SJ CR III

HERE IT IS...FRIDAY MORNING
and I am free of the dental tourism bit.  All I have to do is to comply with the follow-up instructions (pills, mouthwashes, diet rules, and etc.,)  The procedure went really smoothly, and was much easier than I had anticipated.

I had my first implant done by my brother who, until several years ago, had been the first Professor of Prosthodontics at Sydney University School of Dentistry, and was largely responsible for the introduction of implant practice in New South Wales, Australia.  That was 28 years ago and that single implant has given not trouble through all that time!  He must have been OK at it as he recently received one of the high honors from the Australian Government for the work he has done with Veterans in this area. Certainly, not just by doing that work but by keeping me up to date with his professional interest, I have great confidence in this aspect of dentistry.  Much thanks to him!

So I knew generally what to expect but things went even better.  Dr. Wong, the oral surgeon, did not however sing to the music although he did hum along occasionally. Also, he took some nice photos and sent two on to me.  If you do not mind looking into my mouth, here they are.

Implants 

This one shows the three implant about to be screwed down into the holes drilled into my jaw.  Dr. Wong did this using a surgical guide to ensure accurate position.  The drilling requires several passes, each a little wider, using a slow drill irrigated with chilled water.  This to prevent heating and destroying the surrounding bone.  Once they are fully inserted the bone will begin to heal around them, treating the titanium of which they are constructed as if bone.  The surface of the implants is specially treated to encourage this process so that, in about four or so months' time, each implant will have become integral with the surrounding bone.  Very cool indeed!

Healing Caps

Once properly in place, he then screwed on healing caps to protect this process. In December, I will return for the final work.  This involves removal of the caps, attachment of special abutments means of screws. Crowns, to make it all look like regular teeth, will then be glued to the abutments.  All I have to done is to take good care of the site to ensure no infection of the wound.

I had thought that it would have been two implants and a bridge. However, the local oral surgeon surgeon who extracted the tooth next to the incisor had done such a good bone graft that good bone density was assured. Although the extra implant adds a little to the overall cost, I consider that this will be cost effective and a sounder restorative approach.

So there you have it. I am forced to confine myself to eating icecream, yogurt, smoothies, and the like for today and soft solids tomorrow.  No alcoholic drinks until tomorrow evening (had to forego the Jamesons last night), so that is when I will truly give thanks.  In the meantime, many thanks Costa Rica Dental Team.

SAN JOSE CR II: A pleasant surprise

WEDNESDAY:  CHOOSING A GOOD PRACTICE at a distance might seen somewhat of 'pig in a poke' exercise.  I did the best I could (more details later) with two practices in mind, one I was fairly sure of and the other, also promising, as a backup.  Imagine how it might feel to travel to a distant county and not to like what one discovers.  With governments backing dental tourism there is room for lots of hype and possibly practitioners of dubious competence but gifted with advertising elan getting into the market place.

As it turned out, I liked what I saw at Costa Rica Dental Team.  Paul, the client coordinator, did indeed pick me up in good time to take me to the offices.  As everywhere, there were forms to fill in at the outset. Then it was off to the first examination consisting a detailed examination that included using a special camera to take several views of each tooth.  This showed up some questionable shadows at the margin of two crowns, one of which seemed serious enough to take preventive replacement of one crown.  The  molar that might have needed a root canal did not yield any more information and we agree that the endodontist due to visit the next day would provide the final opinion (which was that a prophylactic root canal would be in order).  Over that last two days I have been moving through a maze of replacement of crowns, root canal, cleanings, consultation with the oral surgeon about the implants, x-rays, and various other stuff.  All very boring, no doubt, but altogether an impressive demonstration of how a dental team can go about providing excellent service.

There are quite a lot of women dentists in CR and I think they bring quite a different approach to care.  Mike, the owner of the practice, has a preference to employ women at all levels and I think this is a good strategy.  He is an American trained as a Dental Technician who, for much of his early career, ran a laboratory for a large practice.  He had opportunity to acquire clinical knowledge through working alongside the dentists and to see the connections between clinical and technical aspects of advanced dentistry.  The next step was to set up a laboratory of his own, eventually in Florida although he originates in Michigan.  He received work from all over the US and finally moved his laboratory to San Jose, the distribution center remaining in Miami. The laboratory is his main business stream, serving 800 US dental practices.

Prosthetic and cosmetic dentistry is more an add-on, using a core team and bringing in specialists according to patient needs.  He stands behind the work, giving a 10 year guarantee.  The oral surgeon has his own practice, where Paul took me for the necessary imaging.  Altogether, I think this is a neat way to package professional services.  Permanent crowns are to be fitted this afternoon, leaving the oral surgery and placement of the implants for tomorrow.

To date, I have been very busy with the dental stuff but yesterday I had enough free time to walk do the down town area...about a half hour's distance.  Recall that SJ is at almost 4000 ft elevation and quite hilly and it is enough to say that I have learned a respect for the macro terrain. At the more micro level one must watch the steps and the unevenness of most of the sidewalks and smaller streets.  These seem to have been in constant repair for the last century or so and lagging the wear and tear.  More importantly, watch out for the drivers who have scant, if any, respect for pedestrians!  The streets are narrow and traffic thick, so their eyes are not focused on people trespassing the road.  To give the drivers their due, pedestrians seem singularly unconcerned about risk, most often just stepping out into traffic with nary a glance.

