A TRUE DENTAL STORY …. (S’s story)

About a year ago I went to have my first dental checkup in nearly two years. My dentist didn’t even bother to X-ray my front teeth. He hung the back X-rays up for me to see, comparing them with my two year old X-rays, and announced “if you don’t have these teeth capped soon, you are going to lose them.”

“And how much does that cost?” I asked. Two years before, Dr. S had tried to sell me a splint to ward off the effects of my bruxism (teeth grinding). But I couldn’t figure out how this $125 implement was supposed to help and he didn’t really explain it, so I passed on it.

“Seven hundred and fifteen dollars per tooth,” he said with what I hope wasn’t really the I-told-you-so air I seem to remember in his voice. “At a minimum, we need to cap these five, which are almost down to the nerve, immediately.” To “cap” or “crown” a tooth, the dentist grinds the original dooth down to a post or cone shape, and creates a sculptured replacement tooth which is cemented to this sculpted receiving surface. I would later learn that $715 is actually a very reasonable rate in the US; I’ve spoken to people who paid from $850 to $1,400 for the same procedure, and to only one whose rurally located dentist charged “only” $650.

I had a once-slight underbite which was no longer slight. My top teeth were sliding down behind my lower teeth instead of meeting them, and my back teeth were all worn down to varying degrees so that the tips of my incisors nearly met the opposing gums. All in all I had seven front teeth that weren’t disastrously worn — and they were badly misaligned, as well as discolored.

What Dr. S was proposing was nearly four thousand dollars worth of work which would be little more than a stopgap measure, leaving me with the same messed up bite and at least 15 more teeth waiting to give me trouble in the future. I really couldn’t see spending that much money to end up with the same problem. Getting them all pulled and having dentures made was looking like a very reasonable alternative.

It was obvious to me, even though Dr. S didn’t seem interested in telling me, that what I really needed was to have all of my teeth capped at the same time so that instead of simply duplicating my messed-up condition, my bite could be elevated and corrected. I didn’t know it at the time but this is a somewhat standard procedure called “full mouth rehabilitation.” If Dr. S considered me a candidate for such a procedure, he probably figured I was too cheap to pony up for it — which was at least partially true.

I mentally multiplied $715 by 28 and groaned. Either my teeth were about to become the most expensive thing I ever owned, or I was going to lose them and likely have to start wearing dentures at the age of 39.

The Idea

Some of you may remember that one of the good things that happened to me during the rollercoaster year of 2003 is that a nice person gave me a perfectly driveable 1982 Chevy van. The nice lady who gave us the van did so because she had only recently become a nice lady instead of a nice guy after her sex change operation. And the van, as she said, “just wasn’t me any more.” In the process of collecting this gift we heard her story, which included how she had travelled to Thailand to have both her sex reassignment and gender enhancement surgery performed, because it was so much cheaper and there was no waiting list there.

A few days after getting the news from my dentist I put the words “Dentistry” and “Thailand” into Google and my jaw hit the floor. The ceramic-over-metal caps my dentist wanted $715 for could be had for $125 at several places that would even make my appointment and plot my course of treatment over the Internet.

It was still an iffy proposition, though, what with that $3,000 round-trip airfare to consider.

Thinking of other places, I remembered that Costa Rica has one of the best medical systems anywhere and is also much cheaper than the USA. Googling “Dentistry” and “Costa Rica” revealed that I could have the services of a world-class expert who had a lot more experience than Dr. S, at $350 per tooth.

I have to admit it was the girlfriend elsewhere known as “Y” who thought of Mexico. Once again we found tales of $120 caps, and of an entire industry catering to American medical tourists. In several places along the US-Mexico border, clusters of dentists operate within convenient driving distance so that an inexpensive bus tour from Las Vegas or a trolley ride from San Diego could bring you to where this cheap care was available.

Nowhere did we find a horror story — indeed, everything we read was very enthusiastic. We did research and began to lay plans.

Who Should Consider This?

