Q and A with Dave

By CometGlare Monday, September 22, 2014
Photo credit:   High Smile    by Yacine Baroudi  (CC 2.0)
ow that we're together, here's your chance to pick my brains.  Go ahead, I'm ready.

1. What is the purpose of this blog?
             To share my own story, and to give me a place to post my comments on the Costa Rican dental scene.
             I also want to encourage folks to think of Costa Rica for their major dental needs.  Yet at the same time I want to gently steer them toward the better clinics and away from the mediocre ones.  These two goals are something of a mixed message, which is reflected in the visual themes I've chosen for my blog.  The award medals signify the fine dentistry available in Costa Rica, and the puzzle pieces are there to remind readers to do their own research to find their perfect dentists. 

2. My local dentist warned me to stay away from Costa Rica dentists.  Was he wrong?
            Not entirely.  Sadly, there is a lot of mediocre dentistry going on in Costa Rica. But Costa Rica has a lot of great dentists, too.  It would be a shame to throw the baby out with the bathwater.

3. There are hundreds of dentists in Costa Rica.  Why are so few of them discussed on your blog?
          I only discuss dentists I have a lot of information about, and the information is overall very positive.

4.  Why not tell us which dental clinics to avoid?
          That's not the purpose of this blog.  I'm trying to keep it upbeat and cheerful and hopeful, and that requires my limiting my discussions to select dental clinics.  Plus, I just don't have enough lawyers on my staff to handle blowback from negative reviews.

5. In your opinion, how do Costa Rica dentists stack up against US dentists?
          Well, of course, it's hard question because every country has its share of both medicore and excellent dentists.  I'm not aware of any scientific surveys of dental excellence, so I'll just have to give you some of my subjective feelings on the issue.
       Consider Dental Excellence on a 0 to 100 scale. (I really like these numeric scales.)  The advantage of bringing numbers into this discussion is that it permits me to talk about quality when it varies widely among dentists. 
        I would rate the dentists described in (1) to (4) above as 90 and above. I leave it as an exercise to the reader to figure out precisely where each dentist stands in the range 90 to 100.  The point is that these are all excellent dentists.
        I would rate the average general dentist (*excepting* those mentioned above) in Costa Rica as probably a 60 to 70.  This reflects my personal bias against general dentists.
        I would rate the average general dentist in the US as probably a 70 to 80.  I think that the "typical" US dentist is better than the "typical" Costa Rican dentist, even though the variation among the dentists in each country is huge. 

6.  You rate all the dentists on this blog as 90 or above.  Do you think that they're all equal in quality?
          I think they differ somewhat in quality, but that they are all excellent dentists.  I tend to think that my own dentist, Dr. Prada, is a little better than many of the others, but you should take any opinion from any patient about his personal dentist with a grain of salt. As I mentioned, I have less personal knowledge of Dr. Obando and Dr. Anglada, but they are rated highly on the Internet.
       I think that it is the duty of each prospective dental patient to do his or her own research to find the best dentist for him or her.  But if you pick a dentist on this list, I'm not worried for you.

7.  So, what I'm really wondering is, Who Is the Best Dentist in Costa Rica?
          There is no single CR dentist who is the Best Dentist for every patient.  The dentist that best matches your own specific personal needs and preferences is the best dentist for you.

8.  How do the dentists on this blog measure up against my local neighborhood US dentist?
          I suspect that in general the dentists mentioned on this blog are better than your local dentist for complicated procedures like implants or full-mouth restorations.
           I have nothing against US dentists. In fact, I hired one in 1995 to do my full-mouth restoration.  Please use your local US dentist if he's your best choice.    There are many superbly capable dentists in the US.   If you are fortunate enough to know one, you should be proud to let him (or her) do your dental work.
           That said, I should mention that Costa Rican dentists have a built-in advantage over most US general dentists.  The dentists on this blog do complicated cases day-in and day-out.  After all, patients don't travel to Costa Rica for teeth cleanings; they travel only when they need major work.  If "practice makes perfect," as the old saw has it, then Costa Rican dentists should be a select group indeed.

9:  How do prices for dental work in Costa Rica compare to US prices?
            Prices in CR are 50% to 70% lower than US prices, and often the work is of better quality.
            For example, one specialty clinic charges a less than $2000 for an implant including crown.  Many US dentists would charge $4000 to $5000 for the same thing.
            Of course, the lower prices are partially offset by the costs and inconvenience of foreign travel.

10.  How do the prices of CR specialists compare with those of CR general dentists?
                 Specialists charge more, perhaps 50% more for comparable work.  There's a fair amount of variability in prices though, so check with your clinics for exact prices.  

11.  How does the quality of the work done in Costa Rica compare with that of US dentists?
                 If you stick with the top CR dentists, your work should be better than what you could obtain at most local US dentists.  This is a major theme of this blog.

