In Search of Affordable Dentistry: Part V

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If you follow the blog closely, you may have noticed that I’ve been conspicuously silent this month. If you follow me on Twitter or Instagram, however, you may have deduced that I spent a little more than a week this month in Thailand on the second of three dental tourism trips to undertake a fair amount of work that I really needed to get done for the sake of my long-term health.

The Story Thus Far

The short version of the story is that despite how well we are doing now on our quest for financial independence, I had an extended period of joblessness after a layoff a few years back. It was just bad luck that that time coincided with two old crowns failing completely, and a number of other large essential expenses coming up. I could either pay the rent and for groceries, or pay for the dental treatment I needed, but not both.

In the time since, those failed crowns had become unsalvageable, and I knew that I would need to have the roots extracted. If I wanted to look normal, I would need to have two dental implant surgeries (and subsequent crowns). Upon seeking treatment, I also learned that I had developed a number of cavities, desperately needed a deep cleaning, and that another tooth needed a root canal.

According to an internet dental cost estimator, the cost of all the items in this course of treatment would be $21,230, not including any consultation fees. Ouch. I was again faced with a choice: afford my wedding, or see to my dental situation (which was only becoming worse every day).

Being the frugal fellow that I am, I decided that that was an unacceptable choice, so I started doing research on dental treatment abroad. I eventually found my clinic of choice in Bangkok, Thailand: Bangkok Smile Dental. I took a trip late last year to get my extractions, fillings, cleanings, and root canal done. After getting the extractions done, we needed to allow about four months of healing to occur before implants could be successfully set in my jaw. Last week, I returned for those surgeries.

New Trip, New Clinic

The clinic I visited on my last trip was the very clean Sukhumvit Soi 21 location, which was one of the company’s first clinics. That facility was sparkling clean, but apparently it was due for a renovation to match the newer locations, so I (and my entire dental treatment team) were transferred to the brand new “Smile Republic” clinic on Sukhumvit Soi 5.

The Soi 5 clinic is located in a neighborhood that appears to cater more to middle eastern tourists. All the hotels, restaurants, and miscellaneous businesses advertise in Arabic, and the smiling caucasians with gleaming-white smiles in the signs at the clinic on Sukhumvit Soi 21 are replaced with smiling middle easterners in hijabs and keffiyeh. It was actually a pretty fun contrast to experience. On the less fortunate side, the neighborhood is noticeably seedier. Getting to the Soi 5 clinic from where I was staying meant walking through a few blocks heavy with touts and extremely shady massage parlors. It made me pretty uncomfortable, as I have taken care to avoid going anywhere near the red light areas of the city.

With that said, once I arrived at the clinic, I was blown away with how modern and comfortable it was. Everything is meticulously clean, spacious, and numerous nice touches like a lobby waterfall and spa-like patio are evidence that the clinic is really trying to make the experience as relaxing as possible. It will be very interesting to see how the renovation of the original clinic compares to the clinic I visited this time.

The Treatments

On my first full day in Bangkok, I met with my prosthodontist (a dentist concerned with restorative treatment), Dr. Sunisa Jeungjitrak. Dr. Sunisa is in charge of my whole course of treatment, and it is her overall plan that my other dentists are following. If you’ve read this entire series, you’ll know that I was really impressed by her kindness and gentle treatment on my last trip, and that experience continued this time.

Dr. Sunisa examined my teeth and assured me that my healing has gone very well. This time, Dr. Sunisa would be placing the final crown on the tooth that had required a root canal. She took a series of molds of my teeth. Since the crown was a molar, I had several options (and several price ranges) for crown material, from all metal to full ceramic zirconia.

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Me smile pretty one day.

I’ll be honest: given how substantial the savings were, I wanted the top-of-the-line crown in terms of aesthetics and durability, and I said so. Dr. Sunisa advised me to choose an all-ceramic crown. To technology nerds like myself, the process by which these crowns are made is completely fascinating. From the molds of my mouth and a CT scan, a CAD model of my crown was generated. Then, an ingot of zirconia is loaded into a robotic milling machine, where computer controlled diamond burrs whittle the ingot into a perfect little crown. The crown is painted by a technician with subtle differentiations in color to make it more closely match my other teeth, and then the whole thing is fired in a furnace to produce the finished product. Dental zirconia is effectively indestructible, so I don’t need to worry too much about it cracking or shattering under normal circumstances. Dr. Sunisa trimmed my tooth down, fitted me with a temporary crown, and sent me on my way.

