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How to find your perfect Costa Rican dentist

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Interview with Dr. Mariano Kriebel of Kriebel Dental 

Here's an interview--conducted via the magic of email--with an excellent Costa Rican specialist dentist, Dr. Mariano Kriebel, about his great specialist clinic, Kriebel Dental.  Readers of this blog know how much I like specialists, especially those trained in the U.S., such as Dr. Mariano Kriebel and his father, Dr. Ricardo Kriebel, and their associates.

Here's how this interview happened.  A few weeks ago, I posted a favorable review by a patient of this clinic. (To find that post, click on the "DrKriebel" label.)  Dr. Kriebel saw it and sent me a thank you note, suggesting that I put up some testimonials from his web site.  This I couldn't do, though I'm happy to put up testimonials that I receive directly from patients.  Instead, I suggested that we conduct a little interview.

Disclaimer:  I have no business or financial interest in this clinic (or indeed any of the other clinics mentioned on this blog).  Even though I have not met any of the dentists at Kriebel Dental, I feel confident in recommending this clinic because of the previous patient's excellent report and the specialty training of the principal clinic dentists.

I have not edited Dr. Kriebel's responses except to improve on spelling in a couple of places. 

Question 1: You are a father-and-son team of prosthodontists, trained in the US.  Does dentistry run in your family?  

Answer: Kriebel Dental means four generations of dentists serving national and
international patients for over 100 years. The clinic was founded by Dr. Ricardo
Kriebel Staats, who arrived from Dusseldorf, Germany, in 1894. My grandfather,
Dr. Kriebel Rodriguez, an Honorary Member of the American Dental Association
among many distinctions, retired from the practice of dentistry in 2008, after 66
continuous years of treating patients.

My father Dr. Ricardo Kriebel Coronado, trained as a specialist in Prosthodontics
from Indiana University, joined the practice in 1981 and is currently working
with me. I joined the practice in 2012 after graduating as a Prosthodontist from
The Ohio State University. I also served as a clinical instructor in The Ohio State
College of Dentistry for 4 years.

Question 2:  You have an interesting CV, Dr. Kriebel.  You are the first prosthodontist I know of who can boast of specialty training in implantology too.  What is your role in the clinic, which also has another implantologist, and an endodontist, and your father, the prosthodontist?

Answer: I have a specialty in Prosthodontics and also have advanced training in
implant dentistry in both the surgical and restorative aspects. I spent one extra
year at The Ohio State University only working with implant patients. We
managed to restore over 1000 implants between the 3 resident doctors. In the
clinic I work as a full time prosthodontist as well as my dad. I do implant
placement surgery and we have an oral surgeon who supports the clinic in
specific cases, example: third molar extractions, block grafts and pathology. We
have an endodontist, Dra. Perez, she graduated from Baylor College in Texas. She
is a great professional and her expertise are very hard to beat.

Question 3:  There's always discussion about which dental implants are the best.  I imagine that questions like this are best decided with the patient in front of you, but could you give us some general advice about implant brands that might be useful to many US patients thinking of getting implants?

Answer: Currently here in Costa Rica we have a wide variety of options regarding
dental implant selection. The majority of implant brands are very good and I
personally feel they all work very well. It all comes down to the personal choice
of the dentist, the most important aspect is to find a dentist with the right
training and knowledge in order to use them correctly. Some of the implants I
like to use are: Zimmer and Bio-Horizons. Both of them very popular in the USA.

Question 4:  Along these same lines, what types of crown materials does your clinic tend to use in  which particular situations (e.g., front teeth, molars, etc)?

Answer: Regarding crown material selection, this is very specific for every case. When
selecting the material we need to take multiple aspects into consideration and
select the material accordingly. I like to use a lot e-max crowns from Ivoclaar.

They offer great strength and aesthetics. In cases where we have very limited
space and we require a stronger material, we might consider Zirconia or
porcelain fused to metal. I sometimes combine, using a more aesthetic material in
the front teeth like e-max and a stronger material for the back teeth like
porcelain fused to metal. It depends in the clinical situation, the important thing
here, is to have adequate knowledge of how to pick your material correctly in
order to have good longevity with your crowns. The biggest mistake I see, is
some dentists don’t know their materials and rely on their lab-technicians for
advice, trust me, understanding what materials to use is a critical component of
success.

