Apr 212017
 

 

Short Answer: Probably not. Tooth sensitivity can be caused by many things besides cavities. Cavities need to be really deep to cause any symptoms at all.

Long Answer: In my office, when a patient comes in to see me with a complaint, about 9 out of 10 times that complaint is, “my teeth are sensitive”. In many cases, their assumption is that they have a cavity. It’s important to know that about 90% of the time, those sensitive teeth have nothing to do with cavities at all. The culprit is usually something that has sensitized teeth to biting pressure, cold, hot drinks or sweets. Below are the most common causes of tooth sensitivity (besides cavities) and some things to try to troubleshoot the problem.

Typical causes (besides cavities):

1. Sinus infection – Above your top back teeth is an air space which connects to your nose. That air space is called a sinus and it can fill up with fluids, especially when you have a cold or allergies. When this happens, it can directly impact the sensation felt by your teeth and you might describe it as an “ache” which is hard to pinpoint as coming from one specific tooth. Symptoms that would indicate your sinus is the likely culprit for your tooth sensitivity include pain that changes as your head position changes (if you tilt your head to the side, does it hurt more or less?), pain during a time you have a sinus infection, allergies or just a cold/flu.

2. Wear (on the tops or sides of your teeth) – You may be grinding your teeth at night and are unaware of it. Before you confidently profess, “I don’t grind my teeth!”, I would ask how you know that? You are not aware of nearly anything you do when asleep, and grinding your teeth during the night is extremely common. That grinding wears away protective enamel that keeps your teeth from being sensitive much like you might strip a house of its insulation.

Similar to wear on the tops of your teeth, you can also have excessive wear along the sides of your teeth as well. This can occur when you brush your teeth too hard or with a brush that isn’t soft. You would be surprised how much tooth you can wear away even with a soft brush. Need convincing? Remember that the Grand Canyon was formed by just water! If you use “whitening” toothpaste, the problem gets compounded because whitening toothpaste doesn’t actually whiten your teeth chemically, it simply removes stains more aggressively by using rough sandpaper-like material in the toothpaste. This makes them appear whiter, but that sandpaper-like material also strips away more insulation around your teeth.

If the biting surfaces of your teeth have too much wear, you might even feel a little “zap” on one tooth when you bite on it with a specific piece of food. Your next bite may have no pain at all and then five bites later…”zap!”. This is usually caused by a food particle pressing on just the right spot where you have excessive wear and where the tooth is more sensitive.

3. Foods and Acids – There are many foods/drinks that sensitize teeth because they are rather acidic. Acids actually strip away a microscopic film of protection around teeth that makes them more sensitive (examples: soda water, lemon juice, apples, pineapple, citrus, tomatoes, sauerkraut, etc.). If the acids are particularly strong, they can literally melt small craters on the tops and sides of your teeth and we call that “erosion”. This can sometimes occur if you have GERD (heartburn) as the acids from your stomach literally come back up into you mouth (usually at night) and then sit on your teeth. There are other causes of erosion, but untreated heart burn is a common cause.

4. Tooth Grinding– We already discussed how tooth grinding can wear away your tooth and cause problems, but in this case I am referring to pain caused by the actual pressure of your teeth clenching and grinding together for hours at a time at night. Again, you are not likely to be aware of this problem just as you are generally unaware if you snore or talk in your sleep. If you do grind your teeth, that pressure can cause the nerves around your teeth to get sensitized and hurt during the day. Imagine you are a couch potato and I somehow convince you to run a half marathon in the morning. The next day your muscles will be very sore and even if you just walk to the kitchen, you will feel pain with every step. The same thing can happen with teeth.

5. Referred Pain – Sometimes we feel pain in our teeth even when the source of the problem is not actually our teeth. Pain from a sinus problem is one example we already discussed. There are many other causes like an issue with your jaw joint (TMD), teeth that are erupting like adult teeth in children or even wisdom teeth in adults, a cold sore, gum infections and even some diseases can create a situation where you feel pain in your teeth when the teeth are perfectly fine.

