Gummin' it out in Thailand: My Southeast Asian Dental Saga (or how I developed a Novocaine addiction)

Most people who take a year off to travel the world get a tattoo to commemorate the experience.  I got a root canal and two crowns.  

Two brand new shiny crowns, the latest additions to my mouth

This past Wednesday marked the conclusion of all the work I needed to get done on my mouth. It took five weeks and a large chunk of my budget, but for now, my mouth is in much better shape than when I started and we can finally start the trip in earnest. Since it's played such a huge role in the first part of our adventure, I'd like to recap what happened and share my experience with the Thai health care system.

First, if you haven't read the background into the initial reason as to why I needed to get this work done, you can see it here in one of my first blog posts.

I was working with Dr. Aubonrutt, founder of the Bangkok Periodontist dental cabinet.   Dr. Aubonrutt is a straight-talking Thai who did her studies at the University of Alabama Birmingham (UAB), which is a renowned periodontal school in the United States.   Having grown up in Nashville, Tennessee, it was comforting to work with someone who spoke English fluently, and with a clear southern influence to boot.   

After initially getting the pain treated, Dr. Aubonrutt examined the rest of my mouth to give her analysis.   Her assessment concluded that while I wouldn't need to get the tooth damaged by the wisdom teeth extraction repaired right away, there were more pressing issues to get addressed.

Mainly, the problematic tooth needed a root canal and a crown as it would alleviate the pain and protect the tooth.  Also, I needed another crown on an adjacent molar as I had received the root canal in Belgium but never had a crown.  Additionally, I needed to get a filling replaced as it was filled poorly (multiple times) in Belgium and was creating a space for bacteria to leak into the gums (yeah, that's a bit gross, but leaving these gaps as-is would expose me to a range of health problems such as gum and heart disease).

Grand Piano on the first floor of the waiting room
at the Asavanant Clinic.

For the root canal, Dr. Aubonrutt referred me to an endodontist at the nearby Asavanant Dental Clinic.   Where Bangkok Periodontist is a small practice, Asavant is a five-storey cabinet offering any oral treatment under the sun.  With an impressive staff of doctors, most of whom have studied in the US (my Endontist did her residence at Harvard), and a waiting room spanning two floors and sporting a grand piano, Asavanant is a high-end state of the art mouth hospital treating foreigners and middle-upper class Bangkokites.


Root canals, for anyone who hasn't had one, aren't exactly pleasant.   It involves the doctor drilling down to the root of the tooth and killing the nerve that lays inside it.  The idea is that it will kill the tooth, eliminating pain.    When the doctor drilled down to the nerve, we promptly found the root cause (pun intended if you laughed) of the recurring pain; the nerve itself had become infected and was causing the gum to constantly become inflamed.

How did we realize that it was infected? There were two ways; 1) the doctor saw that it was infected by finding pus, and 2) when she put an instrument in there, sharp pain shot from my mouth to all corners of my body.   Keep in mind that I was under a high dose of Novocaine and hadn't felt anything up until this point.   This was bad.

The doctor, realizing that there was an underlying infection, cleaned the root and applied an antibiotic directly to the the inside of the tooth.   She then prolonged the antibiotics I was on from the earlier work and we set an appointment for the next week, as the infection needed to clear up in order to complete the work.

We killed the time between appointments by visiting Pattaya and Ayutthaya.  Upon our return, we successfully completed the root canal.  From there, I headed back to see Dr. Aubonrutt to continue with the rest of the work.

The next step was to get a filling replaced that had been problematic for a few years.  Initially in  late 2013, I had a cavity that needed to be filled on the bottom right side of my mouth.  Due to the material used in Belgium, the cavity was never filled in properly, which had irritated my gums to the point where I needed another appointment to get it fixed.  After having to find another dentist to do the repair (the first one had fallen ill and was unavailable), leading to the cavity being removed and reset.    Again, it wasn't set properly and I needed yet more work to make it fit without hurting.

In the end, the filling was left that covered (most of) the cavity, but left a space between the gums that could lead to leakage.   Dr. Aubonrutt wanted to re-do the filling but instead of using a composite material that wouldn't fill the hole properly, elected to go with a ceramic remake of the top part of the tooth that would fill every single gap of the tooth and restore it back to its former self.

