El dentista

My dentist office in San Jose, you can see my bike and its security guard patrolling outside the building

So finally, the reason this whole adventure started to begin with, my dental work! I went to the Dentist for my first appointment the Friday after my arrival in San Jose, but first a little history for those who don't know.

About four years ago I went to a dentist in the states with the idea that after years of either neglect or simply not having the money or insurance to keep up on my teeth, I was going to do what ever it took to get them up to where they needed to be. I was working on a very good case of periodontal disease that I didn't even know about. Mainly due to not going to the dentist enough, getting my teeth cleaned regularly, and other bad habits like diet and smoking.The amount of money just for a crown, let alone a root canal or an implant, as most people know in the states is very expensive. To look at having to get several, well, it seemed not even worth looking at for where I was at during that time in my life.

So I started my journey back to trying to recover my teeth and have a healthy mouth once again. And while dental insurance which I now had would help, with up to 50% of $2000 a year of covered things, like fillings, teeth pulled, partial dentures, ect. There is a lot it won't pay for including implants. Still a thousand dollars a year, spread out over 14 months and 3 different years adds up to be a lot of money, especially if your looking at 6 or 7 thousand dollars worth of work. Throw in partially covered cleanings twice a year and and a tax free flex medical spending account thru work and I felt I did have the means to put a dent in the work that needed to be done. The thing now was to find out what and how much the work was going to be.

The first dentist I went to looked at the amount of bone loss that had occurred from the periodontal disease and recommended me having all my teeth pulled and getting full dentures. The cost about $6000. My insurance would barely touch this, and I didn't have the money anyway at the time to do it. This was not the diagnosis I was hoping for. Plus I was attached to my smile.... I ended up going to his brother who is a orthodontist for a second opinion. Not a good choice since not only was it his brother, but without great evidence to the contrary, what Dr. is going to go against the known diagnosis of another Dr. He concurred, all the teeth needed to come out.

Then I made another error. I went to another orthodontist who had worked on a friends teeth, and told him of the two previous diagnosis. Well of course he wasn't going to go against two of his colleagues. In his opinion the periodontal disease and bone loss were so bad, having all my teeth pulled and getting dentures was the only option. Or he said full dentures fixed to implants would work, the cost about $40,000. The news wasn't getting any better after seeing three doctors. For me I simply could not believe since I still had most of my teeth and they were functioning fine, why they would have to come out. I argued that if the periodontal disease could be eliminated, and then proper hygiene used, why should I have to lose any of them? He said that the pockets formed due to bone loss were too deep, and it would be impossible to keep them clean enough so the periodontal disease wouldn't come back. Again I didn't agree, and knew I needed more information.

So onto another dentist for a fourth opinion.While his news was better it still wasn't what I was looking for. He suggested I leave a few bottom teeth in for the partial dentures to attach to, but all the top teeth would have to come out. He wanted to start pulling teeth that day. I said I needed to think about it. I still didn't get why teeth that aren't rotten or falling out on their own have to be pulled? Even if a tooth is lose, that doesn't mean its going to come out, or is not healthy. There had to be a way to not only stop the periodontal disease, but also keep up on it so it wouldn't come back.

Reading a Mother Earth news one day I came upon an ad for a book which tells you how to save your teeth using the " Smile Method". A way to treat deep pockets around your teeth and stop periodontal disease from coming back. It was just the book I needed. Used in conjunction with an "open minded" dentist here was a definite way to work on what was going on with my mouth, progress. Now I just had to find a dentist that was opened minded enough to work with me. I contacted the last dentist I saw and he said he had given me his diagnosis, if I wasn't going to follow it he wasn't going to see me, or work with me. I don't remember if I contacted the others or not, but they too had already given me "their diagnosis".

At this point I was sort of running out of dentists in the area, and at $150 a diagnosis it was costing a lot just to have them tell me what I didn't want to hear. So the 5th person I saw, a women dentist told me, not only had she seen the book I was talking about, but there was an antibiotic that would knock the periodontal disease out, and then with regular periodontal cleanings and good dental care in between, I should be able to save most of my teeth. More progress, I was and am so grateful to her for not only what she knew, but also her willingness to work with me and have an open mind.

It was not all good news though. She said seven of my back teeth would have to come out. Some of them were simply too far gone to do anything with, and another one was just hanging in there. And my periodontal disease was very advanced. My gums and teeth were all badly effected with deep pockets. It was going to take a concentrated effort to not only knock the disease out, but also to not keep it from coming back. As she told me, I had to quit smoking as well. Smoking constricts the blood vessels in the gums and prevents the flow of blood to those areas. It would be hard for them to recover if I continued to smoke. I knew if I was going to put in all this time, effort and money into my mouth, then I needed to quit. Without a real reason to quit smoking I don't know if I would have been able to. I have smoked for almost 30 years of my life.

