A New Smile (cont.)

(Page 3)

I don't know if my dentist was aware, in 2001, that less expensive dental care might be available overseas. If he was, he certainly didn't mention it.

And he declined to be interviewed for this article. "You're asking me to discuss the outsourcing of my business overseas," he said, when I asked if he would evaluate and comment on the work I had done in Costa Rica. "I think it's understandable that I would not want to do that."

Prof. David Farber, currently affiliated with Carnegie Mellon University in Pittsburgh, has curriculum vitae of such accomplishment that he has been called the "Grandfather of the Internet," without anyone raising a ruckus. Thousands of people who have never met him call him "Dave" rather than "Professor Farber" because one of the best-known things he has done is to publish the "Interesting People" mailing list, which has chronicled technology issues, news and anything else Dave finds interesting, daily since 1993. More than 20,000 people around the world appreciate Dave's filter.

On the evening of Feb. 16, I was minding my own business, not thinking about my teeth and reading the latest e-mails from Dave. The topic was the outsourcing of technology jobs overseas. Jim Warren, a computer professional and longtime online activist, went off on a mild tangent about how it is not just technology jobs that are leaving the country.

"Many Americans fly to Bangkok to get needed - or simply desired - medical and dental procedures ... everything from crucial transplants and sex reassignments to cosmetic surgery and liposuction. The surgery, hospital and drug costs are `almost nothing' by comparison to U.S. medical, surgical and hospital charges."

Warren told of a good friend who had a laparoscopic adrenalectomy - an operation to remove a benign tumor of the adrenal gland - that would have cost $30,000 or more in the U.S. In Thailand, she paid 100,000 baht - a little less than $2,600. The quality of care, he said, was outstanding.

Surgical - and dental - procedures for almost nothing! Hmmmmm ... Yeah, I was thinking about my teeth again, and I was perhaps on to something, and I was fascinated. Plug the phrase "cosmetic dentistry" into a search engine and you'll find pages and pages of stuff about American services, American dentists. But start looking for cosmetic dentistry and surgery in other countries and ... well, there's a whole 'nother world out there.

I soon ran across the concept of medical or health tourism - people going abroad and combining elective surgery with a great vacation for less money than the surgery by itself would have cost at home. You can get package deals - airfare, hotel, car, tours, meals, hospital stay and face lift, for example. Or you can go à la carte.

I made a list of countries where the health tourism business seemed to be booming or at least well organized, where prices were low, and where there was documented praise for the quality of service. Thailand made the list, of course. India. Singapore. South Africa. And, finally, Costa Rica. I looked briefly into Mexico, but did not turn up enough information to inspire confidence. For each of the other countries, there existed persuasive websites, doctors available to answer questions by e-mail, developed support systems and even government backing of health tourism.

Price was absolutely my first consideration. I would have had the work done locally if I could afford it. I didn't even know, for certain, what it would cost to repair my teeth here. But I had a three-year-old opinion that I needed, at the least, 12 crowns for $9,600. The cost of just the crowns was surely not the full cost, I knew; and I had determined that prices locally had gone up, if anything.

If I could get all the work done for substantially less than that, I decided, I would at least entertain the idea of traveling for my health. I looked into Costa Rica first, for no other reason than that it is the closest to home.

How does one generally go about picking a dentist? My whole adult life, I had picked my dentists based on where they practiced, from lists provided by insurers or from the yellow pages of the phone book. Doesn't everyone do that? It sounds a little crazy to say so, but I've never gotten a bad dentist by picking one this way. Then again, I've almost never had any work done beyond the call of routine dentistry - cleanings, X-rays, the occasional small filling. Part of the insular security of having dental treatment in the U.S. is the underlying assumption that there is a baseline standard of care, that service quality is nearly uniform. We mostly believe that. We trust them all unless we are given reasons not to.

As I always had, I chose my first prospective dentist from overseas from a list, this one on a website. The dentist had a nice site of her own, which gave the credentials of her and her partner. The site included a rave review in the form of an article from the Washington Times in 2002. A reporter on assignment in Costa Rica was stricken with a toothache, and was treated so well and professionally that he wrote about the experience under the headline "Cosmetic dentistry: The best Costa Rican souvenir."

All of this inspired confidence. I already felt I knew more about these dentists than I did my own. But the clincher, I think, was that the dentist was a woman. Rightly or wrongly, I felt that she would be more patient with my questions from afar, more communicative. In the back of my mind was still the thought that going overseas for dental work could be the mistake of my life - and I have made some dandies. I knew I would need reassurance.

I discussed all of this with no one. I was sure my family would think the idea of going abroad for dental work was preposterous.

I wrote to Telma Rubinstein, D.D.S., of Prisma Cosmetics Dentistry, San José, Costa Rica, on Feb. 18, telling her briefly about the condition of my teeth, asking for prices on crowns, telling her I could provide photos of my teeth, and inquiring as to how we might proceed. I was surprised to get a breezy, confident e-mail back within hours.


Hello Jeff:

Thank you very much for your interest in our services.

The treatment that you need can be performed perfectly.

This is what we do - all-mouth reconstruction. We have our lab on premises.

The cost of each pure porcelain crown is U.S. $350. Metal-porcelain crowns are U.S. $250 each.

I would appreciate very much if you'd send me the photos. Any other questions, we will be more than glad to answer.

We are going to attend a dental meeting in Chicago, so we won't be answering e-mails until Monday of next week. We are looking forward to hearing from you soon. All the best,

Dr. Telma Rubinstein D.D.S.

Prisma Cosmetics Dentistry


It sounded almost too good to be true. As did Telma - the informality and openness of even her first communication were what I was looking for from my dentist. I was painfully aware that I speak no Spanish at all, beyond pleasantries. I needed my dentist to speak English.

The math of it worked. Twelve crowns would cost $3,000 to $4,200. I started to look into airfare and accommodations. My mind was not made up; but fixing my teeth, restoring my smile, finally seemed financially possible.

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Intro/Cover Page

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For more information on traveling outside the country for medical care, see:
Beauty from Afar

... and if you like this article, you might also like my blog at: www.jeffschult.com.

Drs. Rubenstein and Cordero oblige the author's request for a photo on his last day in Costa Rica. They're standing behind the often unmanned front desk area of Prisma Dental. There is no assigned administrative staff assistants are generally busy with patients and the phones are answered, frequently, from extensions in examination rooms.

There also is little paperwork or recordkeeping going on, at least visibly. Rubinstein keeps her own appointment book by hand.

Photo by Jeff Schult .

Additional Links (Will open in new window):

The Butterflies of La Paz (story, photos)

Home and Abroad: Comparative Cost Chart

Prisma Cosmetics Dentistry

Las Cumbres Inn/Surgical Retreat