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How Much For The Boxtox?

“Fifty bucks for a cleaning and check up,” Luke grinned, flashing newly whitened teeth.  


We were in Tamarindo, Costa Rica watching our kids take their weekly surfing lessons after school. New friends, newly expatriated, we traded information every Friday afternoon on the beach over beer.  Luke’s boyish smile drew me in. 


“It was fine, really,” Luke exulted. “I’m going back next week to have this chip fixed.”  He pointed to a small imperfection in his front tooth. “This would cost a fortune in the U.S.”


We looked dubiously at Marla, Luke’s wife, an auburn-haired beauty with the suggestion of Georgia in her accent. “It’s true,” she said.  “I took the kids in for check ups and cleanings too.”


She entered the info on my phone while I handed Luke another beer. A few days later I made the appointment but will admit to second guessing when I walked into the office.  


The chair reminded me of one I’d seen in a Norman Rockwell painting, charming in a nostalgic sort of way but nothing I wanted to sit in.  White cement block walls and a sheet metal medicine cabinet furthered the ambiance of austerity, and the sink looked like the one in the girls’ bathroom back at Our Lady of Lourdes Elementary school in 1987, white and utilitarian, a no-frills fixture that would have had the approval of my depression-era Catholic nuns.


I settled into the chair and thought of my dentist in America, where I looked up at shifting scenes of cloud cover and migrating birds, where soothing music piped in from unseen sources, where chairs were so comfortable that surrender was easy.


“Good morning,” the dentist chirped in perfect English with just enough of an accent to be intriguing.  Her dark hair was pulled back from her pretty face, and her smile felt genuine.  “Okay?” she asked.


I nodded.  She tied a paper bib around my neck and handed me the suction apparatus.  I took it tentatively.  “How bad can it be?” I thought, and off we went, the dentist scraping with more vigor than I would have thought possible.


I winced while she plied away, trying not to visualize the sharp curving tools so close to my gum line.


By the time we finished, my bib was soaking and my clothes and hair were splattered with gritty, mint smelling paste.  I ran my tongue over my teeth.  For fifty bucks, I was satisfied.


All the expats we know, including my husband and I, are entrepreneurs, mostly middle class.  All of us pay our own tab for overpriced insurance and were thrilled with the health care options in our adopted country.


“I can replace that crown for you too,” my new dentist said as I was walking out the door.


I knew my crown needed to be replaced.  For two months, I had been swallowing chunks of tooth, and I wondered when it was going to wear down to a painful nub of nerve endings.  It was a procedure I would have dreaded in the most opulent surroundings and one that would cost over $1,500 at home. 


 “How much?” I asked, dreading that the answer was going to be too advantageous to turn down.  I was right.  We made a deal for $450 cash and agreed to meet the very next day.


In the morning, with resolve that surprised me, I plopped into the chair again.  


I felt the zing of Novocain and then remembered a Christmas tune I learned in the first grade:  tap, tap, tap, tap went the little hammer.  The dentist was tapping away at my tooth until suddenly I heard an unnerving sound of gravel inside my head as the tooth crumbled.  She scraped up the bits and started yanking hard on the crown, but it didn’t budge.  


Her body pressing hard against mine for leverage, she leaned in, tugging. Nothing.  I felt her perspiration on my bare arm.  "I got eet," she said finally with one more gusty lunge against my shoulder. Then she grabbed a tool that sounded like a bottle opener, and pop, off went what was left of my crown.


After pausing to make a quick mold of what would be my permanent tooth, she slid on a temporary.  


In the U.S., temporary crowns are nearly identical to the size and shape of the one to come, and they are usually a fairly painless placeholder and minor inconvenience.  This one was the size of an everlasting gob stopper, the giant magical candy that never changes size in Charlie and the Chocolate Factory.  It was huge, so big that I couldn’t close my mouth all the way.  


Breathing through my mouth, drooling from through what felt like seriously disfigured lips, I made my way to the door.


“Its just for a few days,” my dentist cooed.  “I’ll call you as soon as your permanent tooth arrives.”


I went home and my face swelled.  My mouth was rebelling at this massive foreign object jammed into my gums, and I counted the days until the permanent tooth would arrive. 


I started swallowing the off-brand Advil we had purchased in Nicaragua a few weeks prior during a side trip and wondered when my phone would ring.  Where was my dentist? 


 Finally, I called her.


“She’s on vacation,” the receptionist said in Spanish.  At first I thought I misunderstood, my Spanish being terrible on a good day.  But I repeated back to her what I thought she said, and she confirmed that I got it right. Costa Ricans joke about being on “Tica Time,” their relaxed sense of punctuality, but I didn’t think that part of their culture would apply to dentistry.


A week and a half and a lot of Nicaraguan Advil later,  I finally got my appointment.  It had been a long wait, but when the time arrived,  she popped off the temporary crown and fitted the new one as expertly as any doctor in the U.S.  


I peeled off $450 in small bills as we had agreed and turned to leave, thinking about the thousand dollar savings, the migrating birds I didn’t get to see, the pain I had endured, and whether or not it was and worth it.  


Amidst my musings, I bumped into a man in a white coat, a man whose face and build took my breath away.  “Pardon me,” he said in perfect English.


“No, pardon me,” I replied.


“I’m Dr. Lobos, a dermatologist,” he said.  


Calculating a deal on botox and microdermabrasion, I took his card.  After all, how bad could it be.

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