Episode Summary
In this episode of The Expat Files, Johnny Mueller provides an honest perspective on living in Latin America, contrasting it with the idealized versions often found in travel magazines. He dives into the topic of dental care, discussing the high-tech equipment available in some high-end dental offices, which is comparable to that found in first-world countries. However, he also highlights the lack of infection control practices, such as the use of plastic covers on frequently touched items, which are standard in first-world dental offices. Johnny emphasizes the importance of infection control procedures to prevent cross-contamination between patients, noting that such practices are enforced by agencies like OSHA in the first world.
Johnny describes a dental procedure in a third-world setting, highlighting the lack of proper hygiene and cross-contamination practices. He points out that the dental assistant and dentist are not following OSHA standards, which could lead to the spread of germs between patients. He explains how contaminated surfaces, such as a computer keyboard or a chair, can transfer bacteria from one patient to another. Johnny also discusses the lack of oversight in third-world countries, where dental professionals are not held to the same standards as in the first world. He concludes by saying that even well-intentioned dentists in Latin America struggle to meet first-world standards due to limited access to English-language resources and the lack of formal training on cross-contamination and sanitation.
Johnny Mueller discusses his personal struggle with reading Spanish literature, noting that it feels more like homework than enjoyment. He mentions that many long-term expats share this sentiment, even if they are fluent in Spanish. He highlights the challenges faced by medical and dental professionals in Latin America, as modern technical literature is predominantly in English, and translations lag significantly. Johnny also critiques the lack of a reading culture in Latin America, pointing out that books are often displayed but not read. He contrasts this with the first world, where people also often display books without reading them, using vinyl records as an example. Johnny shares a statistic from a bookstore in Panama City, where selling five to ten books a week qualifies as a bestseller, which he contrasts with the much higher sales numbers required in first-world bookstores. He concludes by acknowledging that while Latin American professionals may lag behind in reading and technical knowledge, he does not advocate avoiding them entirely.
Johnny Mueller discusses the historical context of dental hygiene in the first world and compares it to the current standards in Latin America. He highlights that in the past, even in the first world, dental practices were not as hygienic as they are today, and that the current standards in Latin America, while not up to first-world levels, are still better than the past. He categorizes dentists in Latin America into three groups: the higher-end dentists (5%), the lower-end dentists (5%), and the middle-tier dentists (80%), explaining the varying levels of quality and recommending expats avoid the middle-tier unless in an emergency.
Johnny Mueller discusses the poor hygiene and sanitation standards in dental offices in Latin America, emphasizing the importance of inspecting the bathroom as a way to evaluate a dentist's professionalism. He describes the unclean conditions, such as dirty toilets, lack of toilet paper, and the use of a wet, overused kitchen towel for hand-washing. He warns that these conditions can lead to cross-contamination and highlights the importance of finding dentists in high-tier locations like medical buildings or shopping malls, as opposed to second-tier dentists who operate in residential areas and often lack modern equipment like x-ray machines. Johnny also references his friend Eddie's opinion on the importance of checking the bathroom smell as a first test for a dentist's hygiene standards.
In this segment, Johnny Mueller discusses the differences in dental practices between the first world and second-tier dentists in Latin America. He explains that in the first world, dentists are required to use x-rays to avoid malpractice lawsuits, while many second-tier dentists in Latin America lack x-ray machines due to financial constraints. Johnny also highlights the lack of modern technology and the reliance on pulling teeth instead of more advanced procedures like root canals or crowns. He further comments on the overpricing of dental floss, suggesting that it is essentially just string sold at a high markup, and speculates on the potential for a local brand to undercut global prices.
In this segment, Johnny Mueller humorously advises expats on how to identify second-tier dentists in Latin America. He suggests looking for outdated or damaged dental chairs as a sign of poor quality service. He also encourages expats to take action on opportunities, such as cheap dental floss, and emphasizes the importance of being proactive in their expat lifestyle.
