We have now been traveling full time for 17 months. During that time I’ve seen dentists in Thailand, Panama, and Mexico. It’s been very interesting to compare these experiences to each other and to my previous experiences with my dentist in Seattle. Visiting the dentist on a regular basis is a part of our nomad travel itinerary, mainly to have regular dental cleanings but also to take care of regular maintenance of old crowns and fillings as well.

My Dental Baggage

The bad: As a kid I was terrified of my dentist because she was intimidating and impatient with kids. No idea what she was like with adults because when I was around 15 I refused to ever see her again. Because I saw that dentist for so long and had so many bad experiences with her, I still kind of freak out when I go to the dentist as an adult.

The good: I loved our last dentist in Seattle because he was gentle, understanding, and made sure I was as comfortable as possible when I saw him. He took my wisdom teeth out in 2006, and then he replaced some old fillings with crowns over the next few years, and after that I was just returning every six months for a dental cleaning and a checkup. I felt so fortunate to have a dentist I really liked and trusted!

The bad: Once my teeth were in good shape, I barely saw that fabulous dentist anymore. I went to that dentist’s office every six months to get my teeth cleaned, spending an hour at a time with the hygienist followed by about 5 minutes max with that lovely dentist. And those visits were hard for me! The hygienist was friendly, maybe too chatty, but very nice. I have no doubt she was well trained and highly skilled. But it was oddly painful when she cleaned my teeth. And since my teeth and gums were supposedly in good shape when I walked in, it pissed me off that when I left I was in pain and sometimes my gums were bleeding gums from her sharp tools. Since I liked this team so much and we were friends with some people in the office I was able to be really honest about how tough those cleaning visits were for me. The dentist, dental assistants, and the receptionist there all said their hygienist cleaned their teeth as well, and they aways used nitrous oxide (laughing gas) during their cleanings. So I got on board with that too and it helped a lot.

Moving on: Regardless of my dental baggage, I was excited to start seeking dental care outside the US. And now that we are not employed and we don’t have dental insurance in the US to help cover costs, there is zero incentive for me to see a dentist in the US. I’m glad I have my Seattle dental office as a comparison for what I experience in other locations, and I’m enjoying having dental work during our travels because that has turned into a good research project!

Seattle Washington USA – My Gold Star Dentist

I really did love our last dentist in Seattle, and I used to call him my gold star dentist because after a checkup if everything looked good he used to say, “you get a gold star!” Woohoo! Before leaving Seattle we went back to in to have a last cleaning and checkup before heading off on our travels, and since we still had insurance at that point. One thing I loved about that office is that it looked and felt very modern and appeared to have the latest and greatest technology and equipment. It felt very fancy in there!

After leaving on our travels and doing some research I learned that my Seattle dental team primarily used “conventional hand-held scaling” for dental cleanings. I like to call that – barbaric scraping and stabbing at your teeth and gums using sharp metal pokers. That’s the only kind of dental cleaning I ever had there or at any dental office in the US. And I’ve seen a lot of different dentists across both Seattle and a variety of cities in Northern California during my adulthood. I thought that was the only option.

Dental Tourism Round 1 – Thailand, Panama, Mexico

Chiang Mai, Thailand – Dr. Kitcha

My first dental experience outside the US was at Kitcha Dental Clinic in Chiang Mai. This happened to be our location six months after our last cleaning in Seattle, so the goal was just to go in for simple dental cleanings. We used the website Dental Departures to find a selection of dentists in town. We read reviews, picked one office, and used Dental Departures to book two appointments so we could go in together.

When we arrived they promptly sat us down to do a blood pressure reading (my first at a dentist office). I liked the idea that they do a general check on health and anxiety before their procedures. Within minutes we were each whisked into different rooms for our cleanings since this office has a larger staff of dentists. In my exam room I noticed all of the new and very modern looking equipment, which actually seemed more new and modern looking than what our fancy Seattle dentist had just installed a few months prior in their office.

And I was quite surprised when the head dentist there, Dr. Kitcha, introduced himself and said he would be cleaning my teeth. That was my first introduction to the idea that dentists themselves handle the actual cleaning procedure in many countries. I like that! Dr. Kitcha told me he knew I was nervous and they were prepared with nitrous oxide to help me relax, but I surprised myself and declined because all of a sudden I was very interested in what was happening and I didn’t feel a need to zone out on a nitrous cocktail at that point. I lay back in the chair and the dental assistant put a big purple bib that was practically an outfit over my face and chest (so much bigger than the little blue paper bib I was used to from US dental offices).

