Overseas Dental Treatment? Beware!

I just saw this headline in an airline magazine: “World-Class Dental Services at 50-70% Savings over U.S. Prices!” A lot of other verbiage, mostly misleading, continues. Then is the kicker. “With all the money you’ll save, you can vacation in style in Costa Rica.”

Here’s the story, one of many stories: A long-time patient of mine had the idea that he would save lots of money on dental work, much of which by the way he didn’t absolutely need, by going to Costa Rica. Not only that, but he had also decided to become part-owner of the Costa Rican dental clinic. He had the work done. My hygienist then saw the patient, saw the dental work, and described it in a one-word term that summed it all up, “substandard.”

I then see the patient. I look at the work which consists of crowns on nearly every tooth. And visually, it looks all right, except around the gum line which is redder than I had remembered. Then I check it with dental instruments to see how the crowns fit. And on crown after crown, I’m able to get my examination instrument between the crown and the tooth. In other words, the crown doesn’t fit the tooth. Then I examine the other crowns. Every crown doesn’t fit. Then I check the bite. The front teeth meet when he closes down, but the back teeth don’t.

He is working for the Costa Rican dental clinic, so he’s interested in my opinion. I say, “Let’s take a set of x-rays.” So we did. I have an advantage. My x-rays are digital and are projected on a 37 inch video screen, so anyone can look at the x-ray and see what I see. I show him each crown and rather than the crown fitting like a finely-designed, custom-made restoration, it looks like a cowbell on a stick. It’s obvious. It would be plain as day to you as much as it was to me. The patient, better termed “the willing victim,” defends the work saying that he “rushed the dentist.” I then asked him, “Are you selling this?” He said that he wasn’t selling it yet, that he was going to be a test case before he starts selling it to others. He then went on to defend himself and the clinic, telling me how cheap it was and how “this is for people who work at [a convenience store] and can’t afford dentistry.” He then told me proudly how much he paid for it, a bargain price.

So, here’s what he received for his bargain price; crowns that don’t fit causing gum inflammation as well as a predisposition to decay; a bite that predisposes him to jaw problems; and a greater chance of premature tooth loss.

As patients, you are at a disadvantage. You can’t tell your dental condition, nor can you evaluate the treatment. Good dental work requires time, good understanding of bite relationships and their corresponding jaw relationships. It requires the understanding of how to prepare a tooth, the conditions of the nerves of the teeth, and the biology of gum disease and dental decay. It requires understanding of cosmetics and specific instructions and communication with the dental laboratory. If implants are to be considered, good dentistry requires knowledge of the shape and density of the bone as well as the relationship of the position of the bone with the position of the teeth. And with all that, things can still go wrong. They can go wrong because biology and mechanics are not always perfect. The best dentists I know immediately recognize when things are wrong and make them right. That takes training; that takes practice; that takes time; that takes integrity.

Where will this patient go now? He says that he’ll go back to Costa Rica to have the work “done right.” But if a dentist is willing to do substandard dentistry, do you really think that he is capable of doing it right? And when the patient has a problem, where is he then going to go?

To quote a popular maxim in dental circles, “Beware of bargains in parachutes, brain surgery, and dental treatment.”

Lee N. Sheldon, DMD