How to find your perfect Costa Rican dentist

Browsing "Older Posts"

his page is for miscellaneous readers' comments.  If you have a comment on a particular dentist, please post it on that dentist's page.  If it's a general comment, you can post it here.

Please observe blog guidelines for posting. Be polite and respectful when talking of other folks' dentists.


Readers' discussion forum

By CometGlare → Thursday, October 9, 2014
here are several active threads on TripAdvisor about Costa Rica dentists.

I like TripAdvisor because moderators remove posts that are irrelevant or self-promoting.

Here is the single longest TA threadanother long conversation here, and yet at third long one (now closed for comments).
And there are shorter conversations: here, here, here, here (mostly about Costa Rica Dental Team), here, here (about NOVA).  You get the idea.

To see all the conservations about C.R. dentists, you need to page through the lists of individual conservations in the "San Jose (C.R.) Travel Forum".  I've listed the significant ones that were "active" from January 1, 2014 to Oct 9, 2014, when I composed this post.

Searching TripAdvisor and other parts of the Internet:
Press Here

TripAdvisor threads on C.R. dentists

By CometGlare →

I'm not a dentist. I don't have any implants. I have never researched implants and I really shouldn't be commenting on implants.  But I can't help myself, so I'm going to go ahead and tell you what I do know about getting implants in Costa Rica.

Implants are a mysterious topic for many US patients who suddenly learn from their dentist that they need one (or several).  Let's see if we can demystify it some.

First, as I explain elsewhere on this blog, I have nothing against US dentists.  If you have a local dentist that's an expert in implants, by all means, take advantage of him. Not all US patients are so fortunate, and so there has always been a demand for dental services abroad.

Implants are not an exotic specialty in Costa Rica.  CR dentists have been doing them for over 20 years.  Implants are now a bread-and-butter service at many CR dental clinics.  Services can range from a single implant to replace a diseased tooth, to several implants and associated crowns/bridges/appliances to replace all the teeth on the top or bottom of the mouth. I won't presume to give you any advice for your particular needs; that's the job of highly trained dentists.

You won't save much money going to Costa Rica if you just need a couple of implants: The travel costs will eat up the savings, especially since patients generally require multiple trips.  But if you need a whole bunch of implants, the savings can add up fast.  More importantly, you might be able to afford a much better dental solution in Costa Rica for the same price you would pay in the US for a lesser solution.

All of the clinics listed in the "The Dentists" menu do implants.  Patients frequently post on the Topix and TripAdvisor forums about their experiences in Costa Rica with implants.  In the last year alone, people have posted on Topix from these clinics: Cavallini clinic, Nova (Dr. Obando), DDS (Dr. Prada and Dr. Gonzales), Dr. Anglada and others.  My knowledge about implants comes from these posts, and occasional conversations with other patients.

The Cavallini clinic offers high-quality, economically priced implants.  They have placed over 21,000 implants since 1980.  There is discussion on the Internet boards from time to time about the best types and makes of implants, but I don't follow those discussions.  Sorry!  Most patients don't care about the particulars as long the final result is solid and aesthetic.

The Costa Rica Dental Team also does implants; please see their page.

This photo of a lone surfer at the edge of the Costa Rican surf is so relaxing to me.  I hope it relaxes you too.  And if you're reading this blog to research dental implants abroad, you could probably use a little relaxation!  (123RF stock photo)

The specialist clinics discussed on this blog (DDS, Nova, Anglada, and other specialty clinics) offer specialist services, naturally:  One specialist places the implant and another specialist fits the crowns/bridges/appliance.  The dentist placing the implant is sometimes called an implantologist.  Though a graduate of a US specialty program would more frequently be called a periodontist with training in implants.  Implantology is not a separate specialty in US dental schools, though it is in other countries. The dentist placing the crowns would be called a prosthodontist (if he holds a graduate degree in that specialty).  Prices for implants by specialty clinics are pretty standard, about 800 or 850 for just the implant (no crown) according to one person I talked with recently (Oct 2014).  Prices for a crown-on-implant run a little higher than crown-on-natural teeth.  As there are different choices of crown material with different prices, it's hard to quote a figure.

If I needed an implant today, I would probably use my current dentist with a high-end crown made by a top outside dental lab. (I would go to Costa Rica even if I needed only one implant.)  I think that this would run a little above $1800, implant plus crown.  This is the route that one patient took last year for his rather involved case.  It worked out well, judging from Rod's blog, which has already inspired several people to make the pilgrimage to Costa Rica.