Question 5:  Your clinic web site is in English to attract patients from the US, in addition to all your local clientele.  What are the most common concerns of your US patients, and how does your clinic try to address them?

Answer: In relation with international patients, we have been blessed to have great
patients and make a special friendship with lots of great people. Our website
provides some information and we are putting up a new one this week.

International patients always have concerns and are sometimes a little scared to
travel to a different country to get dental care.

When a patient contacts our office, I always take the first phone call, I spend as
much time as the patient needs to answer questions and make them feel secure.

We provide our patients all the necessary information and follow up before,
during and after their treatment. We explain every single detail, procedures,
pricing, lodging and all aspects before they come to Costa Rica. Once the patient
feels comfortable, everything becomes smooth.

We provide our patients a boutique type service, I usually only see one patient a
day when there is a big case. I talk with my patient and provide them special
individual care. We don’t do assembly line type dentistry (this happens a lot) we
serve each patient with quality. This helps them a lot and calms them down, after
all they are looking for a positive experience and good results.

We have a lot of pride in our dental work, we don’t compromise our quality and
patients can feel that. They like to see we have our own dental lab and do
everything custom for them, all these details add up to eliminate the fears and
concerns.

Thanks a lot David!!!!

Dr. Mariano Kriebel D.D.S,Ms

And thank you, Dr. Kriebel!







Interview with Dr. Mariano Kriebel of Kriebel Dental

By CometGlare → Sunday, May 8, 2016
Patient Report on Kriebel Dental

 Picked the wrong dentist in CR?  You're not necessarily doomed if you cut your losses in time and re-orient yourself.  Here's an example from a US dental patient who did just that.

She emailed me directly to discuss her adventures (or misadventures, rather).  But it all has a happy ending!

(She's given me permission to post her private email to me.  I've also posted her long review of Topix, a shorter version of which she posted #7662 earlier today on Topix.)

Thanks!  She found Dr. Kriebel on my blog (The Dentists==>Dave's Faves: The Specialists). It makes me feel good that my blog has rescued someone from a bad dental experience.

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Hi Dave,

I thought I would send you off a note, because, although I did not find your website early enough to avoid my initial dental catastrophe, I did find it in time to make a determination about which dentist to follow up with once I had to find someone to fix some problems.  Just an FYI-I was referred to your website by [name redacted by request]. I had a terrible dental experience.  I was not able to get in to Nova quickly enough given the severity of my situation, and my limited time in San Jose, but someone had recommended Kriebel Dental, and your review of them sealed the deal for me.  I am just dropping this note because I wrote a review of my experience and want you to know that you are not steering people wrongly to see Dr. Mariano Kriebel or his dad Dr. Ricardo Kriebel (or any other staff members at Kriebel Dental), for reasonably priced, top of the line dental work. 

I would be happy to answer any other questions you have…but just wanted to say thanks for spending the time and effort putting together such an intelligent and informed website (not driven by profit)…it really helped me.  

Again, thanks for hard work that really benefits people,
Best regards,

XXX XXXX,


Here is what happened to me-and how I wound up at Kriebel Dental: 

Without a doubt, Kriebel Dental is the BEST dental facility I have EVER been to ANYWHERE that I have lived, including six states in the US, Japan, The Netherlands and Mexico. 

Across the board, I have never encountered such a stellar combination of attributes in one dentist: Scholar-level education and training, polished, adept and PAINLESS clinical skills, experience borne from a 100-year lineage of dentists, and unparalleled, patient-centered treatment ethics.  Bar none, Kriebel Dental is in a league of their own.   The fact that I left Costa Rica raving about my dental experience says quite a bit about the provider.  This is especially true given the severity and complexity of dental problems I had developed by the time I finally (and fortunately) found my way to Kriebel Dental.  It’s difficult to articulate just how grateful I am that I wound up under the care of Dr. Mariano Kriebel, because I know the outcome would have been different had I not been directed to someone with his skills and experience.  The work that I required took a level of assessment and planning that most dentists are not trained for, and among those that are, few, if any, will actually invest the time to do the work correctly.  It simply does not maximize the profit margin, and, from what I have seen and experienced, many dental tourism clinics are focused on one thing: profit.  But, that was not my experience at Kriebel Dental at all. In fact, it was just the opposite: the treatment I received was patient centered and compassionate.  And, the final goal was excellence in dentistry-so my story ends well.  