First of all, if you live any distance from the Mexico border you should need a fair amount of work — at least two or three caps, or bridgework or some similar work that would run a few thousand dollars at home. Depending on what you need done it is likely to take three or more trips to complete your course of treatment, and it’s silly to let travel expenses eat your savings.

Second, you may want to be wary of any procedure that involves major anesthesia, such as removing impacted wisdom teeth. The drug laws make it practically impossible for a Mexican dentist to prescribe the most potent pain therapies for you; an American pharmacist can’t fill the prescription, and you can’t bring scheduled drugs back across the border if you fill it in Mexico. On the other hand there is also a lively cosmetic surgery business operating in the same way, doing liposuction and facelifts and similar procedures, so there may be a way to deal with this. It might involve staying in Mexico for a few days to recover; more on that below. My procedure was extensive but involved no drugs other than novacaine and antibiotic mouthwash.

Third, the work you need should not be just-invented cutting-edge stuff. Most Mexican dentists will have access to state of the art adhesives, crown and facing materials, whitening agents, and so on; but only the top tier will have lasers, computer models, and other recently introduced high-tech tools. While my procedure was extensive it was done entirely with equipment that hasn’t changed much since 1950.

Finally, you should be able to take the time off of work for the travel and “slop” days you’ll want to schedule in case something needs retouching. Like the travel itself, the lost work can quickly eat up your savings on a modest job that requires multiple trips.

How do you Find a Dentist?

I did not do this, but most of the people who have had dental work done in Mexico tell you to go to Tijuana or wherever it is convenient and look for a dentist. If you live in the Southwest you can probably find a tour service that will make travel arrangements for such a “dental vacation.” And if you just have one tooth that needs a cap or similar minor work and you live within easy travel distance of a Mexican dental destination, it might even make sense.

I have never felt comfortable taking such an informal approach with something so expensive and important, though. I had to travel over a thousand miles and take significant time off of work, so I wanted to know what I was getting into before getting on an airplane. So I waited to find a dentist who had e-mail. This is still an unusual thing among Mexican dentists but I expect it to catch on fast. This way you can e-mail photos and X-rays, and make travel accommodations sensibly. I found Dr. T in Tijuana, which is not very close to New Orleans but makes for very convenient air transportation from just about anywhere in the US.

If anyone reading this needs work like mine done, e-mail me in private and I’ll refer you to Dr. T. But if you Google for tijuana-dental you will probably find him anyway.

Once I sent him my X-rays and photos of my teeth, Dr. T confirmed my own self-diagnosis and told me about “total oral rehabilitation.” He gave me several references who had had very similar work done, and indeed on my first visit he showed me a study model of another patient whose condition was nearly identical to my own.

How Long Does This Take, and How Much Does it Cost?

I had to send Dr. T my physical X-rays, since scanning them doesn’t do justice to the details. Like all the dentists I contacted about this he warned me that I would probably need an unknown number of root canals in addition to 28 caps. (Depending on one’s condition, bridgework and facing may also be part of the mix.)

Generally, it takes five days or so to make a cap, so you need two visits — one to prepare your mouth, and one to install the cap. The days in between can be vacation time in your strange destination or you can go back home, whichever makes more sense.

In my case the extensiveness of the problem meant that before Dr. T could make caps, he had to make a study model of my mouth and plan a course of action. He did not use any computer models to do this — it was all done with impressions, casts, and plaster models. He also had to verify, as I suspected from my local dentist, that I didn’t need any root canals after all. Root canals greatly stretch out your treatment because it’s unwise to do more than one or two at a time. They also add cost, because the root canal (extracting the diseased nerve tissue and replacing it with inert material) must be followed by inserting posts into the tooth to receive the cap. So you still have the cap, plus the posts, plus the root canal. This is why some people who have this kind of work done in the US end up spending $40,000 on their teeth.