CLICK THE IMAGE FOR A SUMMARY OF SYMPTOMS AND SOLUTIONS

 

Signs you might have a cavity:

  1. Severe pain – Usually the sensitivity caused by the five causes above is not severe. On a scale of 1 to 10, most people would describe the pain as a 2 or 3 out of 10 and sometimes as high as five. Pain caused by a cavity typically feels much worse like a 9 or 10 on that scale. Tooth pain might keep you from sleeping at night.
  2. Constant and lingering pain – Tooth pain generally does NOT start when you drink something cold and then disappear. A tooth problem will hurt and continue to hurt for a long time, perhaps for days or longer. If you feel pain when you drink something cold and the pain disappears immediately after you swallow, it is unlikely to be caused by a cavity and more likely from one of the causes in the list above.
  3. Spontaneous pain – A problem caused by a cavity usually isn’t triggered by cold or sweets. The pain usually happens spontaneously.
  4. Swelling – If you see swelling around a particular tooth, a bubble that “pops” right next to a tooth or see pus coming from specific area, this is more likely to be related to a specific tooth problem.
  5. Focused pain – If you feel an “ache all over”, something else is likely going on besides a cavity. Pain caused by cavities typically cause one specific tooth to hurt, not a group of them. If you can tap on just one tooth and feel a problem, then that is more likely a cavity or tooth-related issue.

You might have one of these issues above and it does not necessary mean you have a deep cavity. There may be other explanations, but when I see patients that do have a deep cavity, they usually present with one or more of the symptoms listed above.

CONCLUSION:

Hopefully I have made it clear that when you have sensitive teeth, there are usually many good explanations besides a cavity. The most effective advice I give to patients when I have ruled out cavities as a cause of their sensitivity is:

  1. Discontinue use of any whitening products (rinses, toothpastes, bleach gels, etc).
  2. Buy sensitivity toothpaste (ANY toothpaste that has 5% Potassium Nitrate). No need to buy any specific brands, they are all identical.
  3. Brush gently with the softest toothbrush you can find or use a good quality electric toothbrush, which I think is better than a manual brush anyways.

Remember that if you feel pain when you drink something cold and the pain disappears immediately after you swallow, it is unlikely to be caused by a cavity.

Lastly, if in doubt, see your dentist for peace of mind and confirmation.

Please leave a comment if you have further questions or feedback.

Jan 142017
 

Short Answer: Sometimes they do, but usually they don’t.

Long Answer: When you go to a dentist in the USA, you may see many things in front of or after their name. There are differences, but for general dentists, the differences don’t add up to very much. We will assume that we are only talking about dentists who are legally licensed to practice and not some horror show dentist that pretends to be one even though they are not:

Man Arrested for Practicing Dentistry Without a License Pulled 10 Teeth Without Anesthesia in His Fake Office

Unfortunately, there are many examples of things like this. But if they are legitimate, here are some of the things you will see and what they mean to you:

Dr. Bob Smith = All dentists are doctors, you may see them addressed this way by their staff and peers. It doesn’t really indicate anything other than that they achieved a doctoral degree somewhere at some time. My dad has a PhD degree (a doctor of philosophy degree) in engineering. He is not a medical doctor by any stretch, but on his letterhead, he lists his name as Dr. Barniv just like me! People who are unlicensed medical doctors that received their degree in another country could still refer to themselves as “Dr. Smith”. The designation doesn’t really tell you anything.

Bob Smith, D.D.S. = This is a ‘doctor of dental surgery’ and most dentists that obtained their degree on the West Coast have a DDS degree. There are differences, in my opinion, between west coast and east coast dental schools and their corresponding education, but we will leave that to another discussion.

Bob Smith, D.M.D. = This is a ‘doctor of medical dentistry’ and most dentists that obtained their degree on the East Coast have a DMD degree. There is no difference between a DDS and DMD in the eyes of the law. There is essentially no difference between the two degrees for you, the patient.

Bob Smith, D.D.S., FAGD = A dentist with a DDS degree who went on to become a ‘fellow in the Academy of General Dentistry’. This means he pursued extra education in various topics and the AGD (Academy of General Dentistry) recognizes him as achieving a certain level of knowledge. Usually a required amount of continuing education is completed and then tests are administered. A dentist with a FAGD is usually someone who puts priority on their level of education, but it does not necessarily mean they are a better dentist or have special skills. You may also see MAGD at the end of their name which is one step further up the AGD ladder.

You may see many different letters after the DDS besides FAGD which means they are a fellow of some other organization (i.e. they did a lot of studying and took tests in that particular area of dentistry). The designations almost always start with ‘F‘. For example FAACD = Fellow of the American Academy of Cosmetic Dentistry. FAAID = Fellow of the Academy of Implant Dentistry. These designations certainly show that dentist’s dedication to that particular field of study. They are not considered specialists in that field, but you can bet they probably know more about it than the average dentist.