The cleaning technique they used was “ultrasonic power scaling” which I had never heard of or experienced before. Power scaling is a newer and more modern technique compared to standard traditional scraping. And since ultrasonic cleaning is super fast I was done and back in the lobby in about 20 minutes (compared to an hour long process in Seattle).

I was weirdly blissed out by that teeth cleaning experience so I asked the front desk staff if Dr. Kitcha had time to fix one of my oldest crowns in the next week, and he did. I knew I had a few crowns and major fillings that were 20+ years old that need to be replaced in the next couple years. Dr. Kitcha told me that when he was cleaning my teeth he noticed one particular crown on a back molar that was clearly old and worn and that one probably had the most probability to crack and cause problems so he recommended that we fix that one. Even though the cleaning was fabulous I was still a bit freaked out by the idea of getting a crown on a back molar so I had nitrous oxide during my second visit. Having nitrous meant there was a bigger team in the room with Dr. Kitcha, a dental assistant to assist him, and another dental assistant to manage the nitrous.

So I lay back in the chair, the dental assistant put on the familiar big purple bib-outfit, and I breathed in the nitrous for a few minutes and thought about how the lights weren’t bothering my eyes under that fun purple thing. When Dr. Kitcha gave me the first anesthetic shot it didn’t bother me, thanks to that jolly fun tipsiness from the nitrous. I think it took about an hour to remove the old crown, do some cleanup, and add a temporary crown. And I basically enjoyed that whole experience thanks to the nitrous. A few days later I went back in for the permanent crown which only took about a half hour which was a very simple procedure with no fuss and no pain. And that was it. It was very easy. As of this moment it has been almost a year since I had that done and it still seems just fine! I’d go back to that dentist or anyone in that office for sure.

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Boquete, Panama – Dra. Mónica Sanjur

Since my first dental tourism experience was such a success I was actually looking forward to my next cleaning. We were in Boquete Panama when it was time to see our next dentist and since we had made friends who live in town we didn’t bother looking on Dental Departures to find a recommendation. One of our local friends who was born in Boquete recommended Dra. Mónica because her son has a tough time with dental work but Dra. Mónica makes it easy for him and he trusts her, which is a perfect recommendation for me. Another couple we met in town said they also love Dra. Mónica and she’s the reason they stopped planning to see dentists in the US when they go back every year. Enough said. We simply walked in to this dental office one day and asked for two appointments for cleanings and they were set back to back for the following week. 

Everyone in the office was very friendly. I could tell there were a bunch of different rooms for procedures and the one I had was not fancy or modern, but there are other rooms with newer equipment. I’d say the chair and basic equipment in the room was a bit worn and well-used. But I did not mind that since everything was sparkling clean and I’m not expecting anything fancy in smaller, more rural areas.

The cleaning was done by the dentist, which reinforced the idea that it’s quite normal for dentists to do cleanings themselves outside theUS. When I met Dra. Mónica I liked her immediately. The dental assistant gave me a little purple bib, very much like the little blue paper bib used by my dentist in Seattle. And Dra. Mónica used modern ultrasonic power scaling as the cleaning technique. I was impressed to see that even in this small town in a more rural part of Panama they are using modern techniques and equipment rather than just scraping at teeth the old standard way. The cleaning took about 20 minutes and then I was done and back in the waiting room.

Since I still have a few old crowns and fillings that will definitely have to be replaced in the next couple of years I asked a few questions about crowns and root canals from this team. That’s when I learned that nitrous oxide is banned in Panama. I considered whether I wanted to volunteer for a bigger procedure again and replace another old crown or filling, and I know it would have been simple to get a Xanax or Valium to help with my anxiety if that was the critical decision factor. After my second visit to a dentist outside the US, I was 100% sold on having my dental care handled out and about from now on. But I decided not to consider volunteering for a bigger appointment there. Maybe I want to see the newest equipment and technology for a more difficult procedure like a crown, or maybe I want the option of nitrous, or maybe I was just convinced that I didn’t need anything else right away? But I would gladly return to this office for a cleaning in the future because I really like this dentist.

