Q and A on choosing a dentist

By CometGlare Monday, September 29, 2014


1.  How can a patient in the U.S. research dentists in Costa Rica?
       The best way to research CR dentists is to make a fact-finding trip to Costa Rica specifically for that purpose.  If you find your "perfect" dentist, there might be time to start your dental work on the same trip.  But for many clinics, and especially the specialty clinics, there will be a waiting list and you will have to wait for another trip to start your dental work.

       To avoid the expense of such a fact-finding trip, many US patients try to research dentists remotely.  Many CR dentists will make themselves available for phone consults with likely patients, and will even provide some treatment plans based on x-rays and photos sent by the patient.

       An important part of research is to contact former patients of the clinics you're considering.  Many US patients neglect this step, which I think is a mistake.


2.   What are the signs of a great dentist?
        Problems with dental work are quite common and are not necessarily a reflection on the quality of the dentist.

           Whenever I read the blogs or talk with patients--and I still do, even though my dental work was completed in 2011--I ask two questions:

      (1) Did the dentist spend enough time on the tasks, or was he rushed?  In my opinion, 70% of dental problems stem from haste on the part of either the dentist or his lab technicians, who make the crowns and bridges.

      (2) In the case of problems--which are common in complicated procedures--how did the dentist handle it?  Did he make himself easily available for follow-up questions, or did he hide from unsatisfied patients?  Did he offer to re-do unsatisfactory work, or did he merely cut the patient loose?

         Of course, it goes without saying that the dentist's formal training counts for a lot.  This is sometimes a problem with some general dentists, in CR or the US, attempting procedures like implants for which they have received little training.  If this is the problem, then it will become evident as a follow-up issue in (2):  The dentist will typically be unwilling to help the patient and may attempt to blame problems on factors other than his own skill.  Charges of this type are not credible if coming from a dentist whose CV lacks relevant education or who does not have testimonials from many happy patients with the same procedure.

When I stayed at the Christina Apartotel in San Jose, I would sometimes walk to La Sabana park.  (123RF Stock photo)


3.  Do I need to check the references of a "general dentist" (a dentist without a graduate degree after the DDS degree)?
      Yes! I urge you to personally talk with or email about five patients who have had procedures as complicated as the ones you're contemplating.  It takes some time to do this, but it's well worth it.  It will weed out the mediocre clinics that you want to avoid.


4.  Do I need to check the references of a "specialist" (a dentist with a graduate degree after the DDS degree)?
       A. In my opinion, it's less necessary than in the case of general dentists.  Most US-trained specialists won't give you as many references as the general dentists, nor should they be expected to.  The fact that they graduated from their specialty programs counts as several references.  Despite this, I think you owe it to yourself to talk to at least one or two patients.
           I have less personal experience with non-U.S. trained specialists.  I would probably ask for a few more references, though, just to be safe.


5.   Do I need to check out references of dentists recommended on your blog?
         Yes!
             Regarding my "Internet favorites," I don't have much personal information about these dentists.  You should research them yourself, though I would expect favorable testimonials.
             Even for "Dave's faves," I would urge you to check references.  Things change at dental clinics, and you want early warning of any unfavorable changes.  And talking with patients is the best way to learn about the quirks of the clinic.  So you owe it to yourself to talk with patients of any CR clinic.

Mount Arenal is still on my Costa Rica bucket list.  (123RF Stock photo.)

6.   I'm considering a certain general dentist in CR.  He says that it's unreasonable to ask for five references from patients who had complicated procedures.  Why do I need so many references for a general dentist?
        Good question!  Now let me ask you a question.  This dental clinic you're considering sees hundreds of patients every year.  And out of all these hundreds of patients, the clinic can't find half a dozen that speak English and are willing to vouch for the dentist.  Does that seem reasonable to you?


7.   Which kind of patients make the most informative references?
       Patients who had their dental treatment at least six months--or preferably one year--earlier.  Problems in workmanship rarely show up immediately, but often show up within a year.  Keep in mind that many patients that are not particularly astute or knowledgeable observers.


