One Night in Bangkok, One Afternoon at ... the Dentist?

No, I didn't take singing lessons from Murray Head, but my first night in Bangkok is behind me now, albeit a day late due to the vagaries of modern air travel.  The primary purpose of my trip is a visit to the dentist.

That's right, the dentist.  Back in 2006, I had the shock of a $7500+ dental bill for a few onlays; fast-forward to this year, and my current dentist (different guy, obviously!) gave me the bad news that those platinum-priced onlays were failing and needed to be replaced with crowns.  After a $1800 dentist bill for just two crowns at that dentist (and mind you, that's after my insurance paid $900), I wasn't quite ready to fork out another $3600 for four new crowns!  Factor in that I'd used up my dental insurance for the year already, and we're talking a $4500 expense.

Rewind to 2006 for a moment, when after hearing of the ridiculous cost of those onlays, several friends suggested my money would have been better spent on a trip to Thailand--one of the world's premier "medical tourism" destinations thanks to the quality of their medical system plus the exchange rate between the baht and dollar--where I could have paid for the same work, a flight, and a week at a five-star beach resort to recuperate and still have had several thousand dollars left over.  I kind of laughed at the idea then, but the frequent traveler in me coupled with sticker shock over necessary dental work had me seriously thinking about going to the kingdom of Siam.

As for the costs of a trip, hotels in Thailand are cheap by US standards.  Bought at the advance-purchase rate, a night at a five-star resort hotel like the Millennium Hilton is around $100 (and I've paid nearly double that for a Hampton Inn stateside this year).  Dining can be had for $10 or less per meal for some tasty cuisine.  And airfare isn't ridiculous; I paid a bit over $1000 for my ticket, but that was to get an upgradeable fare which would let me fly in business class instead of economy.  So add up airfare, hotel, meals, and the dentist, and it's still less than what I'd be paying stateside.

Needless to say, weighing the cost of those crowns in the US vs. a trip abroad came down on the side of travel.

After doing much research on clinics, I settled on Thantakit, who despite having a somewhat cheesy Web site (though you should see a few of their competitors--definitely seems like the Thai medical industry hires Web developers who studied site design circa 1995), came highly recommended by both personal experiences of frequent travelers I know as well as with good online reviews.  They are a bit pricier than several of the ubiquitous dental clinics in Thailand--on par with the top-line hospitals in Bangkok--but even at that and a worsened exchange rate with the baht, cost less than half what my out-of-pocket would have been even if I hadn't used up my dental insurance for the year.

Thantakit sent a shuttle van to pick me up at the hotel, and after a 40 minute ride--traffic being atrocious in Bangkok--I arrived at their very classy, clean offices.  Now, no ding on my current US-based dentist, but I'm so used to dental facilities which look like they were build in 1970 that this was quite a pleasant change.

On to the consultation and initial appointment itself: the dentist spoke very good English and took a quick look  at my teeth, took several photos, and then sent me over for x-rays.  The x-ray equipment was the same state-of-the-art computerized system I'd used at the $7500-onlay clinic in Washington, D.C., though to save on my final bill, the dentist only took bitewings and not a full panoramic set.  The clinic took them digitally, instead of on film (this is a nice plus), and rather than having to bite down on an awkward film cartridge holder, one of the technicians positioned the sensor and held it in place during the x-ray--the only strange bit of the procedure, as she's taking a bit much radiation to her hands in the process.

Back to the exam to go over with the x-rays with the dentist.  Now, I'd expected a pressure-sell technique where the dentist would try to get me to go in for pricier options or for more services than I needed; I've had that happen in the US before, and was certain I'd experience it at a clinic whose primary business is dental tourism.  But I was honestly and pleasantly surprised to have the dentist argue for a more conservative, less-expensive treatment plan.  The remaining two one-surface inlays didn't need crowns, he explained, pointing out on the photos and the x-ray that most of their problem was in their surfaces having worn badly.  They simply weren't large enough fillings or in teeth used heavily in chewing to require a crown.