To be fair, it was more expensive than just filling it in with the regular material, but after having the tooth constantly worked on and never properly treated, I wanted to spend the money to get it done properly and not have to deal with it anymore.

Before heading out to Pattaya and Ayutthaya, Dr. Aubonrutt took a few imprints for the new partial tooth.  We completed the restoration of the tooth the day after I had the second part of the root canal.   From there, we set another appointment to get the crown put in place and Nathalie and I set out south for Ko Lanta and Ko Tao.

When we got back from the islands, I got measured for the crowns.   During the four hours of work, we discovered that a root canal I had in Belgium was only filled in with composite material and never crowned.  This meant that the 'post' which the crown would fit on had to be rebuilt and that, due to the material used in Belgium to fill teeth, the tooth was exposed to bacteria leak for nearly five years.   In short,  I'm at risk of losing the tooth later on in life.

Panoramic of the first floor of the waiting room at the Asavanant Clinic

Anyways, after getting measured, Nathalie and I set off for a ten day trip to Laos.  When we got back last week, I had my final appointment to get my crowns put in.   After a short hour of work, I was officially crowned, and free to break away from Bangkok for more than two weeks at a time.

With this being said, it's given me a few things to think about.   First of all, I got to discover a part of Bangkok that I've grown fond of.    I would've never made it out to Thonglor if I didn't have these issues with my mouth.  I'm going to write an article about this part of town soon and I'm looking forward to sharing my experiences on it.

Second, I got a great lesson in different health care systems from around the world.  The Thai system, at least the part I've seen, leans more to the American model of care than the European one.   It wasn't as cheap as Belgium, but definitely more affordable than in the United States, at least at the same level of care.  Both doctors I used had studied in the US, where, despite our problems, still is an education powerhouse, with our top schools envied the world over.  I was thoroughly impressed with the care I received here and definitely feel that I got my money's worth.

On the Belgian side, it taught me more about the health care system I've used for over the past decade.   "Socialized medicine"  has a notorious reputation throughout many parts of the world, and Belgium has a system that provides universal health care to all its residence.   What's important to note about the system is that unlike in the UK where it's a single-payer system with the NHS providing the bulk of the work, Belgians buy private insurance from different companies and use that to pay for their medical care.  

Depending on the package you take, you can choose different tiers of care, ranging from public hospitals to high-end private clinics.   Employers can buy supplemental packages for their employees to enhance the care they receive (for example, I didn't pay a cent for my wisdom teeth to be removed thanks to my additional employee-granted insurance)

Where the 'social' part comes into play is with the reimbursement system.   The social security and health ministries agree with different organizations representing doctors, insurers and other partners what equipment and procedures doctors can use that will qualify for reimbursement and at what percentage will these items be reimbursed.     The reimbursement is partially funded through the state, who subsidizes insurance for citizens .

The problem, however, is that it seems that the dental field is restrained in what materials it can use for filling teeth.  As it was explained to me by Dr. Aubonrutt, my molars, where I had the majority of my problems, were filled with a material that is normally used for the front teeth.   Additionally, it couldn't fully cover all the holes and gaps in the filling, leaving the tooth exposed for bacteria leak, which caused the infection in the root.

As we use our molars to do the bulk of our eating, the fillings would wear down and it would require them to be re-filled.   Every time I was having these fillings repaired, they would use the same material and reshape the tooth, weakening it in the process.

It raises a big question for me: how do you find a balance between providing adequate health care to all citizens and getting the most out of the money spent?  Sure, the Belgian system is good and universally accessible, but in the end, if dentists there were allowed to use a wider range of materials, I don't think I would've had to have so much work done nor recurring issues.   And while my work done here is easily more expensive than what it would've cost me back in Belgium on a one-to-one basis, the cost of having it done right in Thailand was cheaper than the multiple times I went in Belgium to get the work done.   As it's the state, and ultimately the tax payers like myself who are funding the system, it's only fair that we get the best, long term  care our money can buy.

I'm glad it's over with.   The problems I faced greatly complicated our trip and has forced us to ditch our initial plan and re-adapt as we go and even though that's in the spirit of the adventure, it was frustrating to be tied down to Bangkok for so long.   But it's really okay.  My mouth hasn't felt this good in years, and I'm confident knowing that I'll be able to enjoy the rest of my travels without having to worry about my mouth falling apart on me.