Bob Smith, D.D.S., PC = The ‘PC’ at the end doesn’t mean they are politically correct dentists 🙂 . It means they have registered their name as a “professional corporation”. It is essentially meaningless to you, the patient. If a dental office is listed as an ‘LLC (limited liability corporation)’, ‘Inc. (incorporated)’ or similar, it is also pretty meaningless. It is just another way to list a practice. Most practices limit their liability this way and it has essentially no effect on you.

Bob Smith, D.D.S., MSD = This means they are dentists that have received a ‘Masters of Science in Dentistry’. This dentist has pursued more education at an accredited university and it typically goes along with dentists who are also specialists like orthodontists. You may also see an MS degree which is a ‘Masters of Science’.

Bob Smith, D.D.S., MD = This is a dentist that also has a ‘Medical Doctor’ degree. That is the same degree your family physician has and it is usually awarded to dentists that completed training in oral surgery (oral surgeons).

Unfortunately for you, this list is not exhaustive. There are so many different designations for dentists that even I don’t know what they all mean. The internet is your friend. If in doubt, look it up. Sometimes the letters mean something and sometimes they don’t. I have seen dentists try to make themselves look better by adding more letters that really don’t mean much. For example, you need a bachelor’s degree (BS or BA) in order to get into dental school in the USA. This means you did 4 years of college. A dentist with a DDS degree is assumed to have a BA or BS. But some dentists will write their name Bob Smith, B.S., D.D.S. to make themselves look smarter than they are. I would be weary of someone who writes their name this way. If they wrote their name as Dr. Bob Smith, B.S., D.D.S., then they might have some kind of inferiority complex…

So as always, be alert and look it up if you aren’t sure!

May 172016
 

Short Answer: Yes, but it requires some homework.

Long Answer: This question recently came up and I thought it was an important topic. Many times when my patients leave the area and need to find a new dentist, they ask me for tips on finding an “honest” one. Dentistry is one of those industries that can harbor unscrupulous practitioners and doesn’t always have the best reputation in that regard. I believe that stems from the fact that most dentists practice alone or with a partner in a small clinic setting with little or no oversight.

Imagine if you went to work every day and your boss had no idea what you were doing. All they knew was whether you were sitting at your desk doing work or not, and they were checking to see you weren’t causing harm to the company. You were generally paid well whether you did a good job or not. Now also imagine telling your boss you had more work to do today than you did yesterday, even though you basically made up most of that “new” work. Not only would you still get away with doing a crummy job, but your boss would also give you a raise for supposedly doing more!

This is the situation most small clinic private dental offices find themselves in. The patient only knows if it hurts or not, if it costs a lot or not and if it looks good or not. Beyond that, there are few metrics the typical patient can measure against. But what about all the stuff behind the curtain? Were good materials and labs used? Will the work hold up like it’s supposed to? Were possibly better and less expensive options presented? Was any work needed in the first place? That’s where ethics come into play. So here are some tips on finding an honest and ethical dentist. Feel free to add comments if you have your own ideas or tips. Keep in mind this discussion is most relevant to USA-based doctors and patients. I am not well-versed with international dental practices (with few exceptions).