8.   What is the "honeymoon effect"?
      This is my term for the period immediately after a patient gets dental work in CR.  Typically, the patient is overjoyed with the work, the dentist, the clinic, the climate, the sites, etc., etc., etc.  It's a normal reaction for getting through a psychologically trying experience, which includes most medical tourism adventures.  Importantly, this is also too soon for most problems to show up.
        When talking with references, I try to discount patients who completed their dental work in the past month.  Get their contact information and check back with them a few months later.


9.   I'm looking for a dentist with a perfect record.  Do you know of any?
       If you are looking for dental perfection, you will be looking a long time.
             I don't know any dentist--in CR or the US--with a perfect roster of satisfied patients.  Every dentist has some patients that are unsatisfied with their experience.  It's just a matter of digging deep enough to find them.
        There are numerous reasons for unsatisfied patients.  Sometimes, the dentist or his lab just had a bad day.  Dentists are only human, after all.  Some patients exaggerate the problems, and--here's a news flash--it's not just dental clinics that lie; some patients lie too.  Sad but true.
         And some problems are really no one's fault; they are sort of acts of God.  Lacking omnipotence, there's only so much even the best dentist can do when faced with such cases.    


At least I've seen the crater of the Irasu volcano, alas without a camera.  (123RF Stock Photo)


10.   This dentist in CR has the most fantastic web site I've ever seen.  I just know he's my perfect dentist.  Who needs to research when it's love at first sight?
               Don't be seduced by beautiful web sites.  Many dentists in CR have beautiful web sites.
              The web sites are created by third-parties that specialize in creating elegant business web sites.  The quality of the web site doesn't necessarily reflect the quality of the dental work that goes on in the clinic.
              My free advice:  Of all dental tourists, you especially need to do due diligence on your dentists.


11.   I had to cross this one CR dentist off my short list because he doesn't answer all my emails.  If he doesn't respond to me now, how can I be sure he'll respond if I'm his patient?
       Dentists are under no obligation to personally answer your emails or provide treatment plans.  They do so as a courtesy for their distant patients.
             Before you see your dentist, you are just a prospective patient; he doesn't really owe you anything (except possibly to tell you the truth, which they don't always do).  Once you see him for treatment, you become an established patient, and he has ethical and legal responsibilities to you.
             In my experience, there isn't much of a correlation between how well a dentist treats his prospective patients and how well he treats his established patients.  I have heard of dentists who roll out the red carpet to prospective patients, but turn a cold shoulder to established patients if problems develop.  My own dentist ignored some of my early emails (possibly because I wrote a lot of them as I'm a difficult patient), but now that I'm an established patient he answers them.
              Also, keep in mind that dentists frequently travel or have emergency responsibilities at the clinic that prevent them from immediately returning email queries.


12.  I'm comparing prices of CR dentists. What should I consider?
      Just compare apples with apples and not apples with oranges.
           Some clinics will include other services in a quote for free (such as extractions when quoting an implant).  While most clinics quote prices as paid by credit card (and often offer a 5 or 10 percent for cash payment), a few clinics quote cash prices (and charge more for paying by credit card).


13.   Is it true that CR dentists will give me a treatment plan for free?
      Yes, many dentists will work out a treatment plan or plans for you.  They do this as a courtesy.  It's the dentist's prerogative as to whether or not he wants to work up a treatment plan for you.  Please don't abuse this:  Limit the number of clinics you ask for treatment plans to a reasonable number, such as two or three.
            Working up a treatment plan from emailed photos and x-rays requires a lot of work and thought from the dentist. I recommend doing some research on the clinic before asking them for a treatment plan.  Let them know that you're interested especially in them.


14.   Can I get quotes for dental work in CR?
        Yes, most clinics will be happy to give you a price list.  The office staff can easily provide this if it's not already on their web site.  Or you can email them a list of the procedures you want, and they should be able to quote you prices and a total.
               It is much easier for a dentist to prepare a quote based on a prospective treatment plan than to develop a treatment plan from scratch.


