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Dental Work in Costa Rica

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I need twelve dental crowns done. After doing some calling around, I learned I can get this done for just $6000 in Costa Rica. I would have to stay two weeks, but that’s like a vacation and it is still cheaper than what I can do in the states. My sister is freaking out saying this is a huge mistake. She asked me to at least call my dentist and get his opinion on this plan, but of course he’s going to say don’t do it because then he gets my money. I came across your website. You are across the country from me and have no chance of getting my money, so what do you think of my plan?

Mason

Dear Mason,

map of costa rica

Should you get dental work done in Costa Rica?

 

I’m glad you wrote. I think I can save you a lot of grief. The dental industry is a real risk in Costa Rica. Because of the way their legal system is set up you have no recourse if something goes wrong. And let me tell you, a LOT can go wrong. Here are just a handful that come to mind:

  • A tooth can be broken off or lost
  • Overdrilling could take place causing nerve or root damage
  • You could end up needing a root canal treatment
  • Your bite can get thrown off leading to painful TMJ Disorder
  • Once you return home, the crowns can fall off
  • The crowns could look terrible, pasty, fake, and the wrong color
  • Poor placement of the crowns can impact your speech

Believe me, I am not exaggerating here. I recently read a case that you can read about in total here, but I will sum it up. A woman went to Costa Rica to save money on her dental care. The job was so badly done that she was in terrible pain. A dentist in the states called it criminal negligence and it would cost her around $35,000 to get the needed repairs done. Of course, she didn’t have that kind of money. She tried to get her money back from the Costa Rican dentist, even hiring a lawyer from the area, who was on her side. However, the law in that area is very corrupt and she ended up getting in trouble for complaining about a Costa Rican dentist publicly who had not been convicted of any crime and they put a warrant out for her arrest. She ended up having to flee the country.

You are at particular risk because of the number of dental crowns you need. There is a lot that could go wrong with that type of bite placement. My advice is to find a dentist here in the states with good qualifications and let him or her do the work. You may even be able to work out payment arrangements. Leave the Costa Rica trip for a true vacation, where you are not putting yourself at risk.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss, an AACD accredited dentist.

Solution for a Tooth Turning Dark

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I’ve had a tooth that has gradually been turning dark over the last five years. My dentist said a root canal treatment may be needed. While there is no infection there is a possible fracture. I don’t know if I should go ahead and have the root canal treatment or just do cosmetic work to repair the graying tooth and only worry about the root canal treatment if it becomes absolutely necessary or if I should just bite the bullet and do the root canal and get it over with. One thing my dentist mentioned is that I would need bonding on several teeth in order to make them look uniform. In that case, would it be better to get porcelain veneers?

Laura

Dear Laura,

before and after dental bonding

 

I am going to be quite blunt here and say that you are not in the hands of the best dentist. Let’s start with the root canal treatment. Either the tooth is infected and you need one or it isn’t and you don’t. You said there was no infection, just a possible fracture. With a fracture, you would not want to do a root canal treatment, which could lead to leaking.

Bear in mind that I haven’t examined you, but given your description of the darkening happening over a period of years, I think you’re dealing with the aftermath of trauma that happened to the tooth several years ago. Over time, your body builds up defenses in the tooth which creates a secondary layer of dentin making the tooth look darker.

The solution to this is cosmetic. You can either do dental bonding or a porcelain veneer. The veneer will be more expensive but has the benefit of lasting longer. With either one you will need an expert cosmetic dentist and I will be honest that your dentist is not going to fit that bill. I know that because of his comment that you’d have to do several teeth to get them to look uniform. That is not the case when you have an expert cosmetic dentist. And with someone who is not an expert, just because they are uniform does not mean they are beautiful. My recommendation is you look for an AACD accredited dentist to do this work for you.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Smile Makeover on a Fractured Tooth

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Years ago, I had an accident which fractured some teeth. They received both root canals and dental crowns. As years past, my smile started to show it’s age. I decided to get a smile makeover after my last promotion. I went to see a highly recommended cosmetic dentist in my area. She did a combination of dental crowns and porcelain veneers. I love how it looks and am much more confident. My problem now is with tooth #9. It’s been sensitive ever since and there is a pimple on the tooth next to it. My cosmetic dentist thinks that the tooth needs to be extracted and to have a dental implant placed. I’m also getting a root canal treatment on the adjacent tooth. I’m attaching the x-ray to see if you think the tooth really needs to be extracted. I just had the restoration done and it seems like a waste of money to remove the tooth. I’ll also send a picture of the new smile in case you need it.

Aaron

Dear Aaron,

Aaron's Tooth X-rayI am in agreement with your cosmetic dentist. Looking at the circled tooth, in the middle of the root there is a horizontal radiolucent line. This is an old fracture that was either missed by your old dentist who worked on your teeth after the accident or he thought he could get out all the necrotic tissue and save the tooth.