At town center pedestrian conditions improve, better pavements and good use of pedestrian malls.

How to describe SJ? An old city becoming  new with vestigial traces of the old and the interim all around. Of course, the people are wonderfully friendly and helpful. Very few know English so do some work on Spanish before you come here.

I am just back from having the final crowns fitted.  They have done an excellent job of preparing and fitting them.  Jessica, my dentist, sang along with the music a good part of the time....there's added value for you!

This evening, I plan to go down to the corner to the Irish Pub for a glass or two of Irish whiskey.  Tomorrow, they drill the sites for the three implants and screw them in.  Not looking forward to this.  More on this in the next posting.

SAN JOSE: Day 1

RELAX, FRIENDS...I do not plan a posting  for each day.

Overnighting at IAH turned out to be something of a bummer due to that Texans just looove their air-conditioning.  I did not actually shiver but I found it difficult to doze.  All the nice lay about places were taken by...yes: lay abouts!  How nice it might have been had I the foresight to pack a light jacket.  However, I managed to read most of the latest Jack Reacher book.

San Jose (henceforth SJ) is set in hilly surroundings.  The pilot of the UA 737-800 executed the approach with commendable elan, air brakes out and rapid descent, managing to cope with an impressive cross wind just before touch down.  'Good job' said I as I stepped off.

At almost 4000 feet elevation but just under 10 deg North, the weather is very like Corning and we can expect thunder storms tomorrow.  The days are longer just now up near the Canadian border while here we have the relatively brief twilight of the tropics.  Really very pleasant, all in all.

My accommodations are very acceptable.  Casa 69 is not too far from downtown.  I ventured out and had Pizza at the eponymous Hut just up the road and found the ambiance much more 'up scale' than any I have encountered in the US, more stylish than many a restaurant I have visited. 

 Just hereabouts the environ is a mixture of the run down, gentrification, and modernity.  For example the side streets are somewhat cobbledied with pot holes matching those one might encounter around Corning, whereas the street up the hill has about five inches of new blacktop.  Of course, the city is hilly but with some very nice parks.

In the line waiting to pass Customs, I asked someone who seemed to know CR well why it is that Costa Ricans live so long, are so healthy, and so happy.  The reply?  'Because they grow all their own food on small farms.'

Well, it is off to bed for weary Roberto.  Tomorrow, three dental appointments.  The CR Dental Team will send a car around to pick me up...don't get service like that in Corning!

WHERE DID HE GO...THIS ROBERTO?

I ADMIT IT...A LONG TIME since my last posting!

Winter hung on, then Spring caught us all by surprise but with little of that rush of energy, so depleted were we all from that overlong and penetrating cold.  'The worst we have had for some years', was the complaint on every side.

For we humans, that is.  As for the plants, they simply took off while we green finger pretenders lagged far behind.  I managed to get sort of 'sick' with a weird low grade sinusitis, partly due to allergies it would seem.  Later it became clear that another villain in the piece has been an incipient abscess in one of my upper molars, possibly affecting the sinus on that side.  Several courses of antibiotics helped somewhat but what can be worst than such in the Winter.  All I wanted to do was eat chocolate!  Supposed to be an natural antidepressant but excellent at adding fat. What is that saying, things that taste good must be immoral, illegal, or fattening?  Seems I am too moral and collected the residual possibility. Maybe the allergist is right...at least the nasal spray he recommended has fixed most of the symptoms.

Please forgive all this going on about overstated illness.  It has been a matter of grinding away at the gym and riding the bike and gradually my trousers have become a little less tight around the waist. To admit to the truth, the fact is that I passed my annual physical with flying colors.  Things cannot be all that bad.

What is prompting this dreary chronicle?  Here I am, sitting out the night at Houston International Airport, on my way to Costa Rica.  Do I hear you asking, 'Why on earth is he going there?'

For the last decade I have marveled at the long life of a bridge' in the right side of my jaw, constructed some 30 years ago and taking the place of two side by side extractions.  Finally, it felt rather loose and then fell out.  The problem was a decayed tooth and the front end.

My dentist effected a minor repair on the tooth at the other end and then pronounce that I would need to have two implants supporting a new crown.  How much would this cost, including the necessary root canal and crown?  Looking at me seriously, he pronounced a total of some $15,000!!!

'What do you think?' asked he.
Me: 'I think, Dental Tourism.'

So, dear friends, I researched this topic from Thailand, Turkey, and finally Costa Rica. In San Jose there are lots of fully qualified dentists doing this work and I expect all this to be done for around $6,000 including travel and accommodation.  Plus I get to go to CR twice, apparently a very nice country to visit.

So watch this space...I will write a brief posting at each stage, beginning Monday.

I was going to have the work done in Turkey, in combination with cycle tours there and, later, in Israel.  But meanwhile came the news that my dearest friend was diagnosed with the dreaded breast cancer; a very aggressive type, Stage III.  So I have been caught up in supporting her through the surgery and chemotherapy.  This next week is a lull in her treatment regimen so it is Dental Tourism for me this week.  Turkey and Israel will have to wait.  It turns out this might not be a good time to go to the Middle East so it seems to be working out.

More shortly.