For exact prices, you will have to contact the clinics directly.  You can find the URLs of their web sites listed on the clinics' individual pages in the "The Dentists" menu of this blog.  To get comparable quotes, please be specific in the work you need done and how you will pay (credit card or cash/wire transfer).  Some dentists include extractions in quotes, others charge separately.  Most dentists quote credit prices, but some quote cash prices, which are generally lower.   You can also explore choices in crown or implant materials.

Some dentists will work up a prospective treatment plan for complicated cases based on x-rays and photos you send them.  The treatment plan will show how the dentist proposes to treat your case.  It might offer alternative approaches.  See my Q and A posts for more information.

Of course, implants are performed by clinics not discussed on this blog.  Feel free to explore your options among good Costa Rica dentists. It's always great to learn about great, new dentists.

So that's it, folks.  That's all I know about implants.  It's not a lot, but it should be enough to give you a few ideas and get you started. And that's as much as this blog aspires to do.

Pura vida!

What I know about implants in Costa Rica

By CometGlare → Sunday, October 5, 2014
Pacific sunset at Matapalo, Costa Rica


Your comments are welcome.

If you had an experience with any of the clinics listed as Favorites on this blog, either Dave's Faves or Internet Faves, your comments are appreciated.  Even if your experience was a bad one, please let me know.  I can't promise that I'll post your reply, but if I see a pattern of unhappy patients, I'll remove that dentist from my Fave lists.

If you had a good experience with a dentist not list as a Fave, please comment on the "Readers Share Their Favorite Dentists" page. If you have a miscellaneous comment not pertaining to a particular dentist, you can comment on the "Readers, Sound-Off Here!" page.

Many readers will want to know:
  • What was the name of the dentist(s)?
  • When did you have your work?
  • What work did you have done?
  • Anything about the experience that's particularly memorable?

Some optional questions:
  • Was it painful?
  • How did the dentist handle any post-treatment issues that came up?
  • Can you comment on the quality of the workmanship?
  • What did it cost (if you're comfortable providing that)?
  • Suggestions on travel arrangements or accommodations?
  • Has another dentist examined the work?  If so, what did he think?
  • If you have a personal blog, you may post its URL.

  • You can help readers find you on Topix or TripAdvisor
    by providing the post number and the URL. Please don't recopy your post, just post a note like this:  "For more on my good experience with Dr. XXXX, please see my post #6383 on http://www.topix.com/forum/world/costa-rica/THGCO47LHH1FS7DR7/p307."
    We need the URL because there are many separate threads on TripAdvisor and two separate threads on Topix with almost 400 pages.  Give us the post number too.  Topix posts sometimes change pages as the thread ages.

  • If you want folks to be able to contact you, please put your email or web site URL in the post, or refer readers to a post on Topix or TripAdvisor where they can send you a private message.

Finally, help me maintain a respectful and upbeat tone on this blog.  Please don't post comments that are: Disrespectful, unfounded in fact, or phrased overly harshly against any dentist.  There are more appropriate outlets for those kind of posts.

If this is the first comment you've posted on my blog or another Blogspot blog, you might want to make a copy of your comment before posting it. Blogspot may ask you to sign up the first time you try to post, and your comment might get lost in the confusion.