Three days later, I needed to report in for a CT scan. A CT scan is really just a fancy 360-degree X-ray. The CT scan was used to produce a 3D model of my jaw and an insert to fit over my teeth. This plastic insert served as a guide for the implant dentist to plan his surgery, so that the implants could be placed at the precise angle and depth needed to avoid the nerve in my jaw, and to maximize the strength of the implant. Again, very high-tech and modern, and to someone who has traveled so far from home, it’s very reassuring to see a cautious and well-planned approach.

On day four of the trip, I met with Dr. Sunisa again to try my new crown on. Though it felt great, it was clear that the color was off. The crown was too white, and even though it is on one of the back teeth, the difference in color was apparent. I was happy to find that Dr. Sunisa also expressed dissatisfaction. She apologized that the match was not close enough, explaining that the technician who painted the stain onto the crown had not matched the color properly. She had the crown sent back to the laboratory, but not before taking a number of photos of the crown in my mouth to aid the technician in more accurately matching my tooth color. This kind of experience is fairly normal, and it’s why the clinic asks that clients visit for a few more days than they anticipate needing.

It's just a flesh wound!

It’s just a flesh wound!

Also on day four, I had both my implant surgeries in a single session. For my implants, I saw Dr. Preeda Pungpapong, a former professor of dentistry at UNC-Chapel Hill. Dr. Preeda was really friendly, and despite the frightening nature of having screw-like objects driven into your jaw, he was gentle and communicative. I guess it had gotten around that I feel best about these treatments when things are explained to me, and Dr. Preeda took care to describe (without being too graphic) what he was doing when he placed the implants. The implant surgery was a total success. It took a little over an hour to numb my mouth, place both implants, administer a bone graft (a little bit of deproteinized bovine bone to give me a little more jaw bulk and strengthen the implant), and put in a couple of stitches to help me heal. Dr. Preeda placed what is called a healing abutment in the implants, which is essentially a little screw cap to hold the place of the final abutment. The final abutment is the “nub” to which a crown will be cemented. The worst part of the experience was really just battling my own anxiety. I experienced slight gum and tongue soreness as the anesthetic wore off, but ibuprofen was sufficient to eliminate the pain completely. I was eating (gingerly) again by dinnertime.

On day seven of my trip, I returned to the clinic to try the crown on again. This time, the color was absolutely perfect, and both Dr. Sunisa and I were very satisfied. She cemented the crown in place, and we discussed how I should care for my implants in the coming months. It’ll take about four to six months for the bone of my jaw to fuse with the titanium implants and become sufficiently strong to withstand the forces involved with chewing food. Until then, I need to allow my gums to heal, and not bite down hard in those areas.

A Testament to my Experience

My fiancée, the Soon-to-be Mrs. Vagabond, joined me for about five days on this trip. She has had a much better recent dental history than I have, but she also had a couple of cavities that her US-based dentist hadn’t yet treated. The reason they hadn’t treated them is that she had exceeded her annual dental insurance maximum for 2015, and in order for her not to pay the full price of about $300 per filling, they had suggested that she defer four fillings into 2016 instead. Even with insurance coverage, her copay for a one-surface, composite (white) filling is about $120.

This is what dentistry is like in the US. Dental insurers cover only the most basic procedures, and when they do, the insured still pays a hefty copay. When the minuscule annual maximum is reached, the insured needs to pay for everything in cash, or defer treatment– which endangers dental health. When you think about it, it’s a total disaster.

Since the STB-Mrs. Vagabond was coming along anyway, I suggested that she think about having her cavities filled at the clinic. She agreed (with a tiny bit of anxiety), and we scheduled a cleaning and let the clinic know that a few fillings were likely to be necessary.