 However, my dental tourism story did not begin well. While still in the US I had chosen a dental clinic based on poor criteria, and when I arrived to have the work done, it was a hellish experience and ended with me having work done that I was unsure of.  This was because I felt pressured and uncomfortable, and was so tired from flying overnight that I was not thinking clearly.  Thus, I allowed myself to be talked into something that I really should have taken time to think about.  By the time I got to Dr. Kriebel, my poor dental health was further complicated by questionable procedures, all adding to an already complex case.    

As background, I had decided to make the trip to San Jose because the condition of my teeth had deteriorated severely from patch-working dental problems for too long. The financial cost of the ‘quick fixes’ I had over the years had far exceeded a full mouth reconstruction, and without any of the benefit.  I have a severe grinding problem (Bruxism) and was at the point where my bite was so far off that I had worn through bonding, veneers and crowns, and was rapidly losing teeth.   

 For years, I had been hearing that Costa Rica was “The Dental Tourism Destination”  (even my US dentist admitted to this), so, once I made the decision to go, I decided to do my own research, believing that my experience as a “researcher” would ensure that I found a dentist qualified to deal with a situation as complex as mine.   This was a bad decision, in that not all dentists who appear to be “qualified” on the internet are equal.  So, although I followed very specific criteria in my search (eg. those listed with the US Embassy, mentioned on dental tourism referral sites, memberships in professional organizations, etc), in the end, I wound up choosing the Clinic whose name came up most frequently in my search.  I now understand that this simply means that they pay for more advertising than others, and says nothing about the dentists’ qualifications, or the quality of their work.  

 The good news is that I WAS directed to Kriebel Dental and I am inordinately grateful.  Everything about the experience can be rated as outstanding.  Upon entering the clinic I noticed that the office reception is immaculately clean, tastefully decorated, quiet and peaceful, and it is staffed with gracious, welcoming people. I immediately felt comfortable and experienced a huge sense of relief.  The rest of the clinic was equally pristine-every room that I saw was spotless, organized and clearly sanitary.  The dental chairs face huge glass windows with a view of Sabana Park, with mountains as backdrop. Thus, the environment itself is recipe for relaxation.   When Dr. Kriebel came in, I explained my situation to him, chatting on, probably way longer than I should have.  He sat and listened calmly, and (I felt) non-judgmentally, as I babbled on about my deplorable condition and horrendous experience.  There was something about his demeanor that just calmed me down.  He took x-rays, did an exam and asked a number of sensible questions that no-one had ever asked me before.  It was clear that he was listening with a high attention to detail.  At the end, he explained that I did have a complicated situation but it certainly was manageable, and in fact, it was his specialization.  It was at this point that I learned that he had done a four-year specialization at Ohio State University-and this was above and beyond his DDS.  Being an academic myself, I know that Ohio is an excellent school and getting in as an international student is no easy feat.   I asked if he could start immediately, thinking he would jump at the chance given the amount of work that was going to be involved.  He said no.  He wanted to spend time reviewing the x-rays and considering options, and then he would draw up a plan and go over it with me.  I was disappointed because I wanted it all fixed immediately, but internally, I knew I was in the right hands.   

In the end, I had two dental implants and some temporary crowns on the uppers, and all of my lower teeth crowned. Dr. Sergio Ortiz performed the implant surgery and was equally professional.  The procedure was seamless and they took care to ensure I understood every aspect of what was happening.   I am absolutely thrilled with the outcome and will be going back to finish the uppers in the Spring.   Everyone I have shown agrees that my new crowns are beautiful and very natural looking.   

 But, in addition to the appearance of the final product, the process itself was extraordinary, and is testimony to the fact that Dr. Kriebel is a consummate professional.  He is a very rare combination of new-school dentistry and old-school work/professional ethics.  He spent an inordinate amount of time attending to details, including consideration of any possible factor that could affect my bite, and then working to perfect each factor.  Meanwhile, he would regularly check in with me to be sure I wasn’t feeling any pain.  At some point I found out that he was using children’s anesthesia on me and that was why he was asking about pain so frequently.  When I asked why not use regular anesthesia, he explained that he remembered me mentioning high blood pressure when he took my medical history, and apparently regular anesthesia can complicate that.   All of this equated to him spending more of his time-a place where other dentists cut corners in the name of money.   In summary, every single aspect about my experience with Kriebel Dental was excellent.  I recommend them to everyone-family, friends, colleagues, etc.  At a time where the state of medicine in the US is questionable, this was a breath of fresh air and really has renewed my faith that there are health care professionals who take pride in their work, and truly care about their patients. For these professionals patient well-being IS THE BOTTOM LINE.   