Topics
Introduction to The Expat Files podcast, Dental care in Latin America, Infection control practices in dental offices, Comparison between first-world and Latin American dental care standards, Dental hygiene, Cross-contamination, OSHA standards, Third-world healthcare, Language barriers, Reading habits in Latin America, Language barriers in professional fields, Cultural differences in book consumption
Chapters
00:00:00 Opening 00:00:14 Honest Perspective on Living in Latin America 00:00:34 Dental Care in Latin America 00:01:16 Infection Control Practices in Dental Offices 00:05:03 The Problem with the Dental Procedure 00:05:54 The Illusion of Sanitation 00:07:47 The Honors System in Third-World Dentistry 00:09:02 Personal Struggle with Reading Spanish Literature 00:09:27 The Lack of a Reading Culture in Latin America 00:12:16 Comparing Bestseller Criteria in First-World and Third-World Bookstores 00:13:21 Introduction to the topic of dental hygiene in the first world 00:13:57 The AIDS scare and its impact on dental practices 00:14:32 Comparing dental standards in the first world and Latin America 00:15:11 Categorizing dentists in Latin America 00:16:54 The role of middle-tier dentists in Latin America 00:17:40 The Unsanitary Conditions of Dental Offices in Latin America 00:18:31 The Importance of Evaluating a Dentist's Hygiene Standards 00:22:17 The Importance of X-Rays in Dentistry 00:22:50 Johnny's Personal View on X-Rays 00:24:01 The Consequences of Not Using X-Rays 00:26:54 Opportunities for Expats 00:27:03 Taking Action as an Expat 00:27:31 Second-Tier Dentists in Latin America
Transcript
Automatically transcribed from the original recording; names and wording may contain errors.
[00:03] Hi everybody, I'm Johnny Mueller and you're listening to The Expat Files, living in Latin America. The show that tells you what it's really like to live, work, play and or retire in Latin America. I tell it just like it is, not the version they give you in those glossy travel magazines, or the picture they paint for you in those international traveler websites, where they're only trying to sell you something. What's it really like for expats living in Latin America? Well, it's time to take off those rose-colored glasses and find out. So let's get started. Now, today I promise I'm going to finish up my bid on dentistry down here in the third world. So let me talk first a little bit about when you're at the dentist down here, the high-end dentist that I recommend, of course. And you'll often see that these guys have very high-tech equipment, exactly like this stuff you're going to see at the dentist up in the first world.
[00:50] But like I said, since even the highest-end dentist down here, even the ones that have gone up to the first world and have received some training up there and maybe even have their specialty degree from up in the first world, well, even they, when they come down here to practice, the problem is once they're back down here on their home territory again and they're confronted with the realities of doing business and working under third world conditions, they inevitably slip a little bit back into some of those less than desirable third world habits. For example, I was recently at my dentist, a high-end dentist, of course, and I was very pleasantly surprised to see that he had dished all his old heavy black Bakelite x-ray machines, the kind that remind you of a laboratory in an old Frankenstein movie more than they do of a dental office. Anyway, he has this very high-tech, brand new x-ray equipment that's completely computerized
[01:38] with a keyboard and a flat screen display sitting right in front of your face. So you can see exactly what's inside your tooth and your mouth from any given angle. And the computer software does all kinds of manipulations so the dentist can enhance the picture. He can zoom it, rotate it, do anything he wants, all with a tenth or less of the radiation that you'd normally get in those traditional x-ray units that we were all used to getting exposed to when we were kids. Okay, so far so good. So the guy's got the highest tech of x-ray equipment. I'm not getting exposed to all kinds of radiation anymore, and for once on my left, I'm starting to feel somewhat calm the day before I'm supposed to go to the dentist. That is, until I saw what happened next. First of all, he's punching away on his keyboard with his gloves on, but the keyboard is not protected. No plastic cellophane wrapping or any of that stuff that you see in every modern dental
[02:27] office up in the first world. Up there, there's a plastic bag or slip cover on every single thing in the dentist's operatory that gets touched in any way. That is, anything nearby that gets repeatedly touched by the dentist or the assistant or the hygienist, and all that plastic wrapper stuff is of course disposed of between every patient and rewrapped with new cellophane or plastic. At least, that's what's supposed to happen, and you hope that your dentist is doing it. They call it infection control procedures, and there have been entire books written on the subject. And first world dentists are required to take seminars on it every once in a while to keep up the snuff. Anyway, first world dentists know all about that stuff because if they don't comply, there's a little very powerful agency known as OSHA that can make spot checks in your office and find you or even put you out of business. Because what they're really trying to prevent is cross-contamination of bacteria and viruses
[03:15] and stuff between patients. So let me give it to you again. I'm down here in Latin America at the dentist's office, a high-end dental office. That is, high-end for Latin America. He's wearing gloves. His assistant is wearing gloves. He's got a plastic bag attached to the handle of the light that he uses to look in your mouth. So far, so good. Just like the first world. Except the keyboard that's right in front of him that he uses to manipulate the extra machine software is not covered with a plastic film at all. Hmm, you see a problem there? And when his cell phone rings, and of course that's not protected with plastic, he answers it with his gloves on, hangs up, goes back to his keyboard again and starts typing away. And then he grabs the arms of the chair that he's sitting in, with his plastic gloves on of course, and he rolls it over to a cabinet.