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San Miguel de Allende, Mexico – Dra. Alma Godinez and Dr. Cesar Rodriguez

Ironically, a few weeks after my cleaning in Boquete I started having uncomfortable sensitivity to cold on an upper back molar. Frak! It was the same one Dr. Kitcha had pointed out almost a year ago. I tried the strategy of just ignoring that for a few weeks until I noticed some actual pain in that tooth. We were in San Miguel de Allende at that point, and we had plenty of local buddies to talk to for referrals so I ended up calling the office of Dra. Alma Godinez one afternoon and got an appointment for the following day.

I was having some major anxiety by the time I got to the office because I was pretty uncomfortable and I was expecting some actual pain from a bigger procedure to deal with that. I know I was rather emotional and sloppy upon arrival as well. The front desk staff was very patient with me and right away Dr. Cesar Rodriguez came out to the waiting room to greet me with a big smile, saying he wanted to meet me and practice his very excellent English. He said I would be seeing him as well as Dra. Alma since they specialize in different things and I might need to see either or both of them. As soon as I was in the exam room with these two fabulous dentists, Dr. Cesar and Dra. Alma, I noticed how new and modern everything was, and loved the floor to ceiling view outside with sunshine and plants. The first thing I asked was if they had nitrous oxide to help with my anxiety, and that’s when I learned that nitrous oxide is also banned in Mexico. I said if they needed to do anything major I would probably want something else like a Xanax or Valium to help with my anxiety and Dra. Alma said yes that would be an option. Then she took my hand, leaned in, and said I wouldn’t need that. She actually promised I would have no pain. And I believed her. There’s something very reassuring about having a confident and calm dentist that exudes a Captain Marvel-like energy. 

I lay in the dental chair and Dra. Alma looked in my mouth, then Dr. Cesar looked as well. They did a fancy digital X-ray to see the whole tooth and then they were looking at that with me about 2 minutes later. As soon as they had the imagery to review they agreed that a root canal was needed and showed me why in the X-ray. They were talking about a tooth that was my oldest and biggest filling, which my Seattle dentist said had to be replaced in the next three years about two years prior, so I wasn’t surprised.

Dra. Alma explained that root canals are Dr. Cesar’s specialty, and things like implants and crowns are her specialty, so they would both be involved in taking care of me. Then she asked if I was interested in their recommended procedure, and I said yes. And then she asked if I would like to start the procedure immediately, or would I rather leave and schedule a time for the root canal? I think I shouted, “Now please!” Then things started moving like a perfectly working engine. Dra. Alma gave me another round of reassurance and said she’d be back to check on me in a bit, Dr. Cesar took assured me again there would be no pain, and the dental assistant asked me to lean back and gave me a little green bib, very similar to the little blue paper bib used by my dentist in Seattle.

When Dr. Cesar gave me the first anesthetic shot, very gently and slowly, I was surprised that it was only very slightly uncomfortable and I didn’t feel the other shots at all. I was tense for a while, but eventually I just relaxed. After about an hour Dra. Alma came in and asked me how I was doing, then asked Dr. Cesar how it was going, and all was well. After another hour Dr. Cesar said he wanted to do another X-ray to check that he had completed the root canal appropriately and that everything was ready for the new crown. Two minutes later I sat up and looked at the image with Dr. Cesar and Dra. Alma and they confirmed the root canal was done and I could go home. 

While I was having the root canal, Alison spoke to the front desk staff and scheduled the following appointments for the crown. Thank you Alison!

I went back a few days later for my second appointment to see Dra. Alma and she announced she was giving me a post/core build-up and a new temporary crown. A post? That sounded scary, but again she said there would be no pain. An hour later I was on my way home and again felt totally fine. There was no pain or even minor discomfort that time. A few days later I went in for a third visit and Dra. Alma gave me my permanent all-porcelain crown. That visit was quick and simple and only took about a half hour. 

I had been worrying about what it would be like to get a root canal for years. And honestly, I probably should have opted for a root canal in Thailand. Surprisingly, it was relatively easy even without nitrous or other medication to help keep me calm. I ate normally that night and enjoyed some mezcal since my jaw was tired from having my mouth wide open for two hours. But they were right, I never did have any pain.