DENTISTS TO AVOID

  1. Avoid Over-Marketed Dentists – If you have been seeing ads all over town for a dental office, be careful. This may be a sign of a “hungry dentist” (see next point). An office that advertises heavily has spent a lot of money on marketing and possibly less on patient retention and patient satisfaction. I had to market myself when I first opened my practice, but I did it for a limited time and it had limited scope. Once people started coming, I developed a reputation and word-of-mouth took hold. If I was not doing a good job, then I would have had to keep marketing to get a steady flow of patients in the door. This is why your Spidey-senses should be tingling if you see an ongoing heavy marketing presence for a particular office. Also, advertising is very expensive and it takes a lot to make back that investment. When ads get someone to call for an appointment, there is extra pressure to make sure that new patient generates a worthwhile profit. Finally, be weary of big “one-time” promotions, coupons and special deals just to get you in the door.
  2. Avoid Hungry Dentists – Hungry dentists are those that desperately need to generate more work in order to keep their practice afloat, so they are also highly motivated to recommend excessive treatment. There are dentists that are generally “hungrier”, like new graduates with very high debt, dentists having financial problems, dentists that are seeing a steady decline in new patients, etc..  Not to say all the latter are dishonest, but a desperate dentist is not your friend and it’s not always possible to explain how to spot one. One way is if a dentist recommends treatment and then exerts a great deal of pressure on you to commit and proceed with treatment immediately. There are other ways, but suffice it to say that most people can spot a hungry lion a mile away. This is no different and I would stay away from both. When in doubt, trust your instincts.
  3. Avoid Offices That “waive your deductible and co-pay” – If you have insurance, you probably have a deductible or co-payment (co-pay) for certain dental procedures. Some dental offices know that if they waive this co-pay, you will be less likely to resist their questionable recommendations for treatment. Hey, if it doesn’t cost you anything, who cares, right? Wrong! Just because a procedure is free doesn’t mean you need it, want it or it won’t cause you more pain and problems later. But even if you are convinced you need the treatment, the dentist usually has a contract with your insurance company which dictates the maximum fee they can charge and your required co-pay. The insurance dictates a co-pay is required because they know they will pay for fewer procedures if a patient has to pay for some of it. That calculation ultimately affects your insurance premiums. So when a dentist waives the co-pay, he is inadvertently making the delivery of care more expensive for everyone AND he is also potentially violating his contract with the insurance company. Bottom line: do you think a dentist that is unethical when dealing with the insurance company is suddenly going to be ethical when dealing with you? You know the old saying: “Once a cheater, always a cheater.”.
  4. Avoid Office’s That Get New Patients Through the Insurance Company – If you have insurance, they will send you a list of dentists you should go to. They really, REALLY want you to go to one of them. That’s because they have a contract with the dentists on that list which dictates how much the dentist can charge and other terms and conditions, most of which they control. Dentists that rely on the insurance company to refer patients to them often have not invested their time and energy in making their practice driven by referrals from other patients. They don’t really need all their patients to be so happy because the insurance keeps sending them new ones. Also, the insurance typically pays these dentists much lower fees for procedures that are covered. The dentist is required to accept these lower fees in exchange for all those new patients the insurance company sends them. So to get around accepting those very low fees, the dentist may recommend you do more expensive treatment that is normally not covered by your insurance (see next point below). Bottom line: find a dentist on your own, not necessarily through the insurance.
  5. Watch Out For Up-Selling – This was touched on above. Dentists that are “In-Network” for many insurance companies make the lion-share of their income by “up-selling” treatment. For example, you haven’t had a cleaning in a while but there are no underlying gum issues. A shady dentist will tell you a “deep cleaning” is required even though a basic cleaning would have been perfectly fine (CLICK HERE for a thorough explanation about this). You need a crown on a tooth but the dentist tells you that it costs extra if you want it to be metal-free or made from special materials not normally covered by your insurance. You have a small stain on the biting surfaces of some of your back teeth and the dentist tells you fillings are required there even though the area could be easily monitored for the time being. These are examples of up-selling. If you plan to meet a potential new dentist before your first real appointment (see item #3 below), then consider asking about their style. Ask, “If I have a really, really tiny cavity on the biting surface of my back tooth, would you be comfortable watching that to see if it develops or do you think that needs treatment right away?”. Ask, “If I need a crown, will it be white or do I have to pay more for that?”. Ask, “If I haven”t been in for a while, do you generally think it is better to do a deep cleaning or try doing a simple cleaning first? (you are asking this before they have even looked in your mouth)”. There is no one right answer to these, but the answers you do get should give you great insight into how the dentist and the practice operate. Did the dentist answer thoughtfully and give you a reasonable answer? An honest dentist should be easy to distinguish from a dishonest one.
  6. Be Cautious About High-Technology – Technology is great, but if a dentist advertises that they use lasers, crown-in-a-day machines, special cavity-detection lights, etc., it doesn’t mean they are a fraud. But that technology costs a lot of money and the salespeople they bought it from helped them calculate how many times a month they need to use that machine to make back their investment. Fun Fact: Did you know that a crown-in-a-day machine costs upwards of $165,000? When an expensive machine is sitting there, it is just begging to be used. But not every situation calls for the use of such a machine in the first place. The reality is that an office that has a lot of these expensive gizmos is more tempted to use them even when inappropriate or unnecessary because they are trying to justify their investment. That’s when some of the dishonesty can creep in. And by the way, a lot of the new technology is useful and wonderful, but you don’t need most of it to receive extremely high-quality world-class dental care. Bottom line: Do NOT avoid office’s that use a lot of technology, but DO be more alert about the potential downside to all that technology. If technology and gadgetry is the focus and main selling point of an office, I would look elsewhere. 