The study model delay meant that my eight-day stay wasn’t long enough to have caps made and installed, so my first visit to SoCal was almost a pure vacation — or it would have been, if half of San Diego County hadn’t burned while I was there. My advice is to plan the first trip as a short one for your dentist to inspect your condition and create a plan of attack.

Trip #2 was originally going to be to completely prepare and finish about half of my teeth, so I booked another week in San Diego. After further study, though, Dr. T decided to do everything at once; trip #2 would be all preparation, and I’d have to wear temporary (plastic) caps while my real caps were being made. In this way my bite could be corrected all at once. Alas, the airline reservations were already made so once again I spent a couple of extra days out of town.

Trip #3 was to be a short one to install the caps and perform adjustments, but by now I was used to spending a week in San Diego so I did it again. This gave me a chance to try out my new teeth at some of the great restaurants I’d discovered on trip #1.

Meanwhile, the basic cost for work which would have run at least $20,000 in the US was around $8,000. Even with all the travel and lost work I have saved between $10,000 and $20,000 by doing it this way.

How Do You Get There?

If you live in the US Southwest you have several options, but the simplest thing if you live any distance away seems to be to fly to San Diego and get the work done in Tijuana. That’s what I did, so that’s what I’ll describe. (If you have a similar experience with another destination, please do comment on it.)

The key to using San Diego as a gateway is the Blue Line Trolley, a high-performance public transit system that goes all the way from north San Diego to the border. Having travelled the entire Blue Line scouting for hotels I can save you a lot of work and grief by telling you to stay on E street in Chula Vista:

• You can find a hotel in the $40 to $80 a night range. A Best Western, Days Inn, and Motel 6 are located within rock-throwing distance of the E Street trolley terminal. Elsewhere the hotels are either very expensive ($120 a night and up in San Diego) or a real hike from the trolley.
• Cab fare to and from the airport is a reasonable $25 or so. If you’re adventurous you can also take the 992 bus from the airport to the America Plaza trolley stop, but it’s a pain to do that with luggage.
• At the E street trolley stop there is a tourist information center that can tell you how to get anywhere with public transit, sell you discount tickets to things like the zoo and Seaworld, and so forth.
• The E street hotels are a manageable walk or short bus ride from a public library which offers free unfiltered Internet access. While there is a library just off one of the northern trolley stops, the Internet access is limited.

There are vending machines at the trolley terminal. You can get a one-way or round-trip pass for a few dollars based on your starting and ending destinations, or a “day tripper” that gives you unlimited riding on all the trolleys and buses for $5.00. You can also get discounted Day Trippers for two three, and four days, with four days coming in at $15.00. (You can also pay the San Diego Stupid People Tax by buying a one day round trip ticket from San Ysidro to the opposite end of the line at Mission San Diego, which they will cheerfully sell you for $6.00 — a buck more than the unlimited use day pass. Go figure.) You can get a lot more transit information online

The trolley has no access controls. Just buy your ticket, stand on the appropriate platform for the direction you want to go, and when the trolley shows up press the button to open the door and climb aboard. They do random spot checks for tickets, and you can expect to pay a hefty fine if you game the system by riding ticketless. I’ve experienced four of these spot checks in the time I’ve spent riding.

Once you reach the border, follow the stream of humanity into the spiral ramp building to the pedestrian bridge over the border. On the ground on the other side you’ll pass through two turnstiles, and find yourself at a cab stand.

Do not try to walk from the border into Tijuana. Trust me on this. My dentist e-mailed me a map and said to show it to the taxi driver, but he did not count on the fact that a lot of taxi drivers in Tijuana can’t read. You need the local map yourself, but find a landmark on it. In my case the Plaza Rio shopping center was the thing every taxi driver knew, with a convenient taxi stand to catch one going back to the border, and about two blocks from my dentist. When you go through the turnstile you will be beckoned by eager taxi hawkers. Ask one of them “How much to Plaza Rio?” (or wherever your dentist is near.) Always get the price first in Tijuana. Border to Plaza Rio should be five dollars, and it’s well worth it even though it’s a short ride. The area around the border in Tijuana is unbelievably snarled and confusing.

