eye care doctor.

The procedure in Canada costs approximately 30 – 40% less as a result of the advantageous exchange rate.

The Bochner Eye Institute can be contacted at 1 800 665-1987 or (416) 960-2020. The website is www.bochner.com

Not surprisingly, dentists almost everywhere have become really nice to patients. Gone are the days when they’d ask a question, then jam instruments into your mouth before you could reply. Now some take the Sistine Chapel approach to customer relations.

In British Columbia, Dr. Anderson offers 20-channel cable television, installed in the ceiling. In Ottawa, Dr. Sam Lewinshtein plasters his ceiling with a vast collection of funny buttons.

Children in Toronto awaiting Dr. Henry Ross get Polaroid snapshots and play Nintendo. Nervous types, adults included, are tucked into dental chairs with hand-crocheted blankets. And patients are welcome to toss their jewelry into the ultrasonic sterilizer, normally used to prerinse dental instruments. "People are just thrilled," said Helane Fischburg, his office administrator. "It polishes diamonds."

To be sure, it’s still great to be a dentist in, say, North Sydney, N.S., where there are only three dentists for 10,000 people. Dr. Colleen LaPierre laughed when asked whether she does anything special. "You don’t even have to be polite," she joked. "We just open up. People come."

That was standard fare 20 years ago, when patients everywhere might wait six months for an appointment. Children invariably had seven or eight cavities. "Even with emergencies, patients had to wait two weeks," recalled Dr. Edward Sonley, director of clinics at the University of Toronto’s faculty of dentistry.

To cope with the crush, provinces founded their own dental schools. Enrolment expanded. Burned-out dentists backed fluoridation, with few envisioning how this simple measure would end the golden age of dentistry.

A decade ago, dental schools began trimming enrolment, but the impact was neutralized by the influx of foreign dentists and by Canadians who, failing to get in, attended U.S. schools and returned home to set up practice.

Now, in these hard economic times, companies have drilled away at dental plans and some workers have lost their benefits entirely. "It’s funny," Dr. Gordan Markic said, sardonically. "People would rather put food on the table than see a dentist."

Banks, which once automatically gave dentists a loan, now demand business plans. And while dental fees have tracked inflation over the past 15 years, overhead has jumped to 64 per cent of gross billing from 45, according to the Ontario Dental Association. Said the U of T’s Dr. Sonley, 64: "I was taught that business was a dirty word. But God help you today if you don’t run it as a business."

Make no mistake, the pain is relative. Dentists enjoy the second-highest incomes in Canada, after medical doctors. In 1992, the most recent year for which information is available, they averaged $103,000, according to Statistics Canada.

The ineluctable law of supply and demand and a 1990 Supreme Court decision permitting dentists to advertise have sparked an unseemly scramble for market share. The Toronto Yellow Pages is filled with dental ads that blare "New Patients Welcome," announce payment by Visa and offer service in Italian, Hebrew, Cantonese, Tamil, Macedonian or Croatian. Many ads openly tout "senior citizen discounts." While dentists are reluctant to discuss discounting because two-tiered pricing – higher for insured customers and lower for uninsured – is considered unethical, many confirm the practice exists.

Dental advertising remains regulated, but now the restrictions aren’t much different from, say, those governing used-car salesmen. "Most of the complaints we get with respect to advertising come from other dentists," said Dr. Roger Ellis, registrar of the Royal college of Dental Surgeons of Ontario, which regulates advertising. "They keep sending us stuff and saying, ‘Is this legal?’ And, most of the time, it is."

As dentistry has gone from boom to bust, dentists have tried to cope. In Toronto, Dr. Donald Chong, who once stopped accepting new patients during the fat years, spent $20,000 (U.S.) on a dental-management course in Portland, Ore., when times turned lean.

Some dentists have fired their hygienists and clean teeth themselves. Others perform root canals, instead of passing the work to a specialist. "If our regular dentist isn’t as busy, he’s less likely to refer as quickly," said Dr. Douglas Pettigrew, an Edmonton periodontist. "There’s a ripple effect. It’s hurt all of us."

A normally morose bunch – U.S. studies indicate dentists have the highest suicide rate of any profession – some are trying to lighten up. Many wear designer dental garb by, say, Simon Chang. Others eschew whites entirely, especially those touting cosmetic dentistry. Many have spruced up once drab waiting rooms with waterfalls, juice bars and two-metre- long fish tanks. Cosmopolitan and Gourmet have replaced dog-eared copies of Reader’s Digest.