[04:01] He opens the drawer to get out some equipment, and of course the drawer doesn't have any plastic on the handle. Then he comes back over to me and while he's looking in my mouth, he touches the headrest of the chair that I'm sitting in, which doesn't have a plastic slip cover or protector on it either. And then he grabs a little electronic film sensor, that little square thing that looks like an x-ray film that they put in your mouth these days, to get that digital electronic x-ray. You know, that little thing that you bite on that has a wire running out of it that goes to the computer. Then he swivels the head of the x-ray tube close to my face to get the shot, and at least the handle of the x-ray tube has a plastic slip cover on it, which is a good thing of course. And then the dental assistant walks out of the room for a second, heads for the administrative office, comes back with a paper file, a chart in her hand, holding it with her gloves on
[04:49] of course. Then she sits down in her little chair and rests her gloves on the unprotected armrests, and then brushes her hair away from her eye with one of her gloved hands, and then her and the dentist get to work on me. Now can you see anything wrong with this picture? Well, I can see about ten things wrong with that picture, because you see, between the dental assistant and the dentist, they've touched so many unprotected, hard and soft surfaces with gloved hands, and have technically cross-contaminated at least a dozen things just while I was sitting there for five minutes or so, that I can't even think of how many first world OSHA rules these two highly trained so-called health care professionals have broken. Now I'm not saying that me or any other of their patients is going to pick up a disease or some kind of sickness as a result of their spotty hygiene and improper cross-contamination
[05:36] technique. At least they're trying to be first world. I mean, they're putting plastic on a lot of things and surfaces that they routinely touch over and over again, but of course there's big gaping holes in their so-called sanitary technique. And if by chance OSHA were ever to drop in and check out this office, they'd shut them down in about five minutes guaranteed. So just because you see plastic coverings here and there, and the doctor and the assistant wearing gloves, don't let it fool you. They'd be better off not putting plastic on anything at all, or even wearing gloves. Since as soon as they touch a surface that's not protected, like a cell phone or a keyboard or a door handle, or the arms of the chair they're sitting on, they're simply moving germs from patient to patient. Because the last guy that sat in that chair before me had remnants of his saliva on the dentist's hands, and then the dentist touched the computer keyboard and transferred some
[06:23] of those remnants onto the keyboard, and then the next time he touched that keyboard, he picked some of that stuff up and moved it to the next patient's mouth, which mixed a little bit with that patient's saliva, which then transferred back onto his glove hands, and then he touched an unprotected cabinet, opened the drawer, sat down back in his chair, handled the patient's paper chart, which absorbs some of that contaminated liquid too. Then the assistant moves that chart back to the front desk secretary, she touches it with her bare hands, picks up a pen and makes a few notes on it, and refiles it back in a cabinet right next to a hundred other contaminated files. You get the idea. Now I hope by going through this example I haven't turned you off completely on the thought of going to the dentist down here in the third world, though I might have grossed you out I admit. Because I'm sure by now some of you first-worlders are thinking, yuck, third world dentists, even
[07:09] the better ones, are going to contaminate the hell out of me. Even though the top 5% have pretty good equipment and the best of intentions. But you see that's what often happens when first and third world cultures collide, and they often do. And because down here there's no oversight agency like OSHA, and by the way OSHA like any government agency is imperfect in a million ways, it's really a bureaucratic nightmare and dental and medical professionals absolutely cringe when you mention it. But at least up in the first world they throw the fear of God into these professionals, which a certain percentage of them really need. So they follow the straight and narrow. Or they could find or lose their licenses, which in the end is good for the consumer, right? And that's why I say down here in Latin America professionals are on the honors system because nobody's watching. And even a guy like the dentist I go to, who has all the best intentions and tries
[07:57] like hell to perform like a first world dentist, no matter how he tries he just can't cut it because down here in Latin America, nobody's offering a weekend course on cross-contamination and how to sanitize your office to first world standards. A dentist down here has to figure all that stuff out on his own. In other words, he's going to have to do all that research himself, search the internet and look for recent articles out of the first world. If he wants to take the time and look for that stuff, it's out there alright. But since almost all that stuff's in English, if his command of the English language is not that great, he's going to give up on it before he even gets started. And how do I know that? Well, take me for example. I've been down here about 20 years and my Spanish is about 80%. That means I understand about 80% of what everyone says and I can understand about 80% of what I read in the newspapers.