Chalk one up to the good guys.  Here I was willing to fork out a lot more money, and the dentist talked me out of it.

He also explained that for a molar and pre-molar crown, a noble metal covered with ceramic crown was a better option than all-ceramic for strength, and that though all-ceramic looked better, for teeth that far back in the mouth, he didn't see the need.  Yes, I agreed entirely.

On to the treatment.  The dentist went over everything ahead of time which he would be doing (that's more than any dentist I've gone to in the US has done), and explained if I was ever uncomfortable, to raise my hand (as opposed to the instruction to "tell us"--yes, that's what I hear in the US all the time from dentists: "tell us" when you've got a mouthful of dental probes, drills, retractors, and the associated paraphernalia off some sadist's confession-extraction kit in use).

"I'll give you the injection to numb the tooth now," he explained, and there wasn't even a pinch from it.  This may be a strange observation, but in the US, Novocaine injections frequently hurt quite a bit (the exception being the $7500-onlay dentist, who used an automated metering system to deliver the anesthetic--though the added cost was not worth it in his case).  I don't mean the needle itself so much, although that "pinch" the dentist warns of does often hurt.  No, I mean the anesthetic itself, which can send quite a burst of pain down the nearest nerves during the injection.  But this didn't hurt at all; I can only chalk it up to the dentist having a really careful hand and taking his time with the injection (it took a good minute to fully deliver the Novocaine).

Then came that most dreaded of dental implements, the drill.  Beth has described our current American dentist as being "quite fond of his drill," and indeed, I've spent a long afternoon or two in the chair wondering when the heck he'd be finished.  But another pleasant surprise awaited me: the drilling itself took a bit less than an hour for the two crowns plus some work on my inlays, and a filling for a cavity between two of my teeth.  It wasn't painful.  I can't ever describe dental excavation as pleasant, but it certainly wasn't an awful experience, either.

Finally, after taking some molds (downgrading to the noble metal + ceramic crowns necessitated molds vs. the photo-aided CAD/CAM milling I'd had for the past several dental procedures), the dentist put in place a temporary crown--explaining up front and apologizing that the process would smell like hot plastic for a few minutes--and sent me on my way, to come back in a few days and get the final crowns installed.

I'm due back to get those crowns in a couple of days--time needed for the lab to fabricate them to spec--and will report back once I've completed my dental tourism experience.  But so far, I have to say: this was the best dentist I've ever gone to.  Wish I could justify going to Thailand every six months for basic dental care instead of only the big-ticket stuff!

Sayonara, Wisdom Teeth

I just wanted to post a brief update; after a critical telecon at work this morning, I drove through the snow flurries (and inevitable traffic jams amongst a DC population that acts like a single snow flake is a biblical deluge upon the streets of Los Angeles) to an appointment to have my abscessed wisdom tooth examined and extracted.

Last Friday when my wife picked up the phone to seek out an oral surgeon who might be able to work me in immediately (and who accepted my dental insurance), she also called my doctor, whose office recommended an oral surgeon in their same building, and my wife had the good luck to reach the surgeon himself on a Friday evening instead of his answering service.

Although I had some apprehension about having the extraction done under local anaesthetic only verses conscious sedation (which I'd had for the last two extractions--figuring the less I would remember of the process the better), the fact I'd eaten within six hours (a light breakfast--I'd never expected to be worked into the schedule so quickly!) nixed sedation.  But it didn't matter; the entire procedure, from first opening wide to the last suture took less than ten minutes total.

I'm recovering fairly well at home now and plan to head out to the store shortly to pick up some nice soft foods to cook for dinner--though the surgeon indicated I could eat whatever I wanted pretty much right away; the extraction went that well.

I'll have to work from home tomorrow for my own sanity, but I do have to say I'm glad to no longer have the pain of that tooth hanging around my neck (or the fears of it spreading a much more serious infection to my heart or brain, etc.!)