Guidelines for Comments

By CometGlare → Wednesday, October 1, 2014

Q: Which dentists do you personally recommend, and Why?
      A: I recommend several dentists.  In my mind, these dentists fall into four different groups depending on how well I know them.
    (1.) Dr. Prada and his colleagues at DDS Dental.  He's my dentist, and I know him very well.  I've sat in his chair for dozens of hours on five different trips.  I've exchanged countless emails with him, and have even ridden as a passenger in his car.  On a scale of 0 to 100, my Personal Knowledge of him is about a 90.
    (2) Specialists, even if those I haven't heard of.  I have a bias towards dentists who received graduate education *after* their DDS degree.  In the interest of full disclosure, I freely confess this bias of mine up front.  In my eyes, the training of specialists not only distinguishes them educationally--as having served an apprenticeship under excellent established specialists--but it also distinguishes them as having been selected for such training to begin with.  Graduate programs will attempt to choose only the best candidates.
          I recommend that you discover new specialists, those trained in the US (therefore, English-speaking) or those trained in other countries (often English-speaking).
           On my Personal Knowledge scale, all these specialists taken all together as a group rate only a 15 out of 100.  I know them mostly by reputation and some Internet postings. However, my belief in the implicit guaranty provided by their specialty training prompts my recommendation.
    (3) My two favorite general dental clinics of which I have personal knowledge:  The Cavallini Clinic and Costa Rica Dental Team.  I sat for an exam at both clinics in 2010, and have researched them carefully.  I have followed their progress in the years since, and have been impressed with the quality of the work done at very affordable prices.   On my Personal Knowledge scale, each of these clinics individually rates a mere 5 or 10 out of 100.
   (4)  Two clinics that appear over and over on the Internet blogs:  Nova Dental (Dr. Luis Obando and his colleagues) and Dr. Anglada.  I have researched neither dentist, but I've heard excellent things about them on TripAdvisor and Topix.  I would be remiss in not mentioning them to you as you begin your own research.  On my Personal Knowledge scale, these each of these clinics individually rates a mere 5 out of 100.   Dr. Obando and Dr. Anglada are both specialists, trained outside the US, so they fall comfortably within category (2).

Each dentist named above has a page devoted to him in this blog under "The Dentists".  There is a also separate page for specialists as a group.

Q: Do you personally guarantee I'll be happy with any of these dentists?
      A:  I have a lot of personal faith in these dentists, especially "Dave's Faves."  All of these clinics provide quality work.
          But I don't suggest choosing a dentist at random.  Quality is important, yes, but so are other things.  Some are tangible, such as price; others are intangible, such as clinic atmosphere or dentist-patient rapport.  Find a dentist who is an good "fit" for you, not merely one who is excellent in the sense of having good technical skills and access to a good dental lab.
          And if you're not happy with one of the dentists on my site, let me know.  I don't expect much dissatisfaction here--provided you choose a dentist who's not a bad fit for you to begin with. 
          And I apologize in advance if you're not happy.

Q: How about the other great dentists in Costa Rica not discussed on your blog?
      A:  I apologize in advance for not knowing about other great dentists in Costa Rica.  I always wonder about the specialists trained outside the U.S.  I think some of these could be real hidden gems, waiting to be discovered.
            I know there must be little known great dentists in CR, and I'd encourage you to seek them out and sing their praises.

Q: How about great dentists in the U.S.?
      A: If you have a great local dentist in the U.S., by all means, take advantage of the situation.
           I'm not trying to break the bond between Americans and their local dentists.  I'm trying to steer people away from mediocre local dentists (in the US or CR) and toward fine dentists in CR.  It's just a bonus that CR dentists are usually more affordable than their US counterparts.
           But if you somehow got the impression that I had something against US dentists, I apologize.

My Preferred Dentists: One Overview and Three Apologies

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?
             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.

See My Favorite Internet Resources: Press Here.

Or browse some of Dave's favorite dentists from "THE DENTISTS" menu.

Q and A on choosing a dentist

By CometGlare →
What do you think of dental tourism agencies?

              I think dental tourism agencies have their place. They can be very helpful with transportation and lodging choices, but I'd be cautious about allowing them to pick my dentist for me.