 XXX XXXX, February 2016, New York, U.S.A.


Note added 5/8/2016:  I just put up a new post with an email interview with Dr. Mariano Kriebel. (Click on the "Dr.Kriebel" label to find it.) It gives some more background on this clinic. 

Kriebel Dental-New report from US patient

By CometGlare → Sunday, March 6, 2016
I promised to update this blog when my dental condition changed, even in a minor way, so here's my latest adventure in dentistry.

A first molar came unstuck during vigorous flossing right before New Year's.  These things always seem to happen on major holidays.  The following week, my local dentist removed it with a special tool; apparently some of the glue still held the crown firmly in place.   He examined the crown and the prep (tooth stub) and said both were fine.  He recemented it, and the dental assistant had a time removing the stray cement.  The dentist said that the molar had a short prep, but my teeth were short to begin with.

Since the crown was never loose even after it got unstuck, I'm not too worried about it now.  I've changed my flossing habits so now I floss with only one strand of floss rather than the two strands together I had been using.  End of adventure.  Will update as needed.

Happy 2016 to you, dear reader!

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Update: 1/2016 Loose crown, recemented without problem

By CometGlare → Sunday, January 17, 2016
Here's a list of holidays in 2016 when one dental clinic in Costa Rica is closed.  I thought it would be of interest when scheduling visits. It's obvious that ticos observe different holidays than us norteamericanos.  In particular, it seems that they observe only a single day for Christmas, but take a whole week off for Easter.

Be sure to contact your own dentist: His holiday schedule might well be different than the one below.

List of Observed Holidays in 2016

·         March 21st to 25th (Holy week)
·         April 11th
·         May 1st
·         July 25th
·         August 2nd
·         August 15th
·         September 15th
·         October 12th
·         December 25th
·         2017:  January 1st
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Typical Schedule of Holidays in Costa Rica

By CometGlare → Monday, January 4, 2016
Just an update about my dental work after about 4 years and 4 months.

Things are going well, which I'm grateful for.  The dental hygenist says I have the cleanest gums of any of her patients, probably due to clean living...and seeing her four times a year.  I also love my Sonicare toothbrush (the model with the selectable settings so I can brush on "sensitive"), which I use twice a day.  And, oh yeah, I also sip bottled water all the time and swish it around in my mouth.  I'm not going to complain about success.

I also saw a local periodontist for complete periapical x-rays and to see how the work is holding up.   I was concerned about my upper right teeth which have a long history of feeling funny, but there are sinus issues too.  He said the teeth and gums were fine.  My upper left lateral incisor still feels unnaturally numb after the root canal; but there is no pain.  He said that the root looked fine, echoing what my Costa Rica dentists had told me a couple months back.

The periodontist found two small issues with how the crowns fit the gums. As he didn't notice these four years ago when he first examined me, these must reflect changes in my gum tissue since then.  The defects are quite small now, and my general dentist never even mentioned them.  However, if they continue to get worse, the time may come many years from now when I might need a couple of new crowns. There is also a small (1 mm) recession in my gum on the back side of my upper front teeth.  This actually seems much less of a problem than it did when my general dentist commented on it a year ago.  Specialists are excellent in finding irregularities.

So, my 28 crowned teeth are no longer perfect. Oh, well. But I still have 23 or 24 crowns and gums that are as good now as they were in April 2011.

I'll continue to provide updates.


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My dental work at 4+ years (20 September 2015)

By CometGlare → Saturday, September 19, 2015
I have dental x-rays taken once a year, typically in the summer, and last week was the chosen week.  My usual local dentist did the honors.  After an uneventful teeth cleaning and exam ("Wow, those are great margins," he semi-whispered to no one in particular), he looked at the x-rays.  His hygienist pointed him to my #10 tooth, which is the upper lateral incisor that I had so much trouble with in 2013.  (It couldn't hold a crown, so DDS's Dr. Carranza did a root canal and Dr. Prada inserted a metal post. I've already written about how I'm not thrilled with the general idea of root canals.)