12. How safe are dental offices in Costa Rica?  I've heard rumors about problems with disinfection and sterilization procedures.
      Procedures are generally the same as in the US, with the same autoclaves and other equipment used in the US.  Obviously, I can't vouch that this is the case in every single CR dental clinic, but it is certainly the case in the overwhelming majority.  I've talked with scores of real CR patients--by phone, by email and in person while in CR--and this topic has never come up with real patients.  It only comes up on Internet boards.
      This myth has a lot of staying power.  I continue to see it, though less frequently now than four years ago.  Some of the photos posted by patients or by clinics show dental assistants sterilizing supplies.  There's nothing like photographic evidence to ease one's mind.  Once you're at the clinic, you'll immediately see how serious and professional everyone is.
      So stop worrying about this.

13.  Is travel in Costa Rica as safe as in the US?
       I feel quite safe when visiting CR.  Then again, I'm careful by nature, and I've been to CR five times.  But let me say a few words, because I'd feel badly if any reader of this blog got hurt in CR. 
     Costa Rica is different than the U.S.  For one, the infrastructure isn't as advanced as in the States, though it is slowly improving.  For example, not every area has sidewalks.  There are some potholes in a pedestrian path in Escazu about half a mile away from Dr. Prada's office.  I could see careless tourists stumbling into them, especially at night.  Motoring in the country is more challenging, so I'm happy to play it safe and not drive.  Some more daring tourists, like RJ, have rented cars with success.
     Culture differs too.  It took me a while to learn how to cross busy streets without crosswalks. (It's a matter of timing one's run.)  I myself have had no problems with crime, but the topic does come up.  Reports of pickpockets show up occasionally on Topix.  During a visit to CR, a fellow guest at the hostel lost his wallet while dancing at a nightclub, which was obviously not a prudent thing to do.  I'd like to hang onto my wallet, so I keep my credit cards and bills in a neck purse when in CR. It's much more secure than a wallet in a back pocket.
     In July 2013 a guest at my hotel told me about a serious accident involving a US tourist.  A few years earlier, he said, a young man on a rafting trip was killed when a branch struck him in the face.  What a tragedy.  I imagine that such a trip in the U.S. would have been more closely supervised.
      Realize that CR is not the same as the US.  Keep your eyes open and use common sense, and you'll be okay.

14. Has CR dentistry changed in any ways since you first visited there?
     Yes, I think it has--and for the better.  There have been improvements in both dental materials and in procedures.

15. What improvements in dental materials have you heard about?
       In my visits in 2010 and 2011, the most aesthetic type of crown material was porcelain fused on zirconia (PFZ).  Zirconia "cores" are strong, white, and opaque.  They reflect light and look great behind a facing of translucent porcelain.  Costa Rica attracts dental tourists from all over for its zirconia crowns.  In the past couple of years, a new material--e.max--has stolen the title of "Most Aesthetic" from PFZ. 
      There have been major improvements in another material, called "full-contour zirconia," which is a solid zirconia crown without a porcelain facing.  The enamel look is built into the material.   My own crowns are of this type.  The brand name is "Prettau," made by Zirconzahn.  Local dentists in the US were skeptical of my choice back in 2010, and tried to persuade me otherwise.  Their concerns proved to be unfounded.  Over the past few years, this material has become more widely accepted in the U.S.  There is even an new version of Prettau with improved aesthetics (see TheDentalTourist blog). Another manufacturer has come out with their own competing material.  What had been a tiny niche market four years ago has now gained inroads in both the US and CR. The speed of innovation in crown materials is startling to me.
      All this innovation is great news for dental patients.  Everyone benefits when materials become more durable, more beautiful, and easier to fabricate.
      Dentists in Costa Rica offer crowns in e.max, PFZ, full-contour-zirconia, and others.  Not every dental clinic offers every material.  (Many CR specialist dental clinics can make crowns in full-contour zirconia, especially if they use an outside lab with the necessary equipment and expertise.  However, when I last checked, the Cavallini clinic did *not* use this material.)
      Finally, a word of advice.  As pretty as it is, e.max has limitations and is not the best choice for every patient and every location.  I'm not a dentist, and I can't advise you on the best choices for your particular case.  I can merely inform you that options exist and that some dentists and some patients are happy with them.  To add to the range of options, good dentists will sometimes use one type of crown for the front teeth (emphasizing aesthetics) and another type for the back teeth (emphasizing strength and durability).  It's your dentist's job to advise you on the best crown materials (or implant types) for your particular case. 

16. What improvements in dental procedures have you noticed in the past few years?
     It seems that some of the fancier specialist procedures are beginning to trickle into the mainstream.
    When I visited in late 2010, I asked several dentists about crown lengthening procedures for all my teeth.  This wasn't my idea; it had been suggested by an excellent local periodontist as a way to treat my long-standing gum inflammation.  Most of the CR dentists were neutral about the procedures, and the general dental clinics didn't think it was necessary.  (One CR clinic--not a Fave--even went so far as to claim that crown lengthenings would weaken my teeth.  Wrong.)
     In the past year, I've heard posters on Topix talk about having such advanced procedures done at some clinics of general dentists.  This also surprises me.  This advanced, niche procedure has gained greater acceptance in just a few years.  I imagine that what has happened to this one procedure means that other specialty procedures are winning greater acceptance also.
     This is yet more great news for dental patients.  As clinics become more and more comfortable with working specialist procedures into their workflow, patients can only benefit.

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