I went on the "patch" for about two months, took my antibiotics to knock out the periodontal disease, bought an electric tooth brush, later an irrigator to treat the deep pockets and really worked on flossing and keeping all my cleaning appointments. After so long without cleanings, the dental hygienists really had to work, and I thanked them. The first cleanings were the hardest, It took two appointments just to get everything done. But I was on my way, and I knew this was, and is a life time commitment. For there were times in my life where I had put a lot of money into my teeth and got them where they needed to be, only to let them go for a number of years and pay the price, which is what I was doing now.

My mom had lost all her teeth when she was young and she always said, "whatever you do, take care of your teeth". The first time I went to the dentist I had like seven cavities as a kid. In a way it seems I have always been playing catch up with my teeth.

So next up would be having the seven teeth, two wisdom and four molars and maybe a bicuspid pulled. I didn't like that either but I guess I had to listen to my dentist at some point, having seen 5 of them now. The plan was to save all the front teeth, remove the weak or broken teeth from the rear, and then go with partial dentures for the rear. Not only would I be getting rid of useless teeth in the rear, I would be improving the health of my gums.

At this point we had not seriously talked about implant work yet, mainly because of the cost seemed prohibitive. But cost or no, I do want to know all the options available to me at all times. Because as things change I may be able to address those problems later, and I don't want to burn any of those bridges now. For the most part I think we did do what needed to be done for the present and future health of my mouth. Of course I just hated losing any teeth unless I absolutely had to, but some of them were basically just roots anyway.

Its been 3 and a half years now since the two orthodontist's and two dentists recommended me having all my teeth pulled out. And while the final analysis with all this is far from over, it seems a reasonable assumption, verified by at least as many specialist since, if I continue to properly care for them that I should be able to keep the rest of my teeth, the rest of my life.

In some fairness I don't blame the first doctors and their recommendations .Given the severity of my case, and the chance that I wouldn't make any changes or use any treatments to be able to effectively keep the disease away, It looked like having all my teeth pulled was the only option. But, having said that they should have at least given me possible options. The well, "this is what would have to happen for you to save most of your teeth, and if your willing we can try this approach".

The thing is they either didn't consider all options, didn't know about all options, or just didn't believe they would work. Or they didn't want to go against a colleagues diagnosis, and take any sort of risk themselves. If they didn't consider all options, then they were passing on a limited amount of knowledge to me to be able to make an informed decision for myself. In a sense they would be making a decision for me. A decision that once done, I would never be able to undo. If they didn't know about all options then that is sort of unforgivable. As a professional I think you need to keep yourself abreast of all new information coming out (and believe it or not, a lot of this was old information and not that new), especially with something this important, or if your not going to keep up, you should refer me to someone who is, or at least consult with them. I don't feel this was done either, especially by one of the dentists. To not believe different treatment options will work is a judgement call. And for the most part I believe they were making the best decision for the circumstances influenced by the factors at hand, their own present level of knowledge, and probable (but not certain) progression of the disease unchecked. And also I believe to a big degree by the diagnosis of the doctors before them. Which I know I set these evaluations up wrong to begin with so it is partly my fault. I've heard that when seeking a second opinion one should travel at least 50 miles from the first one to get an unbiased opinion. I certainly didn't do this, not only did I tell the other doctors what the previous one had said, I even went to a brother of the first dentist! Its like a trial where the jury already has a preconceived idea of whether the person committed the crime or not. Either way they owed it to me to present all the available options and maybe approach the whole thing from a more open mind. And as I said, the 5th person I saw, thought immediately I would be able to save most of them, so I don't think this was a wild flight of fancy I was on. But I still had a ways to go to prove I hadn't just found some one that told me what I wanted to hear.

After I got my partial dentures made I realized I was probably not going to like them. Losing the feeling of the roof of my mouth while eating, or talking was hard to get use to. They were not all that comfortable, and in fairness I probably never gave them a chance. But even other people I talked to who have used them over long periods of time said they never really have gotten use to them. I felt bad in ways for my dentist because this was sort of our plan, but I really didn't like them. I think she understood. In fact she told me she knew one guy who didn't like his so much he had thrown them into a lake or river or something!

So that was that, my dentist recommended an implant specialist after I asked her about getting an estimate for them. It seemed the only option left. Even if I couldn't afford it, at least I would know what it would cost and even if they would work in my case. The man who did the diagnosis and estimate was a specialist, having studied under the guy who pioneered implant therapy. Its all he did. He confirmed that I did have enough bone left for the implant work to proceed, (the good news). And it would all cost about $28,000 (the bad news).