Anyway, the dentist and hygienist were in agreement:  The tooth was fractured.  I was pretty distressed, because it had been only two years since the root canal, and because I've been extremely busy lately and didn't want to spend time or money on dental stuff.  As much as I've enjoyed reading about OTHER people's experiences with implants, I wouldn't feel deprived in the slightest at not having one.

Nevertheless, I bit the bullet and sent a semi-frantic email off to Dr. P.  He responded fairly promptly, and asked to see the x-ray.  I was chagrined to admit that I didn't have anything to send him; my local dentist still uses his 30-year-old machine from deep in the pre-digital era.  Dr. Gonzalez (who rarely attends to email) also chimed in and stressed that fractured roots could impair implants because when the body tries to seal off the infection, the underlying bone shrinks.  That makes the implant precarious. Was there pain or swelling?, they wanted to know.  No, just a telltale x-ray.

More worried than ever, I promised to find a dentist with a digital x-ray machine as soon as possible.  Of course, this happened on a Thursday afternoon, which is basically Friday for dentists here in North Carolina since they usually take Fridays off.  After a worrisome weekend, I located a dentist willing to take a pic.  It was taken Tuesday morning (for $44).  An hour later it was on its way to Costa Rica on wings of electrons.  Dr. Prada, Dr. Carranza and Dr. Gonzalez all looked at it and said it looked fine: no sign of fracture or bone shrinkage or anything else.

Whew! What a relief.

I talked with the dentist's office about why they thought it was fractured, since I was curious to know.  Apparently the old x-ray equipment doesn't have the resolution of the new digital ones, and movement might affect how it looks, and...okay.  Not sure what to make of all this, but I now realize that I need to find a local dentist with up-to-date equipment to monitor my teeth.  Once again, I've learned to not take anything for granted regarding dentists.

So that's it.  I thought I'd update you on my latest faux dental adventure.  Now I have to get back to work.

-dave
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False alarm! (19 June 2015)

By CometGlare → Friday, June 19, 2015
2015 May Updates!

Well, it's that time of year again... Time for the May Updates on the Topix forum.

This will be the second annual May Updates. Last year was the inauguration of this tradition.  I had this idea back in late 2013, when the Topix forum was going through one of its periods.  There were a lot of off-topic posts back then and some back-and-forth arguments going on.  My idea was to have a lot of dentist reviews posted at one time in the year, allowing interested newbiews to just read a few days or weeks of posts to get the general flavor of things.  Furthermore, I thought it would be an interesting idea to have folks look back on dental work that had been completed months or years earlier and tell us what they thought.  Most dental patients give their dentists glowing reviews immediately after the work is completed, but problems usually don't become apparent for weeks or months.  So that was the idea behind the May Update tradition.

For the May 2014 Jamboree Update, I emailed dozens of old posters and tried to convince them to post.  Many did, but many ignored me.  This year I emailed just three people (who all ignored me).  So the eight people or so who have posted so far have done so spontaneously, for which I am grateful!

Some thoughts about the posts this year...

>>> I posted an update on my dental work from Dr. Prada.  It was a belated admission that I don't like root canals, which is what I always thought.  I'm still happy with the work, but I wish I had a time-machine so I could have had it all done by Dr. Prada back in 1995 when the first set of 28 crowns were placed.  He fixed a lot of the problems stemming from the 1995 crowns when he worked on me in 2010/2011.  But it is just so much easier (and less expensive) to have dental work done right the first time.

>>> I see a sour note regarding Dr. Castro by one of the posters.  I appreciate honest posts like this.  (And in my opinion, asking folks to contact him privately is the best way to handle cases like this.)  I posted a reminder to him to "Register" so that folks would be able to Private Message him if they wanted to follow up.  I remember seeing another post from a patient of Dr. Castro's (maybe by the same poster, I don't remember) in last year's May Updates (sometime in May 2014, obviously).

>>> I don't understand Infoseek's comment (#6996).  Is this directed to me or to someone else?   I don't know.  It's very easy in a public forum to write a post that seems perfectly clear to the original poster, but leaves some readers scratching their heads.  I've written many such posts.  This is another reason why I recommend that people with complaints reserve their hardest-hitting shots for private discussions, where the criticism is less likely to be misunderstood.

>>> As usual, my posts get flagged.  There are one or two guys who hold a grudge against me and flag my posts routinely.  Eventually, they will get bored and go away.  But until they do, the ratings no longer make any sense because of people like that.

Enjoy!



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2015 May Updates!

By CometGlare → Saturday, May 9, 2015