A once proud profession has been humbled. "I know patients don’t like to be kept waiting," Dr. Pettigrew said. "Their time is valuable." Indeed, waiting times at many offices have shrunk to five minutes or less, so short that some patients complain they don’t have a chance to peruse the latest issue of Vanity Fair.

Nowadays, you don’t call them; they call you to set an appointment and even send reminder postcards with cavorting toothbrushes. Same-day appointments are possible. And many dentists are also stocking up on the latest toys to soothe patients. –

In Toronto, Dr. Edward Philips, dressed in a collarless dark print shirt, black pants and lace-up leather boots, offers a choice of music, laughing gas or something called Relax Man, in which patients close their eyes and strap on goggles that flash tiny white lights and supposedly cause the kind of rapid-eye movement that induces relaxation. For those who would still rather be somewhere else, he offers virtual-reality goggles with scenes of Hawaiian beaches.

Some offer acupuncture. Others supply Walkmans or compact discs to drown out the whine of the drill. Across town, Dr. Allan Reiss uses needle-free electronic anesthesia. He also throws in free subway tokens or reimburses parking chits. "I figured: Make it that much easier for them."

Unlike medical doctors, pinched by a dwindling government treasury, dentists work as long as they want. A 7 a.m. start isn’t uncommon. Others open at night and on weekends to accommodate patients who can no longer take time off work. In their office in a strip mall in Mississauga, Dr. Gordan Markic and his wife, Dr. Susan Belavich-Markic, work until 7 p.m. every weeknight and all day on Saturday.

Like a number of competitors, they bought an intraoral camera so patients can see their teeth magnified on a television screen. They also promote services on laser discs and mail newsletters, supplied by a company that lets them customize part of the text. Called Word of Mouth, their latest issue includes flossing jokes, crossword puzzles with a dental theme and a snapshot of their infant son clutching a toothbrush.

Referrals merit thank-you notes and lottery tickets. At least two customers have won several thousand dollars. "It’s a thoughtful gesture for a thoughtful gesture," said Dr. Markic, 35.

Since taking the management course, Dr. Chong, 60, tracks referrals on a computer. When he notices a patient has sent him five or six new customers, he sends flowers. "Always to the office," he said, "because when it gets there, it generates more word-of-mouth business."

Some dentists target niches, such as children, seniors, even welfare recipients, who, until recent government cutbacks, had adequate dental plans. Dr. Kenneth Montague, who practices in Toronto’s hip Annex neighbourhood, goes after the Generation X crowd. He plays Alanis Morissette recordings and has furbished his waiting room in "Caribbean style" colors of sea green and terra cotta. "My personal view is that people equate techno-cyber stuff with the drill."

Other dentists try to lure customers with new services. Dr. Philips, of the virtual-reality goggles, offers "breath disorder" treatment. Patients who fear they have halitosis blow into a Halimeter, which measures volatile sulphur compounds. Dr. Philips then sells topical creams and mouthwash of chlorine dioxide to neutralize the sulphur dioxide chemically. But he and many other dentists see a lucrative future in cosmetics – whitening, bonding, implants and glued-on fakes called veneers.

Dr. Sol Weiss, who looks vaguely like Michael Douglas, recently posed in a magazine ad wearing a wool blazer, tie-less black shirt and khaki pants. He never wears dentist whites and has named his cosmetic practice Art of Dentistry.

"I see my dentistry as art work," said Dr. Weiss, who deemed his native Winnipeg too conservative for cosmetic dentistry and moved to Toronto in 1988. Dr. Weiss, who has his own World Wide Web site, offers his predominantly female clientele a choice of orange blossom, lilac, peppermint or bergamot aroma therapy. He also uses computer imaging to show them how beautiful they will look if they spend, say, $10,000 on a set of veneers.

In these uncertain economic times, will consumers make the switch from insured non-elective care to elective cosmetic dentistry? Some dentists fear not. But they console themselves with the thought that as baby boomers age, there is always gum disease. And the controversy lingers over replacing old fillings with new, mercury-free ones.

"Now dentists are all dying for someone to prove that silver amalgam fillings are bad for you," Dr. Chong said. "Then we’ll all be in business again."

Fluoride works
Three decades of fluoridated water and toothpaste, a glut of graduates and a nineties erosion of welfare and corporate benefits have taken a big bite out of the dental profession.

Dentists lose
Two decades ago, a dentist could survive with 1,000 patients. But these days, with nearly half of all youngsters growing into cavity-free adulthood, a dentist with fewer than 2,000 low-maintenance patients is in trouble. Only half the population normally sees a dentist regularly. In Alberta, there is roughly one dentist for every 1,800 residents, in Ontario one for 1,700 and in B.C. one for 1,600.