I tell you all of this because I figure it is the best way of communicating how good my experience has been so far. I was not just willing to have– but enthusiastic about having– my favorite person in the world treated at the clinic.

After ordering a couple of X-rays, the general dentist reassured my fiancée that her teeth looked good, and that she only needed three small fillings rather than the four quoted to her by her dentist in the US. He did a deep cleaning of her teeth and filled the cavities (which needed no anesthetic). The total cost for the cleaning, x-rays, and three fillings with composite material was $142 (US). In other words, her cost for everything was a few dollars more than her copay for a single filling when fully insured.

Costs Thus Far

This trip was by far the most expensive of the entire treatment series. The only things left to pay for on the next trip are the abutment and crown for both implants. This trip, I paid for the flight, hotel room, some minor outings and food, the crown, two dental implants, and various x-rays, CT scans, medications, and antiseptic mouthwashes.

I should also probably mention that my hotel, entertainment, and food budgets were off the charts on this trip. Partially because I treated myself to more shopping and outings, but also because when my fiancée and I were together, we did a lot more frivolous stuff (like have a ridiculously expensive drink at a rooftop bar). I also didn’t use points on the hotel this time.

This table represents the total cost for all items on all trips (the total cost so far).

ExpensePrice
Grand Total:$7,854.77
Hotel$1,290.42
Flights$1,097.00
Food$249.55
Entertainment$374.27
Communication$20.97
Local Transportation$43.52
Dental (4 X-rays)$13.95
Dental (CT Scan)$127.52
Dental (1 Root Canal - Molar)$317.89
Dental (1 Root Canal - Core Build Up)$92.76
Dental (1 Deep Cleaning/Polish)$39.73
Dental (3 One Surface Fillings)$79.46
Dental (5 Two Surface Fillings)$211.85
Dental (Extraction w/ Soft Tissue Impaction)$92.59
Dental (Extraction)$66.14
Dental (Assorted Medications)$19.33
Dental (Surgical Guide)$56.67
Dental (Zirconia Crown, Molar)$425.06
Dental (2 ITI-Straumann Implants, Bone Level)$2,833.70
Dental (1 Bone Graft)$402.39
Dental Only Total:$4,779.04

The cost estimate for the dental portion of the last trip is about $1,800. Assuming I pay the same amounts for flights and hotel, I’m on track to spend around $11,000 for the three trips and full course of treatment. This means I’m looking at right about half of the cost of getting the same work done in the USA. Needless to say, I (and our wedding plans) are extremely satisfied with the cost and outcome so far.

I’ll return one last time in July or August, and I’ll finally be done!

I hope that this series is of interest to people. Have you ever traveled abroad for medical or dental treatment? Would you? Let me know in the comments!

5 thoughts on “In Search of Affordable Dentistry: Part V

  1. Penny @ She Picks Up Pennies

    This is amazing to me! I’m going to read the rest of this series right after I comment. This is the first year that my husband had to have work done outside of a cleaning…and I think I’m sending him with you next time 😉 I let him handle his own appointments and bills (because I’m trying hard to not be my mother), but I just learned that he actually only gets $1k of coverage a year. Annnnnnnd now he needs a special treatment, a root canal, and two crowns. One crown later, we’re well past the $1K. Oof.

    1. The Vagabond Post author

      Ugh, I am sorry to hear about your husband! I need to sit down and figure out about where the break-even point is, since you incur the extra travel and hotel expense, but my mental math says that at about the $4K US dental treatment cost, you’re there (assuming you spend $2K on flights and hotel and get the treatment for 1/2 the price abroad).

      Best of luck finding savings!!

  2. amber tree

    Amazing series to read… It is hard for me o understand that medical expenses in your own country can be so expensive that it is actually cheaper to fly across half the globe 3 times… I should be happy to life in Belgium and pay a lot of taxes…

    1. The Vagabond Post author

      Yes indeed! Dentistry is sadly (in my opinion) one of our most exploitative medical industries. I actually quite look forward to our future life abroad and being able to seek dental treatment like this regularly.

  3. Pingback: In Search of Affordable Dentistry: Part VI - The Frugal Vagabond

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