              I used a hospitality agency on two of my trips for transportation, but the agency played no part in my finding or choosing my dentist.  By contrast, on my very first trip to CR, I was picked up by an associate of Costa Rica Dental Team, and afterwards took taxis from the hotel to the other clinics during this fact-finding trip.
              Many agencies claim to help American tourists find top dentists in CR.  I discount these claims as mere advertising hype, but some people apparently take these claims seriously.  I'm concerned that these agencies might overcharge or steer patients to less-than-ideal clinics.
              In this blog, I recommend first finding your dentist: The lodging and transportation arrangements should then fall naturally into place.  Most clinics can suggest lodging and transportation arrangements.   Some clinics (usually the general dentists), have staff on payroll that can help with transportation to and from the clinic.  You can find many useful hints on TripAdvisor and Topix. (TripAdvisor is easier to search.)
              Clients of some agencies could pay less by contacting the clinic(s) directly.   I always suggest doing so, without an intermediary.  This usually guarantees you the lowest price and allows you to research dentists at your leisure.  I think that adding an agency merely adds another layer of complexity to the process of choosing a CR dentist from afar.
              Some agencies deal with good dentists, so the only thing a patient has to worry about is overpaying.  In the grand scheme of things, overpaying is not really a big problem.  Far worse than overpaying is the possibility of being steered to dentists based on what's best for the agency and its associated dental clinics rather than what's best for the patient.  I think there can be a built-in conflict of interest here since many agencies are paid commissions by the dental clinics themselves.  The temptation for agencies and clinics to put their own needs before those of their clients and patients concerns me. 
               Some patients have reported that they paid no more for their dental work by using an agency than they would have paid by dealing directly with the clinic.  Maybe so.  But someone has to be paying the agency for their services, and so the dentist must be paying the agency a percentage of the client's charges.  Does not the agency have a financial incentive to steer clients to such dentists?                  I think it's the responsibility of you, the client, to learn how the agency selects its dentists.  I don't keep tabs on agencies in this blog.
              Some dentists in CR don't deal with agencies.  In my visit with the Cavallini clinic in November 2010, I was chatting with Dr. Marco ("the son") by the front desk when an agency called asking for him.  Dr. Marco told him to get lost, in a firm but polite way, and then turned to me and said he doesn't deal with such agencies.  Apparently, this was not the first such call he ever handled.
              Wouldn't you prefer that all the money you fork over for dental work go to the dentist himself, rather than being siphoned off by a third party?  Just saying.
              If you're a dental tourism agency and you think I have unjustly maligned your industry, feel free to post a comment.
              Bottom line:  If you are considering dental clinics recommended by a third-party, you should still research the clinic and talk with former patients of the clinics as discussed above.

Q and A: Dental Tourism Agencies

By CometGlare →
     I've been to Costa Rica five times, but I haven't brought back many pictures; I always had more pressing concerns on my mind.  So when I had to find artwork for my blog, I had to rely on stock photos.  One or two photos are borrowed under free Creative Commons licenses and the rest are licensed.  I started out with a couple of photos from iStock, but soon switched over to DreamsTime.com, which is my favorite stock photo web site.  One of my favorite photos on this blog is the "Tiled Smile" image for the post labeled "Who is the Best Dentist in Costa Rica?".  It looks familiar; I must have seen it before on one other professional website.  I was happy to spring the $13 and claim it for mine.

This page is to help keep track of my photos and to give credit where credit is due.

Photos on this blog without attribution are either from the author's camera or are properly licensed stock photos.

Licensed from iStock photos:



 Licensed from DreamsTime photos:
(Disclaimer: I supposedly get some type of photo credit from the stock photo company if you buy the photo from the links below.)

Seamless jigsaw puzzle pattern
© Photographer: Ratselmeister | Agency: Dreamstime.com

Map Of Central America
© Photographer: Jjvallee | Agency: Dreamstime.com

© Photographer: Sviridow | Agency: Dreamstime.com

Female Blue Morpho Butterfly
© Photographer: Bornin54 | Agency: Dreamstime.com

Woman looking through a magnifying glass
© Photographer: Tijanap | Agency: Dreamstime.com

Browsing the Internet
© Photographer: Leks052 | Agency: Dreamstime.com

Online help
© Photographer: Evgen79 | Agency: Dreamstime.com

Earth with magnifier
© Photographer: Doomu | Agency: Dreamstime.com

Award Ribbons
© Photographer: Sancreats | Agency: Dreamstime.com

Share icons
© Photographer: Eltoro69 | Agency: Dreamstime.com

Blank billboard
© Photographer: Connect1 | Agency: Dreamstime.com

Sunset on the beach of Matapalo in Costa Rica
© Photographer: Piccaya | Agency: Dreamstime.com

Smile Free and happy woman
© Photographer: Ryanking999 | Agency: Dreamstime.com

Tiled smile
© Photographer: Fallenangel | Agency: Dreamstime.com

© Burlesck | Dreamstime.com - Smile. Smiling Lips Photo
Smile. Smiling lips
© Photographer: Burlesck | Agency: Dreamstime.com

Costa Rica
© Photographer: Olira | Agency: Dreamstime.com

 Starfishes on beach sand
© Photographer: Djsash | Agency: Dreamstime.com

Licensed from 123RF photos (www.123rf.com):


About the photos ...

By CometGlare → Saturday, September 27, 2014

a pic is worth a thousand words, how much are twelve pics worth?

I post; you decide.