Patients get popcorn
Not surprisingly, dentists almost everywhere have become really nice to patients. They call you for an appointment. Waiting times are down to five minutes or less. And they ply you with free popcorn, coffee, hot finger towels and Polaroids of your children. To distract you in the chair, there’s Mozart or Morissette, virtual-reality goggles and aroma therapy.

If not, you’re missing out. To stay competitive, dentists now pamper patients with everything from aroma therapy and popcorn to hot finger towels and piped-hi reggae music, not to mention extended hours and hefty discounts.

"It’s such a serious profession, said Dr. Kenneth Montague, 32, recently named "best dentist" In Toronto’s Now magazine (along with "best place to meet a straight man" – Canadian Tire), Dentists didn’t even think of marketing as a business tool until quite recently.

Dentists are bleeding, after three decades of fluoridated water and toothpaste, a glut of graduates and a nineties erosion of welfare and corporate benefits.

‘Two decades ago, a dentist could survive with 1,000 patients.

But these days, with nearly half of all youngsters growing into cavity- free adulthood, a dentist with fewer than 2,000 low-maintenance patients is in trouble.

Only half the population sees a dentist regularly. But in Alberta, there is roughly one dentist for every 1,800 residents, in Ontario one for 1,700 and In British Columbia one for 1,600, according to the Canadian Institute for Health Information.

Thanks to these factors, as well as new technology we can take dentistry to the next level!

Whitening and bonding are two of the most common procedures, but many adults are trying out orthodontics and the new alternative, porcelain laminate veneers, as well.

Dr. Philips says it is natural for people to want a beautiful smile, and the reasons can be found in the past. "The reasons people want a better smile are evolutionary," he says. "Sharp and uneven teeth used to signify the ability to tear and shred. Grinning and showing teeth used to scare away predators. But now grinning or smiling means, ‘I’m okay. I’m friendly. Come closer to me.’ It’s welcoming. Dark teeth or sharp, irregular teeth are still considered hostile and, because a smile now serves different social purposes, this isn’t desirable."

When people speak, the listener often focuses on their mouth as unwavering eye contact might be considered intimate or even aggressive. That means the mouth is one of the first things that is noticed. Now dentists and patients finally have the time and dental health to start thinking about procedures that are cosmetic rather than a requirement for health.

Dr. Philips says large numbers of dentists were enlisted during the Second World War, which resulted in a general decrease in dental care. Consequently, in the following years, many people’s mouths were filled with cavities.

By the I970s, the use of fluoride began improving dental health, but in the 1980s the baby boomers’ fillings started breaking down and had to be replaced. It is only since the 1990s that there has been time for the industry to move beyond damage control.

"Re-whitening is still the most popular procedure," says Dr. Philips. "Everyone wants clean, white teeth!’

Professional cleaning will remove surface stains such as those from coffee, tea, tobacco and plaque. But when teeth age, they tend to yellow. In these cases, an oxidizing agent must be used to break down the yellow pigments. I don’t like to call it whitening because we’re not adding colour," says Dr. Philips. We’re simply removing the yellow or darker pigments to re-whiten the teeth!" That means people’s teeth will never be whiter than their teeth are naturally.

Adult orthodontics are another popular choice in cosmetic dentistry. Straight, even teeth are an important factor in a nice smile, "If the teeth weren’t lined up properly to begin with, they will shift and drift throughout their life," says Dr. Philips. "So even if they had the smile of a cover model 10 years ago, they may not now. ‘Adults often think they’re too old for orthodontics, but it is actually quite common!’

According to the American Dental Association, about 20% of people who now get braces are adults. But this procedure takes patience, as adults often must wear them for two or three years, and afterward a retainer must be used.

Porcelain and laminate veneers are another option for those who want to improve their smiles. Thin, semi-translucent plates or shells can be used to cover discolouration, repair chipped or damaged teeth or change the look of teeth in terms of shape and size. Most of the time you can’t tell where the tooth and the veneer meet, eliminating shadow lines often associated with a crown. But because there must be a certain amount of tooth for the veneer to bond to, sometimes crowns are the only alternative.

‘Veneers are the number one choice for people who want to improve their smiles," says Dr. Philips. "It’s more expensive than bonding, but the results are often better!"

Bonding is another procedure people with chipped or discoloured teeth, or those with gaps between their teeth may choose. "Bonding is a bit of a misnomer as veneers are bonded as well as crowns," says Dr. Philips. "It’s the material we’re using that we’re referring to. With veneers, we’re using porcelain. With bonding, we’re using high-grade plastics!"