On your return, tell the cabbie “to the border” and you will be dropped off at an entirely different place. Again follow the sidewalk and the drift of people to the customs station. You will have to go through a metal detector and show your ID to an immigration official. You do not need a passport, but I have one so that’s what I used. At some peak periods there are long lines; if you make the mistake of taking your car there are always long lines of traffic.

While you are in the Plaza Rio area, you can shop for your one permitted bottle of cheap liquor at the Comercial Mexicana (think “Mexican Super Wal-Mart”) in the Plaza Rio Mall, which is about 30% cheaper than the tourist traps in walking distance of the border. Every business in Tijuana seems to take US currency, and most are used to dealing with gringos like me whose entire Spanish vocabulary consists of “por favor,” “gracias,” “si,” and “non.” If you buy rum or tequila make sure it isn’t made in Cuba — Mexico trades with them, but the US customs people will take it from you at the border.

What Other Ways Are There?

If you have or rent a car, do not take it into Mexico. This is a Very Bad Idea for a lot of reasons. You can park at several places along the route between San Diego and Tijuana which offer bus service into Tijuana, but most of these will drop you off at a place where you will be mobbed by vendors trying to sell you stuff, and probably not very convenient to your dentist. Frankly I think you’d be better off parking at the Beyer Street trolley stop in San Ysidro and buying a round trip ticket.

There is also a bus which has stops much more convenient to the hotels along I-5 in San Ysidro, but most of the buses only offer half-hour service while the trolley offers 15 minute service most of the day. The closer you stay to the border the more expensive it is to get to your hotel from the airport, too.

The border is not a pleasant place; it’s the economic version of an “edge ecology.” Edges where different environments meet make for interesting animal and plant species, because you get all kinds of specialized predators and prey adaptations. If you are going to Tijuana to spend thousands of dollars on your teeth, there is a wide array of predators ranging from the over-aggressive merchant to the pickpocket who will want your money. My advice is to limit their access to you. For the same reason I advise even more strongly against staying in Tijuana itself unless you are very comfortable with the language and culture.

Even Chula Vista may be a little close for some peoples’ comfort; it’s a stereotypical Southern California city that has grown too fast, planted in the desert where there is no particular reason for humans to live, overpopulated with disaffected youth and poor people who struggle to pay the outrageous rents. There is a lot of evidence of gang activity. The inexpensive hotels on E street get a bit rowdy on the weekend. It was within my comfort zone but then I once lived in a similarly blighted neighborhood in New Orleans. The main thing is to use common sense and avoid looking too affluent.

How Will the Work Go?

Here is where one caveat is in order. If you expect a medical facility to be in a nice glass and concrete building with Muzak drifting from hidden speakers and a statuesque receptionist, you’re going to be in for a bit of a shock. Dr. T’s office was small, in a building that needed some obvious repairs that were never going to happen. The trimwork was uneven. And the receptionist doubled as his dental assistant, so she sometimes had to leave my ongoing procedure to answer the phone.

This is all, however, in keeping with the Third World philosophy of putting the money where it’s needed. The equipment was all in good working order, everything was clean, and most of all I was very impressed with both the doctor’s bedside manner and his skill. After examining me on my first visit he explained exactly what he was going to do, and added up how much it would cost before breaking out the novacaine.

Another item is interesting. He said that, normally, as part of an oral rehabilitation procedure that my wisdom teeth would be extracted as a hygienic measure, because they can’t be capped. (Think of where they are, and the size of the tools.) I balked at this, because my wisdom teeth are one of the things my body has managed to get right. They all came in perfectly and have never presented a problem, except for their participation in the bruxism disaster. Where I’m sure an American dentist would have said “no, they need to come out,” Dr. T asked a couple more questions and finally said there wasn’t really any need to pull them now; if they ever become a problem I can always have them pulled. And furthermore, once the pressure is off of them because the other teeth are crowned, they’ll tend to rise, making them easier to extract in the future. That settled it, and at the moment I still have my wisdom teeth.