DENTISTS TO SEEK OUT

  1. DO Look Up Dentists Online – Yelp.com is not perfect at all, but it is a starting point. You might not find a great dentist necessarily, but you will likely avoid a really dishonest one. Look up a potential name at the Better Business Bureau. You can also look up any dental license at the State Dental Board. In California, the site is found (HERE), but you can look up your own state board and search for actions against the dentist’s license.
  2. DO Find a Dentist With His Or Her “Name On the Door”  This means you aren’t going to a corporate or franchise office where you might see a different dentist every time you visit. Also, typical corporate or franchise offices are quota-based, which means they are hungry lions right from the moment you get in the chair (refer back to the points at the top of the page). When a dentist has their “name on the door” it means their reputation is on the line, not the faceless corporations’. Dentists work hard, spend a lot of time and money to open up their own practice. They are less likely to engage in shady behavior if their personal reputation, and thus their livelihood, is at stake. There is also a far smaller risk of dishonesty when a dentist is free from quotas.
  3. DO Make a Short Consultation Appointment – When you have narrowed your list of potential dentists down to 2 or 3, ask to make a short 5 minute appointment to meet them. This is an opportunity to see what kind of style the potential office has and the appointment should be completely free. You shouldn’t have to tell them more than your name because you are just a “potential patient” and would like to “meet the doctor” to see if it s a “good match”. If they are a reputable and honest business, they should have no problem accommodating this request. When you meet the dentist, you can tell him or her about your fears, concerns and expectations but also hear about their practice philosophy. Consider asking the questions mentioned in the first section (#5 Watch Out For Up-Selling). Your gut will usually tell you who is naughty and who is nice!
  4. DO Get a Second Opinion – When you have found someone and that dentist recommends treatment, consider getting a second opinion just to see if the new dentist is in the ballpark. This builds trust for a long-term relationship. Again, a good and honest dentist should have absolutely no problem with providing you with a written treatment plan, x-rays and his blessings to confirm his diagnosis. If a dentist becomes offended or aggressive about getting more opinions, that is a red flag. The only warning I give about second opinions, and it’s very important to remember, is that dentists recommending the LEAST treatment seem to be the most honest. That is NOT necessarily true. Choosing one dentist over another according to who recommends the least is not in your best interest. Regrettably, some dentists giving a second opinion hope you will switch to their practice, so they low-ball the amount of work they think you need in the hopes this will convince you to see them instead. This is the one caveat to a second opinion. I know…confusing!  So I think the real goal of a second opinion is not to see if another dentist comes up with the same treatment plan, but to see if the first dentist was in the ballpark, if their recommendations were reasonable and if there was anything unusually aggressive that stands out. Incidentally, the best place to get a second opinion is a dental school. Unfortunately, it tends to be a long process and generally too time consuming for the purpose of getting another opinion. Also, many people are geographically too far from a dental school; however, if you are faced with a complex and difficult plan by your dentist and you have doubts, it is exceedingly unlikely you will be bamboozled by a dental school.

EXPECTATIONS FROM AN HONEST DENTIST

  1. Treatment Options – An honest dentist should tell you about all your treatment options (including the option to do nothing). If you have a problem and the dentist only talks about one treatment option or completely dismisses other options, this should be a red flag. Also, you should expect the dentist to explain the options to you, not an assistant or financial coordinator. 
  2. Risks Associated With Treatment and No Treatment – Every procedure has risk. If a dentist recommends doing work, especially expensive elective work, and doesn’t take the time to talk about some of the bad things that could happen, then this is a red flag. There is also risk associated with not doing any treatment, and this needs to be explained as well.
  3. No Bait and Switch – Any treatment that is recommended for you should be given in writing. It should be very clear what the total cost of the treatment will be, with and without insurance. And if there is any question about what other additional treatment could be needed (like a root canal), that should be discussed in advance as well. An honest dentist will not try to sell you on less expensive treatment and then switch to a more expensive one after the work is started.
  4. More Opinions – Again, an honest dentist will have no problem with you getting another opinion at any time.

Is the list above exhaustive? Absolutely not. There is no perfect formula for finding a good and honest dentist, but this is a start and I hope it helps you. If you have more suggestions or comments, please share below and I will update this post as new ideas surface.

Nov 092015
 

Short Answer: In my humble opinion, no.