Often micro-abrasion is used to "roughen up" the surface of the tooth for bonding. "Drills create flatter surfaces that don’t bond as well," says Dr. Philips. "Abrasion, such as air abrasion, creates a honeycombed effect."

Some people don’t have a problem with their teeth, but they think their gums ruin their smiles. Dr. Philips says the remedy for a gummy smile is both simple and effective. "That tissue is very easily removed," he says. "It’s much like cutting cuticles, and we have had outstanding results!" Lasers or scalpels maybe used to remove the tissue.

And last but not least, there are people who have lost teeth. The answer is often implants. The solution used to be dental plates, but now dentists install teeth that are attached to the jawbone making them sturdy and realistic in appearance.

Of course, a good way to get a healthy smile is to maintain your teeth. Many of these procedures can be avoided if people take advantage of preventive treatments and care for their teeth by brushing and flossing.

But sometimes, the perfect smile still eludes us. In these cases, a cosmetic procedure may bring patients a great deal of confidence and comfort.

Ed Trelford remembers all too vividly his early dental experiences during World War 11 when he had several teeth extracted without anesthetic.

“The pain was horrific and nobody gave a damn,” he recalls with perfect clarity.

So on his latest visit to his North York dentist, Trelford, 69, was particularly bemused and delighted to discover he could spend his visit wrapped in a form of virtual reality glasses watching a film about eagles.

The dentist froze the appropriate area inside Trelford’s mouth and installed a new crown. Sincere assistants hovered and helped, asking Trelford if everything was to his liking. Trelford spent the hour bird-watching.

“It was really most interesting and I learned all sorts of things about eagles,” the Orillia resident says. “I was quite taken with it I never gave a thought to what they were doing to my tooth and it sure beat sitting there mindlessly waiting for the procedure to be finished.

“I like it when the dentists bring out their new toys.”

Many Metro-area dentists are introducing various high-tech “new toys” to help patients relax and forget their dental troubles and anxieties. Some dentists have televisions or visual games hanging from the ceiling. Others give out headsets and a choice of musical selections. A few have taken up the new kind of glasses Trelford used, which show films on a tiny screen in front of the right eye.

One dentist even offers electronic goggles that use the combination of a light show and musical interlude punctuated by beeps to induce a kind of meditative trance in the patient.

Some U.S. dentists offer patients the chance to play computer games hooked up to headsets while their molars are mended and word is that future dental developments will include the laser drill and a dental chair with built-in massager.

While there are no specific Canadian studies on the subject, American research suggests 40 per cent of people won’t go to the dentist unless they are in pain and 10 per cent wouldn’t go to a dentist no matter what Studies clearly show that older people are considerably more dental phobic than younger folks.

People now in their 40s and older sometimes have nightmarish childhood memories of more primitive treatments from the days of very low-tech dentistry.

Children of the last 20 years, growing up in the days of fluoridated water and tooth sealants, have no idea why their parents and grandparents associate dentists with chilling early experiences of drilling, filling and yanking, sometimes without anesthetic.

Some people are afraid of having trouble breathing in the dentist’s chair. Others feel claustrophobic or helpless. Some are afraid of nausea and those prone to dizziness can fear having it triggered by the motion of the chair or by their position.

A 1988 Canadian Dental Association poll showed that 42 per cent of people still associate a visit to the dentist with pain, although their number is shrinking and their fears are not necessarily founded in fact.

But one of the most powerful elements in dental aversion is a sense that the whole experience is a form of human indignity that makes the patient feel like a hapless cartoon character.

“They’re up in the air with their legs

Just wanna be loved by you…

Dentists just want to be loved.

“The media often present dentists as sadistic, uncaring people just interested in getting the job done – the Little Shop of Horrors kind of thing,” complains North York dentist Ron Weintraub.

“That’s the exact opposite of the truth. You need to present the helping, caring side of dentistry.

“Your dentist is a surgeon, a radiologist, an anesthetist, a cosmetician: there’s a great dogree of difficulty to the work. It’s a very demanding profession. But you will find that it is very important to the dentist to offer information and comfort to the patient”

Weintraub says some patients want to be participants in the treatment, to be kept abreast of each detail and to make decisions about aspects of the treatment He offers these people educational videos on everything from root canal to gum disease and the opportunity to watch their treatment on a screen, thanks to a mini-camera.

“Other people say: ‘Please don’t show me anything, just do what you have to do then I’ll leave,” Weintraub notes.

“We find out from the patients what their needs are, then we focus on the needs of the individual patient”