15.  Do dentists in CR guarantee their work?
         Many do.
         My "faves" (Dr. Prada and DDS; CRDT; and the Cavallini clinic) have good guarantees.  They generally offer to re-do work that is not satisfactory.   (In my research, all three of these clinics have done so.  Dr. Prada re-did a crown of mine that kept on falling out.   He once told me he re-did a full-mouth restoration that failed because the crown material failed too early.  The Cavallini clinic has also re-done work on occasion.  They used to offer a dental insurance policy that would pay for a trip back to the clinic, though I think they had to revise that.  CRDT offers a ten-year guarantee, described in some of the links on their main page here.)    Contact the clinics directly for their current guarantee policy.
              I haven't researched the guarantee policies for Dr. Anglada/Dr. Castro or for Nova Dental. 
              Many other clinics in CR also re-do unsatisfactory work.  Of course, the dentist re-doing the work is the same dentist (usually) that did the work in the first place.  So be careful in whom you choose.  I, personally, would never go back to a dentist if I thought the problems stemmed from his carelessness.
              By contrast, I don't know of any local U.S. dentists that routinely re-do work that is unsatisfactory.  And don't tell me it's because 100% of their patients are happy.


16.   Are there bad dentists in CR?
      Does the sun set in the west?
           

17.  How do I know which dentists to avoid?
              Having learned this lesson the hard way, I now choose only top dentists.  I would suggest you do the same, regardless of whether you're looking to have your dental work done in Costa Rica or in the US.  Who needs dental work that's merely average?
             A few CR dentists are so terribly inconsistent, let's say, that a simple Google or Bing search such as this:
                 costa rica dentists dentistname
or this:
                 costa rica dentists dentistname site:www.topix.com
will dig up a lot of negative reviews.  That's your cue to stay clear of that clinic.
             See my post on searching the Internet.


I saw the Poas volcano on one of my first trips. (123RF Stock photo)


18. A CR dentist gave me a lot of good references.  I talked to some on the phone, and saw other testimonials on the Internet.   But then I found a bad review on the Internet.  Should I scratch this dentist off my short list?
     Maybe or maybe not. A lot of negative reviews about a dentist is definitely a bad sign, but one or two negative reviews--in the context of a lot of positive reviews--probably doesn't mean much.
     Negative reviews sometimes do not reflect problems in dental care.  Sometimes the outcome is just plain bad luck, and sometimes--gasp!--people on the Internet have hidden agendas of their own.  Try to contact the poster and find out the back story behind the problem.  It's crucial to establish the credibility or lack thereof of the poster.   The basic questions I try to ask patients are: Was the dentist rushing or taking short-cuts?  Did he refuse to handle follow-up requests?
    Some reports are posted anonymously, making it impossible to contact the poster.  I tend to ignore these, whether positive or negative. Who knows the motivations of the poster?  I suspect that jealous competitors are behind some of these.
    Finally, if the negative review really torments you, you might be able to get some (private) clarification by contacting the clinic directly.
    Here's the bottom line, in my opinion: Internet research can provide you with leads and sometimes even help you identify the most mediocre clinics.  But for finely focused questions, it's good to talk with patients directly.


19.  I am very busy and don't have time to research CR dentists.  What would you advise me to do?
      I would send you to the dentist whom I know best: Dr. Prada and colleagues at DDS dental.  After you make your appointment, you can book your hotel reservations at the hotel across the street from Dr. Prada's Escazu office, the Villas del Rio Apartotel.  This is one of my favorite hotels.  The hotel staff is very gracious and dependable. Their courtesy shuttle will pick you up from the airport when you arrive, and it will take you back when you're done.  They have a little convenience store in the hotel compound, and you can exchange dollars for the local currency at the front desk.
      There are less expensive lodging possibilities available.  Rod mentioned one of his favorites on his own blog when he visited Dr. Prada, and some are discussed on TripAdvisor.


20.   If I didn't want to see Dr. Prada, whom would you then recommend?
      If economics is the crucial factor, I'd probably point you to the Cavallini clinic or the Costa Rica Dental Team.  Otherwise, I'd probably suggest you look at one of the other dentists discussed on this blog or explore other specialists.  (Yes, I like specialists as I said earlier.)
            I would expect you to talk to former patients from any dentist(s) who intrigued you.


21. What's the single most important take-away message from all this?
When considering general dentists, talk to or email multiple patients who had work as complex as the work you are considering.  For general dentists not on this blog, I'd suggest talking with at least four or five patients.


For my thoughts on dental tourism agencies, see this post.


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