At one point I had talked to the author of "The Smile Method" and he had suggested looking at getting dental work done over seas. He said he got his done in his home country of Greece for much cheaper then in the states, and the money he saved even paid for the trip. Even my dentist admitted that the reason dental work was so much more expensive in the states is because "that is what the market will bear here". Hmmm. Is that why we were paying so much for gas six months ago? Or maybe why insurance won't cover implant work here? I appreciated her honesty. If all those prices are due to the fact that that is what the market will bear, what happens when people can't bear the market? It can come down in price for one.....

So this started my global search to find the cheapest quality implant work. With technology this was made so much simpler. I just went to another dentist office that did Panoramic X-Rays, got a set of those, went online to find implant specialists and started sending the implant treatment plan with the digital x-rays to them all over the world. And the dentist's office that took the x-rays did this for me. Ironically they were also the one's who gave me my first diagnosis for complete dentures. With them at least, I felt their diagnosis was sincere, if not completely informed.

I had responses from Thailand and Argentina at first. Then I found a company out of Colorado that helps from the states find specialists in other countries for their health needs. They do a lot of the foot work for you and thru them I got doctors names in Panama, Costa Rica and Mexico. Maybe just as important they have references on those their sending you to. So again aided by technology and emails I could contact many doctors at once, get their references, treatment plan and costs all within a week or so. What would have cost so much money and time 30 years ago to do, now could be done at a fraction of the cost and in a fraction of time.

The doctors I found here in Costa Rica to do the work were the ones who got back to me the quickest and had the easiest references to check. In fact the doctor who did the restorative work studied at the University of Michigan. As I spoke to more and more foreign dentists I began to realize that many of them had studied in the U.S. In fact one guy who called me for a reference on my doctor in Costa Rica told me he had extensive work done on his mouth over the years at the University of Michigan, and every dentist that had ever worked on him there was studying from another country, everyone of them. He also said that he had gotten the most outrageous quotes for implant work as well in the U.S. and he was ready to seek help elsewhere (one specialist quoted him $30,000, just for work on the top of his mouth, and they hadn't even talked about the bottome. He later told me he had gotten all his work done in Costa Rica for about $10,000 and was happy with it).

Its also worth noting, and this goes hand in hand with my last posting on part of the U.S.'s problem being how we view the rest of the world, that so many people I spoke too thought one, you couldn't get as good of work done outside of the U.S., and that when I said I was going to see a dentist outside of the U.S. they thought I would be crossing the border into Tijuana or something to have it done in a back alley. I have to admit on this trip I have continually had to confront my own prejudices and preconceived ideas as well. With everything from how I expect people to live and act to what they eat and do for entertainment. I'm continually reminded while things maybe done a little differently then in the U.S., that doesn't always make it any better or worst, just different. I think, like all people, I would be offended to be stereotyped as well. When I got to my home stay I was surprised to find out there was Wi-Fi in the house for our computers. I was surprised more because the owners are both older people from that generation that doesn't use computers as much. Their son when I seemed surprised that there was Wi-Fi in the house seemed to take offense, like "of course we have it, we have everything you do". That wasn't what I meant, but his sensitivity to what I seemed to be insinuating was well taken. The reality is his parents have it for people renting here, not for themselves.

Its hard to not make a point here with our own health care system in the U.S. While viewed by many to be the best in the world and certainly it is where some of the best training is, this in itself as my experience indicates does not mean you will receive the best care. There are many factors here, the biggest maybe being what you can afford. If I had walked into those first offices with a hundred thousand dollars to spend and told them that, I may have had hundreds of options. For where I was at they only suggested one. The point of having to shop for your own care, and it being expensive to do so is a real problem in our system. Too many times we just go along with what is being said and never seek another opinion. Or more importantly, and I think its the number one thing you can do, is do the research yourself. Find all possible solutions and in a tactful way discuss them with your doctor. Too many times its their way or the highway. They have all the knowledge, don't question them. Their is a certain attitude that is as big a problem with our health care system as anything. And its the attitude coming from the Dr. that "I know what's best for you", and coming from us the "well you must know, your a doctor, I'll do whatever you tell me". Kind of the same problem we tend to have with our government! And its not to say we should all suddenly think we're doctors, but we should with the help of a doctor, make informed decisions based on what they tell us, our own research, and hopefully the opinions of several, not just one if you feel it is warranted. I could go on and on about my experiences with our health care system, but suffice to say our number one problem and solution lies with ourselves and taking care of ourselves to begin with, and then taking care of ourselves once we feel the need to cross the threshold......and into the realm of the health care system itself.

After figuring I would be able to afford the work down here, and after multiple calls and emails to the dentist here, I flew down to Costa Rica in July of this year to have the seven implants put in. That was the first step of the procedure and it would take 4 months before those healed well enough to have the abutments (I think that is spelled right) and crowns put on. My first visit I was here for a week, had the surgery, had to stay in my hotel room most of the time, and then flew out. I rented a car to go over to the Pacific Coast for a day, but that was all the touring I could do. My dentist told me I was brave for braving the roads here..... Little did he know I would be driving back down in 4 months!