[08:43] Now I might be a bit thicker than the average person when it comes to languages, but in reality, if I was to pick up a Spanish classic like Don Quixote and read it in Spanish, after about three pages my brain would be fatigued because even with 20 years under my belt and reading the newspapers every day, I just can't pick up the subtle nuances of great Spanish writers. And maybe I never will. I've tried to read books by famous Spanish authors, but I just don't get any pleasure out of it. It seems more like work than fun, like homework assigned by a teacher and you know what drudgery that can be. And I've talked about this to a lot of long term expats and most of them feel exactly the same way, no matter how well they can speak and read in Spanish. And even when they read Spanish newspapers every day, like I do. The truth is, though, they don't often admit it. They don't read Spanish for pleasure because if it's not your primary language, it can
[09:31] be drudgery. Unless you're some kind of prodigy and languages come to you very easy. And I'm not. And anyway, don't you just hate those kind of people? And with respect to medical and dental professionals down here, trying to keep up with what's happening in your own field is a double whammy. Because all that modern, up to date, first world technical literature is in English and even though it does eventually get translated into Spanish a few years down the line, like everything else, there's always a big lag down here. And secondly, then there's the fact that Latin America just does not have a culture of reading. You don't see people walking around with books or kindles under their arms. And when you visit somebody's house, what books they might have, if you look closely at them, you'll see that they're just on display. Mostly, they're just unused and dusty and just might have never been cracked open at
[10:17] all. And really, just part of a show that they put on to make you think that they read literature for pleasure and that their cultural habits are a cut above the average guy and maybe even first world. But they're not. It's just a show. And in fact, the only kinds of Latins I ever see carrying books around are students who obviously have assignments to complete to get grades. But as for adults, uh-uh, it's a non-issue. But I guess a lot of people like that up in the first world, too. They have books around the house that they probably never read. And now that there's kindles and iPads and all that junk, you don't even need to have books around the house, really. And I think eventually up there in the first world, people who have books around the house and shelves are only going to display them for show just like the Latins. I mean, look at people who play and collect vinyl records these days. It's a pretty upscale hobby and pretty expensive.
[11:04] And they don't sound any better than the digital stuff, although they'll try to convince you that they do. Even though when you listen to a vinyl record, you hear all those pops and scratches. But it's cool and all the fashion to have vinyl in your house these days, isn't it? But I was talking about Latins carrying books, or Latins who don't carry books, actually. In fact, the only adults down here I ever see carrying books or kindles around with them are expats, tourists, or other foreigners. And here's a statistic that'll shock you. I was at a bookstore in Panama City recently, and I got into a conversation with one of the clerks, and I asked him about books, bestsellers, sales figures, and things like that. Because every week in the paper, that particular bookstore, one of the larger ones, prints a list of the ten best-selling books of the week. And when I asked him about best-selling books at his store and how they make the list, how
[11:49] many units of that book he sold a week to make that list, he said, oh, selling five or ten books a week would make a book in my store a bestseller. And I'm thinking to myself, what? Ten books and it's a bestseller? How can that be? But I guess it is. So all you expat and expat wannabes out there, just think of that. If a book sells five or ten books a week, in the largest bookstore in the biggest city in Panama, that book not only makes the ten bestseller list, it becomes a bestseller in the whole country. Now, if you go to a Barnes & Noble, that is, if there still are Barnes & Nobles these days, anyway, you just go to a Barnes & Noble in any big city up in the first world and ask one of their workers how many books they'd need to sell a week in order for one to make the bestseller list, they talk in triple-digit numbers. That's what makes a bestseller in a single Barnes & Noble store up in the first world.
