Note: This article is not intended to be a definitive guide on choosing a dentist or dental surgeon in Costa Rica, it serves as a reminder that often things sound to good to be true, so be careful where you get your dental work done.

I just saw this headline in a magazine: “World-Class Dental Services at 50-70% Savings over U.S. Prices!” A lot of other verbiage, mostly misleading, continues. Then is the kicker. “With all the money you’ll save, you can vacation in style in Costa Rica.”

Here’s the story, one of many: A longtime patient of mine had the idea that he would save lots of money on dental work, much of which he didn’t absolutely need, by going to Costa Rica. Not only that, but he had decided to become part owner of the Costa Rican dental clinic. He had the work done. My hygienist then saw the patient, saw the dental work and described it in one word: “substandard.”

I then see the patient. I look at the work, which consists of crowns on nearly every tooth. Visually, it looks all right, except around the gum line, which is redder than I had remembered. Then I check it with dental instruments to see how the crowns fit. On crown after crown, I’m able to get my examination instrument between the crown and the tooth. In other words, the crown doesn’t fit the tooth. I examine the other crowns. Every crown doesn’t fit. Then I check the bite. The front teeth meet when he bites down, but the back teeth don’t.

He is working for the Costa Rican dental clinic, so he’s interested in my opinion. I say, “Let’s take a set of X-rays.”

I have an advantage. My X-rays are digital and are projected on a 37-inch video screen, so anyone can look at them and see what I see. I show him each crown and rather than the crown fitting like a finely designed, custom-made restoration, it looks like a cowbell on a stick. It’s obvious. It would be plain as day to you as much as it was to me.

The patient, better termed “the willing victim,” defends the work saying that he “rushed the dentist.” I then asked him, “Are you selling this?” He said that he wasn’t selling it yet, that he was going to be a test case before he starts selling it to others. He then went on to defend himself and the clinic, telling me how cheap it was and how “this is for people who work at (a convenience store) and can’t afford dentistry.” He then told me proudly how much he paid for it, a bargain price.

So, here’s what he received for his bargain price; crowns that don’t fit, causing gum inflammation as well as a predisposition to decay, a bite that predisposes him to jaw problems and a greater chance of premature tooth loss.

As patients, you are at a disadvantage. You can’t tell your dental condition, nor can you evaluate the treatment. Good dental work requires time, good understanding of bite relationships and corresponding jaw relationships. It requires the understanding of how to prepare a tooth, the conditions of the nerves of the teeth, and the biology of gum disease and dental decay. It requires understanding of cosmetics and specific instructions and communication with the dental laboratory.

Good dentistry requires knowledge of the shape and density of the bone as well as the relationship of the position of the bone with the position of the teeth. And with all that, things still can go wrong. Biology and mechanics are not always perfect. The best dentists I know recognize when things are wrong and makes them right. That takes training, practice, time and integrity.

Where will this patient go now? He says that he’ll go back to Costa Rica to have the work “done right.” But if a dentist is willing to do substandard dentistry, do you really think that he is capable of doing it right? And when the patient has a problem, where is he then going to go?

To quote a popular maxim: “Beware of bargains in parachutes, brain surgery and dental treatment.”

For great dental work please check out Dr Simon Flikier of Flikier Dental Institute