Creationists and IDers: If We're God's "Perfect Creations," What's Up With Tooth Decay?

One thing you hear a lot of from Creationists and "Intelligent Designers" is that humans are God's "perfect creation," created in "His" image.  This statement conveniently neglects such obvious imperfections as the vestigial vermiform appendix and tooth decay--and I can personally attest to the latter, if not (hopefully ever) the former.  If humans are so perfect, what's the deal with tooth decay?

Two years ago, I developed an abscessed wisdom tooth; my prior dentist had actually assured me the small missing chip from the tooth was "fine" (it was a sign of decay, duh!).  The pain peaked around the time I was in my cousin Michael's wedding; I could hardly bite down without feeling like I was eating glass or had a mouthful of needles.  I made it through the ceremony with the assistance of massive painkiller doses, and somehow the abscess itself cleared up and gave me several more months without a problem--I ended up keeping the appointment I'd originally made to have them removed vs. going in for an emergency.

Wisdom teeth in and of themselves are of debatable value when examined under the "design" and "perfection" lenses.  They add little to modern humans' mastication; complications range from the dreaded but common teenage pronouncement of impaction to biting surfaces partially covered by the gums or skin, leading to inevitable decay--leaving one to wonder what sort of perverse deity would design such teeth and inflict them upon their beloved creations.

Creationists believe the Earth and humankind were created by their God, not by natural processes like the Big Bang and evolution; likewise, IDers state with no small degree of smugness that the universe and life are too complex to have arisen naturally and thus require "design" by their God--i.e. creationism in a tuxedo, or perhaps a liptsticked pig of creationism (though thoughts of lipstick in conjunction with the strongly patriarchal and often overtly-misogynistic culture typically associated with ID brings to light disturbing images of Ted Haggard in drag).

Friday evening, one of my two remaining wisdom teeth--a tooth I'd had problems with and knew needed to come out eventually--started hurting a bit.  As I'd an empty stomach and was headed to dinner, I figured I'd take an Advil once I had something on my stomach.  Although the tooth had hurt off and on for some time, unlike my prior wisdom tooth, I'd always been able to control the pain with one or at most two Advil--and of late, hadn't needed a dose for at least several weeks.

Over the next five minutes, the tooth went from a bit of pain to an exploding hammer drill in the side of my head.  Given we were headed to our favorite Indian restaurant, perhaps the Christian God felt a bit of petty jealousy for the Hindu pantheon.  But during that short drive--the restaurant is about a mile from our house--I realized something was seriously wrong with my tooth.  This was the worst pain I'd ever experienced in my life, inescapable and nearly unbearable in intensity; it shot from my jaw around my entire mouth and up along the side of my head in waves of pounding agony.  I did manage to eat--by then, the pain and low blood sugar from hunger were making me sick, and I had to ingest something.

Through luck my creationist and IDer brethren would ascribe to providence, my wife reached my doctor's office even on a Friday night, and in short order I had prescriptions for antibiotics and painkillers.  Even taking the maximum dose of painkillers, my tooth throbbed; the antibiotics took about three doses to kick in, after which the pain began to at least be controllable.

One might ask of the Creationists and IDers: even if we allow for the fact of tooth decay itself under your "creation" and "design" schemes (or the Christian notion of the Fall, which seems to explain everything from pain in childbirth to aging and disease), then wouldn't humans be more perfect if they regrew adult teeth, as do some animals including sharks?  Wouldn't an even more impressive feat of perfection be the body's shedding of decayed teeth and their subsequent natural replacement by God's "perfect" creation?

Or will I get the answer and argument that it's all part of an inscrutable "plan," that my tooth pain is punishment for my scoffing skepticism yet the luck of reaching my doctor and getting a Monday morning appointment for extraction signs of that same vengeful god's mercy and grace?  Sometimes I feel like I'm arguing with the Ouroboros, the mythological snake devouring its own tail, in the level of circular reasoning thrown up by my opponents.  Sigh.