[12:37] A hundred-plus books sold a week usually makes a book a bestseller up there. Now, compare that with five or ten books sold a week in a popular third-world bookstore. Sounds a little pathetic, doesn't it? So if the vast majority of books and technical material and scientific journals are in English, a huge percentage of Latin Americans, and of course, even Latin American professionals are never going to read that stuff. Combine that with the fact that they don't have a culture of reading down here and you end up with practically every segment of Latin American society falling behind the first world in a big way, including all the professions down here. But when I gave you that example of my own personal experience at my dentist, I don't want to give you the impression that these guys are completely hopeless and that you should stay away and even avoid these guys like the plague. No way, I'm not saying that at all. But here's what I am saying.
[13:23] Remember 20 or 25 years ago, up at your own dentist in the first world, the dentist and his assistant, Anaheim Genis, never even wore gloves. In fact, I bet some of you expats and expat wannabes up there even questioned your dentist when you saw he was first using them thinking, hey, there's something wrong here. Why is he using gloves? Does he have some patience with AIDS or something? You remember that, don't you? Way back when when they had that big AIDS scare in the dental offices up in the first world and all those scares about being poked inadvertently with needles and stuff. You remember that? So consider that when visiting a dentist down here in Latin America. That AIDS scare and blood in the dental office turned out to be the crisis that never was. Remember the good old days or the bad old days? When your dentist up there didn't even use gloves. Look at the history of dentistry up in the first world, all those millions and millions
[14:11] of office visits where no one wore gloves at all and dentists practiced what we'd call today very unhygienic dentistry. But none of us died, did we? Nor did any of us even get sick from it. Well, maybe some did, but I can't remember hearing about any of it. Have you? I bet you never have. And in all those millions and millions of dental visits, I never even heard of a single person who picked up AIDS from a dentist's office. So if your dentist down here in the third world does not practice as hygienically as a dentist up in the first world, and he definitely won't, at least he's trying. He's putting plastic bags on handles and doorknobs and he's using gloves and wrapped around glasses. But in the sanitation and hygiene department, he's still not up to first world standards. And if this eases your mind, just look at it this way. He's practicing exactly like your dentist did up in the first world some 10 or 20 years
[14:56] ago. There's always going to be that bit of a lag down here. That's why they call it the third world. And when you had some work done 10 or 20 years ago at your dentist in the first world, you thought he was pretty high tech, didn't you? With those glasses and gloves and everything? You get my point, don't you? Now I've spoken about the so-called higher end dentists, the ones you should be going to down here in the third world, and they consist of about 5% of all the dentists down here. And they're the guys that have offices that look relatively first world and have pretty much all the first world equipment you're used to seeing in your dentist's office up north. And I've spoken a little bit about those very low end dentists, that 5% of dentists that do very substandard, even damaging work on people's teeth. And they work basically on the very poorest segments of society and their work is horribly done and looks terrible and wouldn't even receive a D if graded by a first world panel
[15:44] of dentists. And in fact, most of the time these guys aren't even dentists at all. But just backroom garage technicians, who the very poor and indigenous people visit to get little gold and silver decorations drilled into their front teeth, which is kind of accustomed down here with the indigenous people. Now thankfully, expats are unlikely to visit a dentist operating out of a garage. A guy whose workshop doesn't have an x-ray unit, a sterilizer, or even a pair of gloves to be seen. I mean, any first world guy would have to be drunk or delusional to even consider having work done by a guy like that. But then there's the other 70 or 80% of the dentists down here, who serve as the vast majority of people. And those people are the lower middle class and the middle class. People making $300 to $1000 a month. And those are the common folks who are forever and always in need of the usual dental stuff.