Hotel El Esteseo, where I staid my first time in San jose

So somehow the adventure part of me surfaced and I began to think seriously of driving my motorcycle down. In my head I thought it would be like driving thru Florida, only maybe a little more rougher........ Well it has been a little rougher then Florida for sure!

Another contributing factor to my driving down was the fact that I was establishing residency in another county for school reasons, and I couldn't take more then 5 credits anyway in the fall semester or it would mess up my financial aid. If I was going to take a semester off and take a trip like this, this was the time to do it. Even if I did take classes, I still had to come down for 2 weeks of work in the middle of a semester which would mess up my classes anyway. So the decision was made. I couldn't get my college Spanish class to coordinate with my classes at Intensa, my school in San Jose, so I decided to take the whole semester off and do this trip instead. It would also give me a chance to work on my blogging site.

So now that your caught up, like I said, my first appointment was Friday, and in typical fashion it lasted three and a half hours. First the implant doctor had to reopen my gums to check on the implants. Then the restorative doctor had to attach small abutments to the posts and take x-rays and impressions for the teeth themselves. They also did a color test so the new crowns would match my present teeth.

The doctors here treat a lot of people from the U.S. At one point over half the people in the waiting room were from the U.S. There was a couple from New York State who spend their winters down here, and have for 26 years. Another guy was from Hollywood and another couple from California. The doctors have to work long hours and get people in and out as fast as they can. A procedure that could be spread out over several months in the states has to be fit in in a couple of weeks here, because most people are only down here for a limited time. Production Dentistry is what it feels like. Getting out of the chair at 7 p.m. was not all that unusual.

Its good and bad. The good part is your getting a lot of work done in a short time. The bad part is three to five hour days, while not the norm usually, were not rare either. I had five appointments that ended up being about 15 hours total. And this is without travel time. Going out on my bike in San Jose is always an adventure. While my house was only 10 miles from their one office, it could easily take me an hour to drive across downtown San Jose with all the traffic and one ways. For one appointment I was literally two blocks from the office, only to be forced into one ways and pushed into traffic and out of town and into another traffic jam. It took me an hour to get back to where I was, only two blocks from their office to begin with!

At times there were 10 to 12 different people in the office. Two doctors, a hygienist, an x-ray technician ( I had 8 to 9 x-rays total which made me nervous getting x-ray'd that many times), and a host of assistants. It truly is like production dentistry. I had my teeth cleaned as well, another savings of roughly a third or more. The total cost of everything including travel and lodging came to about one half of what just the dental work would have been in the states. And of course the downside is if anything goes wrong it is a long trip back, but the implant specialist does guarantee his work for life. I asked him well what if you retire or something happens to you? I think he got a little annoyed and said he's only 38 and he's not planning on going any where!

Overall the care has been good, the long time in the chair the only real downside to trying to get this much work done in a short time. Most people in the office spoke at least some English, the doctors of course speak it well.

I have one more follow up appointment but all the implants are in. I have to admit they really look natural and real. And more important having the implant work done should stop the bone loss that occurs when you have a tooth removed (another apparent down side to dentures and having all your teeth removed is the continual loss of bone even after the teeth are gone). And also having them to be able to chew with, will relieve the front teeth that have been doing all the work since I had the back teeth pulled. They like dentures will take a little getting used to, and I already noticed food will now get caught in places it wouldn't before when there was no teeth there, and I do have to floss and care for them just like regular teeth. It is early, but it seems like everything has gone about as well as can be expected.

I am grateful to Dr. Anglada, Dr. Castro and all their staff for all their good work. Including Melisa, who wants to be a dentist herself one day and I really hope she makes it. She has such great enthusiasm for her work and would be wonderful at it. Her father Memo, also was very helpful thru out as a driver and at times a guide. Marisa Ryder from Bridgehealth International originally helped with the initial contacts and has followed my blogging site and the work from beginning to end, we both share a passion for travel, she having lived in Argentina for two years.

Also a thanks for you who may have read this and now know more then you ever wanted to know about myself and implant surgery! I can only say like the many different parts and subjects covered in this blog, every part may not be of interest to everyone. I received a lot of calls from people interested in all of this because they were like me, wanting to have extensive dental work done, and were not able to afford it in the states. To those people this post will hopefully be informative and provide some useful service which are both goals of this site. Eventually as noted previously, I would like to set this site up in different categories and make it easier to access information people are looking for. making it more user friendly. For now though its just going to be posts coming out more or less in the order that they occur, tying in with the story as a whole. Like I said, I am hoping this site will continue to evolve and grow, and that by having readers who follow it and give their input as well, it will in a way be useful to all of us.

It was a real biker jam at the dentist office