It was clear to me that Dr. T was very experienced. He performed all aspects of my rather complicated procedure with a manner of unhurried confidence. A procedure like mine is as much an art as it is a medical procedure; working with hand tools the dentist must sculpt the living teeth into appropriate shape to receive caps, and then must create caps which are not copies of existing teeth but instead are an original sculpture which must both look good and function mechanically for eating. It may be important to note that Dr. T is not at the bottom of the Tijuana price scale; while there are dentists who will do a single cap for $120 he is not one of them. His prices run $280 to $350, and no doubt reflect his experience.

On my first visit Dr. T cleaned my teeth and took impressions; it then took him awhile to make the study model and plan my treatment. On my second visit to San Diego I made two trips to Dr. T’s office, spending about 4.5 hours each time as he prepared my teeth and took more impressions. On my final trip, as I walked in he told me “yours was an especially difficult case.” In addition to the grinding down my TMJ (jaw joint) had worn so that my jaw was a tiny bit to the left of where it is supposed to be. Nevertheless he felt that with a couple of caveats my new bite would be acceptable. After about 3 hours of work he announced that the caps were in, and while we would still need to adjust my occlusion I could now see how they would look.

What I saw in the mirror made me gasp. My teeth weren’t just acceptable; for all intents and purposes they were perfect. Although I could see the “cheats” Dr. T had had to accept in order to make my teeth meet, they are not apparent to anyone who isn’t an expert. My teeth which had never been straight or properly aligned even in my childhood now looked like the “after” image from a toothpaste commercial.

That night I ate a steak at the Stuart Anderson’s in Chula Vista. (I had been planning to go downtown on the trolley and eat at Ruth’s Chris, but I was just too tired.) After three weeks of eating mush and liquid food because the plastic temporaries didn’t function very well, and sensing with every bite how my new teeth met properly, I think that is the single most enjoyable steak I have ever eaten.

Paying For It

The logistics of payment are pretty much the same as they are in the US. Dr. T accepts all major credit cards, and that’s how I paid him. He also will arrange payment plans and accepts US dental insurance. It’s worth mentioning that even if you have dental insurance, it won’t cover a procedure like this in full; you will probably still save a lot of money by going to Mexico. It’s worth checking with your provider.

Dr. T quoted me a price in dollars and accepted payment in dollars. This seems to be fairly standard in Tijuana. At the Comercial Mexicana, the cash registers do automatic currency conversion and they keep American change.

I have noted with interest that a lot of online brag pages for dentists show off rehabilitations that didn’t come out as good as mine. I credit that partly with the fact that I got to Dr. T before there was serious root damage — it was another dentist’s warning, not pain, that sent me on this quest. But a lot of it goes to Dr. T’s very high level of skill and expertise. In particular, he completely fixed my underbite. If I didn’t see it in the mirror, I wouldn’t have believed it to be possible. Dr. T is the very opposite of a “discount” dentist, even if his rates were unbelievably low compared to US dentists.

If you’ve read this far, one thing I can’t stress enough is to go to the dentist once in awhile. The amount of grief a thing like this can cause increases exponentially past a certain point; catching it as early as possible is key. One dentist I talked to in Costa Rica had a patient similar to me who was flying down from Alaska once a month for five months to complete his treatment. In my case it came on suddenly late in life, due almost certainly to work related stress. According to Dr. T, my X-rays show that four years ago my teeth were in pretty good shape. Between the ages of 35 and 39 everything went to hell, and because I skipped going to the dentist for two years it went to hell more than it needed to before I realized drastic action was necessary. The occasional checkup can make the difference between minor work, a smile that can be saved with major effort such as I just did — or dentures, and all the hassle that entails.

INTERNATIONAL-PATIENT-FACILITATORS.COM

1 800 210 5124