After all three visits I paid the last bill and we scheduled cleanings and full exams including X-rays with Dra. Alma for April when we return. Those next cleanings are going to be about two months ahead of schedule but that’s where we want to have our next cleanings done so we are excited about that.

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Bottom Line, the Numbers

I started trying to collect some cost information from our last dental office in Seattle during my last visit there at the end of 2018. They were very clear that they don’t share costs or ranges for their services without an exam and scheduled procedure. But I persisted and eventually they gave me some numbers, but when I pushed for more details on an all-porcelain crown as well as a root canal but they made it clear that “there’s no way to quote fees without a current x-ray and exam.” Oh well. I can’t blame them for not wanting to share more price ranges since I’m not planning to return to their office. Though I think being upfront about costs should be the standard. It seems to be standard to quote a price range for all services everywhere else I have looked.

I have also gathered some standardized price ranges for dental care in the US from CostHelper. And I have gotten price information from our three dentists in Thailand, Panama, and Mexico as well. I also recommend using Dental Departures to get clear price quotes for various procedures with the various dentists they work with in various countries.

Once I put the price information I gathered in a table for comparison I was even more impressed with the services I received in Thailand, Panama, and Mexico. And less impressed with my options back in the US. It’s official. I’m a fan of having dental work in other countries outside the US from now on, and I look forward to more excellent dental experiences in our future destinations!

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Nitrous Oxide and Anti-Anxiety Meds

I have read that nitrous oxide (laughing gas) is a standard option for mild sedation and anxiety management during dental visits in the US, Scandinavia, Canada, and Thailand. I have also read that nitrous is banned in the United Kingdom, Mexico, and Panama. I have been searching for a more comprehensive list of countries and whether they allow or ban nitrous but I haven’t found one yet.

Experts agree, and so do I, that if dental work gives you major anxiety using nitrous oxide can be very helpful. It certainly has been helpful for me. And if laughing gas is not available in a certain location, and even when it is available, some dentists prescribe Valium or Xanax or other medications for patients that have anxiety or if a procedure is particularly stressful and some mild sedation is a logical part of the process.

I was grateful to have nitrous for my dental visits in Seattle to help with the stress and discomfort of those procedures. And I opted for nitrous in Thailand for the crown I got there. I would have used nitrous for my root canal in Mexico, if it was legal there. But I’m also grateful for that experience in Mexico without nitrous or other mild sedation so I can add that to my “new truth” about dental work and anxiety. That was my first “emergency dental visit.” And the worst part was how freaked out I got the morning before my first appointment. After that experience including three appointments with two different dentists, I think (and I hope) there will be a big change in my anxiety level around dentists in the future.

Standard vs Deep Cleaning

Once I had a deep cleaning with an ultrasonic tool I decided that I have a huge preference for that modern electronic technique. I’m not interested in having my teeth cleaned using old fashioned “standard” scaling techniques where someone manually tries to clean your teeth with a metal scraper. I know some people don’t like the sounds of power dental tools and that could be a reason to stick with quieter manual tools for getting your teeth cleaned. The sound of the ultrasonic tool does not bother me at all, and neither does the misty spray you might notice with that type of tool. After doing some research I’ve learned that ultrasonic scaling is much more effective in cleaning deeper pockets and root surfaces compared to manual instruments. And the bottom line is that I found standard manual cleaning to be very uncomfortable while the ultrasonic deep cleaning was painless for me. I’m saying goodbye to those old metal poking and scraping tools!

Dental Tourism – It’s My jam!

After living in the US for 44 years I know how typical it is there to have dental cleanings done by a dental hygienist instead of a dentist. But that was always an unpleasant experience for me. No offense to dental hygienists. I’m not sure how I feel about the fact that I got to the point where I always wanted to have nitrous oxide for getting my teeth cleaned in Seattle because it was so stressful and painful. I don’t want to be snarky about dental hygienists, but I have really enjoyed having my teeth cleaned by dentists in different places since we started traveling and spending most of our time outside of the US. I’m definitely ready for some new experiences and have no illusions about the myth that healthcare and dental services in the US are superior. From my experience that belief is not accurate and it’s clear that other countries can offer superior dental and medical services, even if those countries are said to be less advanced than the US.

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