1. Top. 
Before: Front view
BEFORE. All these "before" pictures are of my old crowns, which were 16 years old when these photos were taken in December 2010. The crowns were placed in 1995 by a North Carolina prosthodontist who liked "Dicor" as a crown material. You can see chips on the upper incisors (circled). These chips were caused by age and wear of the old crowns. I wish I could show you photos of my original teeth, but such photos don't exist. The North Carolina dentist tried to take them, but they got lost. Or something. This was an harbinger of trouble to come.

2. Bottom. After: Front View
AFTER. All the ''after'' photos were taken in April 2011. I like that all the crowns have unique shapes. This material is ''Prettau'' zirconia, which is solid zirconia with *no* porcelain facing. It was chosen for strength and durability rather than appearance. Even so, I am very pleased with these crowns. People interested in aethetics should consider emax or porcelain-fused-to-zirconia, which are more lustrous and even prettier than Prettau. Look at the natural gum line on the upper teeth (circled) and compare that with the gum line in the previous photo. That ''before'' gum line really isn't natural at all. (Google images of real smiles, and you'll see how important a natural gum line is for a beautiful smile.) If you look really carefully at this photo, you'll notice that the upper teeth are ever so slightly darker than the bottom teeth. Had I noticed this before they were cemented in, I would have asked Dr. Prada to send them back to the lab. This crown color is ''B1,'' the lightest natural color in the yellow hue. If I had to do it again, I would go even lighter and probably out of the yellow hues completely. The dentist was Dr. Vinicio Prada of DDS Dental in Costa Rica. All these crowns were made at Lorenzo Favini's dental lab, for which I paid a $75/crown surcharge.

3. Top.  Before. Close-up front view
BEFORE. This photo shows severe wear on all the lower incisors (yellow circle), and a deep gum pocket (pink circle). The gums are unhealthy throughout. Telltale gum inflammation can be seen around most teeth.

4. Bottom.  After. Close-up front view
AFTER. Notice how long the new crowns are. This photo shows the subtle shading on the teeth: Look at the two central incisors on this and photo #2. Near the gums the teeth are shaded yellow to look natural. Dr. Gonazles did crown lengthenings all over to accommodate my short "preps" (tooth stubs). (The dark lighting makes the gums look very red and the top surface of the molars look dark. In fact, the gums are light pink and the tops of the molars the same color as the front.) Dr. Gonzales did a gum transplant to fix the pocket while I was under sedation for the crown lengthenings (normally this is an expensive procedure, but he did it for free). Finally, notice that the biting edge of the incisors is not perfectly straight but has a wavy pattern (circle). This was done on purpose. Lorenzo thought that this looks more natural, and I didn't have a preference. But I'm sure he can accommodate anyone who wants crowns with perfectly straight edges.

5. Top.  Before. Back teeth.
BEFORE. Showing severe gum inflammation in the back, and motley crowns.

6. Bottom.  After. Back teeth
AFTER. Back teeth showing healthy gum tissue and matching crowns. (The horizontal streaking in these photos is a photographic artifact.)

7. Top.  Before. Another side shot
BEFORE. Another shot showing inflammation around crowns in the back.

8. Bottom.  After. A side shot
AFTER. Another side shot showing long pretty crowns and healthy gums. (The back teeth on the left of the photo are streaked because of photographic distortion from the digital camera.)

9. Top.  Before. Bad margins
BEFORE. Bite-wing x-ray of molar teeth showing poor margins on some teeth (arrows). These were a defect of the original crowns and were not due to the age of the crowns.

10. Bottom.  After. Fixed margins

11. Top.  Before. More bad margins
BEFORE. Bite-wing x-ray of more teeth showing more bad margins. I count six really bad margins, and a couple of questionable ones. How many do you count?

12. Bottom.  After. Excellent margins
AFTER. The same teeth with the new crowns showing excellent margins.

[DISCLOSURE Updated 5/26/2019:  Since I originally wrote this post in August 2011, I heard third-hand that this clinic is offering fees to former patients who refer new patients.  I have never taken advantage of any such referral fees, though I cannot rule out doing so in the future.  In any case, such fees played no part in my motivation for starting this blog or reviewing this dentist.  When I talk with prospective Costa Rica dental travelers--as I do once or twice a year--I typically give them several dentists that I think might suit them. I never leave them with just one name to research.]
For my detailed experiences with Dr. Prada and DDS, Press Here.

For some Questions and Answers with Dave, Press Here.

Or browse some of Dave's favorite dentists from "THE DENTISTS" menu.

My Before-and-After photos

By CometGlare → Wednesday, September 24, 2014