Long Answer: Yes, it’s true: dental work in the Unites States is expensive. There are good reasons for this and it’s not necessarily greedy dentists overcharging for what they do. It starts with the fact that cost-of-living in countries like the USA are much higher than in places like Costa Rica, Hungary, Mexico, etc.. In the USA, the cost of labor, insurance, real estate, taxes, etc is far higher than in any foreign country we are comparing to in this discussion. It also relates to the longer and more rigorous dental education USA-based dentists have to go through compared to most every other country (including advanced European ones) and the costs associated with that longer education. In almost every developed country, a dental education is 5 years after graduating high school, while in the USA, it is 8+ years. That’s a big difference, especially when considering a US-dental education costs about $60,000/yr in tuition! Costs are also higher due to materials used in the US requiring FDA approved and dental offices having to adhere to much more strict regulations and procedures than in more “lax” countries.

I see questions about foreign dental work come up when people need especially expensive treatment like dental implants, removal of many teeth, dentures or even a full mouth of crowns and bridges. The most expensive treatment a dentist in the United States can charge for is about $60,000, which is a ghastly sum for the majority of middle class Americans to afford. Mind you, $60,000 is for the most extreme and complex cases, while most larger cases fall more into the $15,000 range. Most insurance companies do not even scratch the surface on costs like that. But in a country like Mexico (a short flight for many Americans), any USA treatment costs about ONE THIRD. So a $15,000 USA treatment costs about $5,000 in Mexico. Most of these foreign clinics cater to “dental tourists”, speak English and take care of many travel arrangements to make it easier. But it’s not all roses.

Not to say that some of these foreign clinics do not have well-trained, experienced and talented dentists. The real problem lies with challenges involving follow up for complications and accountability if things “go bad”. There is also much less governmental oversight and the ability to accurately assess the quality of care you are receiving. I have many example of cases where this came up, but here is one:

My patient “John” had many dental problems and he required work totaling over $18,000. The work included 3 implants, 2 crowns and 2 root canals. He told me he could probably afford it all if he had to, but there was no way he would do that when it costs $6,000 in Mexico. So off he went and he came back quite happy. I saw him about 6 months later for a routine examination and took some x-rays. What I noted was that 2 out of the 3 implants had a condition called “peri-implantitis” which means they were failing. The root canals and crowns he had done seemed to be working fine, but they were not done to the standard mandated by the California Dental Board and I surmised they would ultimately need to be repaired as well. When I explained what I saw, it put John in a very difficult position. He had, indeed, gotten a lot done for a lot less somewhere else. But now there were problems and it was not practical for him to fly back to Mexico to have the problems evaluated and corrected in a timely manner. John had to be at work on Monday morning, he couldn’t just leave to Mexico for every follow up procedure and post-operative check that would be required to correct the issues he had. John ultimately required 2 moderately extensive surgeries to correct the problems and it ended up costing him close to $15,000 just to correct the issues with the two failing implants alone. In the end, he spent a total of $21,000 to get what he would have received in the USA for $18,000. That didn’t include the pain and suffering he endured while on “vacation” and when he got back home, the cost of traveling to Mexico and the time he had to take off work to deal with the corrective actions needed. It also didn’t include the repair of the substandard crowns and root canals he had done. John was understandably upset after all this happened. In fact, he even talked to me about suing the dental office that did the work for him, but alas, that was not possible. The laws in Mexico are not like in the USA, and it is far more difficult to sue a dentist in Mexico when you live thousands of miles away. Your potential award will also be significantly less than it would be in the USA, if you prevail at all.

The moral of the above story is not that all foreign dental work will end badly and require expensive corrections. I have no way to know what percentage of these cases fail or are done poorly. What I do know is that corrections are difficult and expensive. The more complicated the dental work, the more likely there will be problems (this is true anywhere including the USA). And what’s more, it is unlikely any of the implants placed in John’s mouth were FDA approved (as is mandated in the USA). It is exceedingly unlikely any official from OSHA inspected the clinic John was treated at to guarantee proper sterilization procedures were utilized. It is also not probable all of the clinic’s employees were licensed and certified to assist John’s dentists during the procedures he received. For that matter, it is not likely John’s dentists had to meet even a fraction of the ongoing requirements USA dentists have to adhere to in order to be licensed to practice.

Bottom line: It is not my opinion that patients should avoid all foreign clinics for dental work outright. However, if and when complications with treatment arise, patients tend to drastically underestimate the time, energy and money required to take care of any such complications back in the USA. It also becomes very frustrating for patients experiencing complications (sometimes due to gross negligence) to find out they essentially have no legal recourse at their disposal. What’s important is that one understands these trade-offs when receiving lower cost but complex dental care in a foreign country before committing to it.