Below the fracture looks healthy. However, above it the tooth looks moth-eaten. That tells me there is probably an infection there. Removing the tooth, will be the safest thing to do. A dental implant is a fantastic replacement so your dentist was right about that too.

Looking at the images you shared of your smile makeover, the dentist you choose was skilled. I’d stick with her for the dental implant as well.  However, she should have caught the fracture and infection.

Because she didn’t, it isn’t unreasonable to expect some flexibility in how this is paid for. Originally, had it been properly diagnosed at the beginning, you would have paid for an implant and a crown.  I’m going to suggest you ask to pay for the implant, but not the new dental crown to go on top of it because you just paid to have one placed. I don’t think she’ll have a problem with that.

From your x-ray, I have noticed one other issue. It looks like another tooth that had a root canal treatment, didn’t get done properly. You see the tooth on the left has filling material that stops a few millimeters short of the end of the root. I wouldn’t do anything about it unless it flares up. For now, the tooth itself looks healthy.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Root Canals Needed after Her Smile Makeover

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I had a complete smile makeover with veneer crowns. When I went in for my consultation I specifically asked about any risks involved. He told me there weren’t really any. I went forward with the procedure confident and excited. Since then, four of the teeth have needed root canal treatments. He suggested I see an endodontist. I did and was informed even more teeth are likely to need root canals soon enough. I thought there wasn’t much risk with these. What happened? Have you seen this before?

Ruth

Dear Ruth,

I think there is some confusion here. There are porcelain veneers and there are porcelain crowns, but there aren’t veneer crowns. So, I’m not sure which you received. However, based on the number of root canal treatments you received, my guess is it was porcelain crowns. I’m going to show you two photos below. The first image is what a tooth would look like with porcelain veneer preparation. The second with dental crown preparation.

Teeth prepped for porcelain veneers

Porcelain Veneer Preparation

Porcelain veneer preparation will take off maybe a 1/2 millimeter of tooth structure. It is rare for this procedure to end up needing even one root canal treatment, let alone the amount you are ending up needing.

preparation for porcelain crowns

Porcelain Crown Preparation

On the other hand, a porcelain crown preparation goes much deeper into the tooth structure, which puts you at a greater risk of exposing the pulp of your teeth. That in turn leads to a tooth infection.

What is a Smile Makeover

You said you were getting a smile makeover. Unless there are other issues such as extensive decay or TMJ Disorder, you would use porcelain veneers for this. Giving you the number of dental crowns he gave you is more of what would happen with a full-mouth reconstruction.

If you really only needed porcelain veneers than your dentist was much more aggressive than he should have been and should be liable for the damage he caused to your teeth. That means paying for the root canal treatments you need. This is especially true because he told you there weren’t really any risks. If he prepped for crowns, there are always risks.

Hopefully, you at least like how these teeth look.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Protecting a Porcelain Veneer during a Root Canal Treatment

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I have porcelain veneers and my dentist recently told me I needed a root canal treatment in one of the teeth involved because of a periapical abscess. I’ve heard that root canals can turn the teeth dark. I’m afraid that will ruin the smile makeover. I’m also worried it will damage the veneer. Do you have any suggestions?

Carolyn

Dear Carolyn,

A tooth being prepared for a porcelain veneer I’m a little concerned you needed a root canal treatment to begin with. When teeth are properly prepared for a root canal treatment, there is very little tooth preparation done. The photo to the left shows the deep limiting diamond bur that is used to remove about a 1/2 millimeter of enamel. It adds the grooves and then a dentist will go back and remove the ridges with a traditional diamond.

Unfortunately, some dentists get aggressive and remove all the enamel and down into the dentin. Others actually do porcelain crowns, which requires massive tooth grinding, and just call them veneers. Both of these last two methods put you at greater risk of needing a root canal treatment. I’m wondering if this is what happened to you.

In your situation, however, it’s already done and you need to deal with what is happening now. You have to have the root canal. You don’t want to leave an infection in your bone. That can lead to serious complications. Fortunately, I have some advice to give your dentist to protect your porcelain veneers.

Protecting the Appearance of Porcelain Veneers after a Root Canal

You are correct that a root canal treatment can make a tooth look dark. Because your porcelain veneers are translucent, that will show through and make the color look off. This can be prevented. Make sure your dentist knows that most of the darkening of the tooth comes from the remnants of root canal filling materials left over in the crown of the tooth. Have him read this post so you can feel confident he knows the right technique for this situation. Here’s what he needs to do.

He needs to clean out any of those materials from the crown of the tooth. Then he’ll need to place a white fiberglass post down into the root and fill the rest of the space in the crown with a light-colored composite. While it won’t forestall the tooth turning dark forever, this method along with the fact that you have a porcelain veneer should keep the tooth white for many years.

Best of luck to you.
This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.