Ninety minutes later, I was writhing in a different kind of pain. The office assistant handed me a bill for $930. That was $900 for root planing and an extra $30 for the numbing gel. I had to bite my gel-numbed tongue to avoid asking why they stopped there: “Sir, would you prefer we do this while you lie on the floor or would you prefer the Chair Package?” “Care for our Adequate Lighting Option?”

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Worse: This was just the beginning. The dentist said I needed at least four crowns — at about $1,500 each. While that’s about the average cost of crowns around our home in Maryland, according to our insurer, that would probably be about $5,000 more than our insurance would cover.

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I was moaning about this to my brother-in-law who lives in Norway, and he said people there fly to Hungary for good, affordable dentistry. Some searches online about dental tourism had me sold. The savings from crossing the border can appear remarkable. Crowns that cost $1,500 would run just $300 to $600 apiece in Mexico or Costa Rica, I found. No wonder medical and dental tourism is a booming business.

The U.S. Bureau of Economic Analysis says Americans spent $2.6 billion on medical and dental tourism in 2018. That’s up from just $757 million in 2008. While there are no reliable counts of how many people leave the United States for discount foreign dentistry, officials in Costa Rica, a hub for dental tourism, estimate that tourists spent more than $200 million on implants, crowns, veneers and other tooth care there in 2017.

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Of course, a cheap but bad dentist is no bargain. Traveling to a foreign country for discount dentistry certainly has additional hassles and risks.

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The Centers for Disease Control and Prevention warns that local standards of facilities and training may be lower than in the United States and that mistakes in translation or communication can result in mistreatment. Also of concern for anyone having major work done: Flying shortly after any kind of surgery heightens the risk of deadly blood clots.

But putting off needed dental care also has risks. So, I was determined to try the overseas route.

First, to find that good and affordable overseas dentist. I opted for Costa Rica because I’d never been there, it had a good reputation for dental tourism and I’d heard it was a great place to vacation. Why not offset the pain with a little pleasure? An online search for Costa Rican dentists returns almost 1.8 million results. To narrow my choices, I used a facilitator, or broker specializing in dental travel to Costa Rica. I figured that was safer, since the dentists are beholden to him for repeat business.

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While it’s difficult to suss out legitimate online reviews of anything anymore, I chose a broker who seemed to get real-sounding praise on sites such as TripAdvisor. I sent him my X-rays and my American dentist’s proposed treatment plan. He distributed those to several Costa Rican dentists, who sent back bids. I chose one who passed my wife’s online investigation. The facilitator also handled my travel, arranging for a hotel ($75 a night), airport pickup and transportation to the dentist’s office. He didn’t charge me for his service. He collects commissions from the dentist and hotel.

Arriving in Costa Rica

I arrived in San Jose, the capital of Costa Rica, on a Tuesday, and the next day a driver whisked me to the clinic, where I was reassured. I saw state-of-the-art equipment and learned that several of the dentists had trained at American dental schools. The dentist I chose had done some training at Baylor College of Dentistry in Texas, now Texas A&M College of Dentistry. The staff was fluent in English.

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After his examination ($80), the Costa Rican dentist announced he thought I needed five crowns. (I really should have flossed more.) The cost: $500 each. I said yes.

At home, a wise person would probably spread out this kind of ordeal over several months. But the Costa Rican dentist was eager to get everything done right away, and my time was limited. So, for the next 6½ hours they ground and they pierced and they grated and they chipped. That’s a lot of Novocain. And conversation between staff members was in rapid Spanish, which Americans who don’t speak the language might find disconcerting.

It would take a few days to make the crowns, so my wife and I took a short flight to the Drake Bay area, where we snorkeled, swam and poked around the mangroves. My mouth was sore for about a day, but ibuprofen and a few refreshing “leche de pantera” nonalcoholic cocktails took care of that.

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When I returned to San Jose for the fitting, an interesting thing happened. One crown did not sit perfectly. The dentist explained that he could grind it down, but best practice was to cast a new one. That, however, would take time, and he knew my schedule was tight. I appreciated his honesty, and it was nice to be given a choice. I opted to wait for the new crown, which he glued in the night before my flight home. It fit perfectly.

The bill

Total dental bill: $2,580, including anesthetics. Because our dental plan is a preferred provider organization, Aetna says we can get reimbursed for some of this expense, but it is still working on that.

My wife’s and my airfare and a week in a San Jose hotel ran about $1,000. Throw in $500 for meals and incidentals, and the total cost of the dental trip/vacation came in under $4,100. People who live close to Mexico and can drive across the border to dental centers such as Los Algodones would have much lower costs.

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That math shows that dental tourism for people who live far from the Mexican border makes economic sense only if you require significant expensive dentistry, such as crowns, implants or veneers, which would cost more than about $5,000 in the United States. And in return for the savings — and the cheap tropical vacation — you have to be comfortable traveling in a foreign country and willing to accept some extra risk.

Generally, your local dentists will repair a loose crown they installed at no charge in the first year or two. If something goes wrong with my Costa Rican crowns, I’ll probably have to pay a local dentist about what it costs to do a crown to take care of that. But after more than four months, I’ve had no complaints.

I can only say that most guests at my San Jose hotel were there for the dentistry. Most were return customers. They had beautiful smiles.

And nice tans.