By Sheri Doniger, DDS, contributing writer

September 21, 2011 -- Editor's note: Dr. Doniger's column, Dental Diaries, appears regularly on the advice and opinion page, Second Opinion.

I have a patient who just built a home in Costa Rica. He currently visits there for weeks at a time, and plans to stay for months at some point. He has a lower appliance that replaces his lower anterior teeth, and he is also missing his lower first molar.

We have discussed implant replacement for years. Now that he is spending more time in Costa Rica, he informed me he is looking into getting his implants down there.

His main reason for wanting the implants down in Costa Rica is the cost. He knows that many people go abroad to get their dentistry, and Costa Rica is one of the most prevalent places these tourists visit. In addition, he will be living there half of each year and feels he needs to find a dental home there. According to my patient, all their dentists were trained in the U.S. and have advanced degrees. I happen to know a pedodontist and periodontist, both trained at University of Illinois, who have practiced their entire profession in Costa Rica.

This patient has been a loyal patient for more than 25 five years, but he wants to save money on his dental care. I understand. And he is certainly not alone. According to an article in the Chicago Tribune last month, medical tourism is on the rise. Costa Rica and Hungary were listed as the top two places to visit for restorative dentistry. Costa Rica also claims to be one of the top spots for Americans to go to have cosmetic surgery and reconstructive dentistry, second only to Mexico. Of the country's 30,000 medical tourists, 85% are Americans.

I live in an area that boasts many different nationalities; more than 60 languages are spoken in our local schools. I have neighbors who return to Romania to have their dentistry done each summer, and I have heard of other people going back to their home countries for many treatments, including bariatric surgery, cosmetic surgery, and other costly procedures.

According to the Chicago Tribune report, the cost of dental crowns in the U.S. range from $800 to $1,200 (I know some practitioners charge more), while fees outside of the U.S. are between $200 and $600. For someone, like my patient, with time and money for vacation on their hands, this is a highly attractive option. So how do we compete?

I did discuss the continuity of care issue with my patient. But when a patient decides this is the way to go, we have very little say in the matter. It is similar to a patient deciding to change dentists and coming back to our office. And our practice is not alone. I have spoken to other dentists with the same issue. Patients go to Mexico for winter vacation and have crowns placed. Some go to India for the same reasons.

I know there is little we can do about this situation. When price is a factor, it wins over patient loyalty -- no matter how long the patient is of record.

Sheri Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, and has written for several dental publications. Most recently, she was the editor of Woman Dentist Journal and Woman Dentist eJournal. You can reach her at

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

Copyright © 2011

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