[16:35] The common least expensive procedures like drillings and fillings and extractions. And technically according to first world standards, these people are always dental basket cases. Their mouths are never in perfect condition, and they're always running from crisis to crisis. And these people almost always go to their local middle tier neighborhood dentist. That 80% of dentists that practice on the general population down here. Now this middle tier of dentists, I don't recommend expats take advantage of it all either unless they have an absolute emergency and can't make it by hook or crook to their regular higher end dentist. And why should I say that, when these guys are full fledged dentists, graduated from dental schools down here, and have their license to practice in good order? Well as soon as you walk through the door and sit down in the waiting room, you'll
[17:21] know exactly why I'm saying this. First of all, the waiting room will be terribly dingy. There'll be a fluorescent light or two burnt out. The seats will be rusted or damaged and look like they're on their last legs. And if you ask the receptionist to use the bathroom, you'll be in for a big shock. It might not have a door on it at all. Just a dingy shower curtain. That's your door. And the toilet itself will be so dirty and dingy, it'll look like a public bathroom in a gas station down in Oklahoma. And worse yet, they might not have toilet paper at all, and they almost never have paper towels for your hands. But instead, there'll be a wet, overused, threadbare kitchen towel, hanging on a little rack or laying alongside the sink that you're supposed to wipe your hands with. Now if you can think of anything less sanitary than that, let me know. Because think about it.
[18:06] When patients are filing in and out of that bathroom all day long, wiping their hands with that wet, used towel. Which means everybody's contaminating everybody. And I say you're better off wiping your hands on your pants. So down here, one way to evaluate a dentist, and for that matter a restaurant, is to walk into the bathroom first before you ever make your appointment. Because that's one very good way to find out if this guy's really serious about being clean and hygienic, or is he just doing mechanically drill and fill dentistry, like they used to do up in the first world back in the 50s and 60s. And like I've said in past shows, walking into a bathroom in restaurants is a good way to find out if that's a restaurant you want to eat in too. And you know what's funny is, my wild and crazy friend, expat Eddie, who's had a ton
[18:51] of dentistry done down here in Latin America, some good and some quite bad, anyway he sums it up like this. He says, Johnny, forget about looking around too much. He says, just walk into the bathroom, take a deep breath, and if it smells any better than a veterinary office, it's past the first test with him. Now I'm a bit more discriminating than Eddie, but I get his point. And by the way, we'll be talking about veterinarians, pets, animals, and veterinary offices in a future show, so stay tuned for that. Now the logical question to ask is, where do you find these higher-tiered dentists and the second-tiered dentists, the ones you don't want to go to? Well these days it's kind of like up in the first world. You find these high-tiered dentists with their offices in medical buildings, shopping malls, multiple-use high-rise business towers, and professional buildings. That's where they usually set up.
[19:37] But those second-tiered dentists, the ones you don't want to go to, that 80% of dentists out there practicing 1950s and 60s dentistry, well those are your neighborhood dentists who you'll find have set up shop in a room in their own little houses or in a little storefront in a residential neighborhood, just like your average first world dentist did back in the 40s, 50s, 60s, and even the 70s. You must remember back when you were a kid when a dentist hung up a shingle in a regular residential house. In fact, he and his family may have lived in the second story or in the back somewhere. And when you walked in, the waiting room might just well have been a converted living room. And when you got your teeth fixed, you could smell what his wife was cooking for dinner that night. And that's how it is for 80% of the dentists down here in Latin America. They're set up in a tiny little storefront or in their own houses too. Now just a few more words about middle-tiered dentists down here.
[20:25] Now you'll notice that sure, their offices are dingy and dirty and there's burnt-out lights and cobwebs and broken or dirty windows and 30 and 40-year-olds stained and faded posters with teeth on them and maybe a cheap, ugly painting or two that the dentist's wife picked out 20 years ago. And of course, that thing's never seen a dust mop or a vacuum cleaner either. Now about the dentist changing his gloves, you'll never know if he did or not. But if you keep your eye on him, you'll see that he might have more than one dental chair and as he pops from patient to patient, he won't change his gloves. So keep an eye out for that. And however unsanitary and disgusting that might seem to you, notice too that his dental assistant never changes her gloves either, unless of course she tears a hole in one of them. But one of the most obvious things you'll note in a dentist's office like this is that there's a 50-50 chance or better that they don't even have an x-ray machine at all.
[21:14] And if they do, it's such an old model that the plastic housing is usually cracked. It looks like it came from a scratch and dent sale or there are actual pieces missing from it. And judging from its generally poor condition, if you're worried that it might be leaking vast amounts of radiation because it does look damaged, you should be worrying more about the fact that they almost never use lead aprons to protect you or your gonads from the radiation itself. Which again is a strict requirement in the first world, but down here, as usual, no one quite follows the letter of the law and no one's there to enforce it anyway. Now you might be asking yourself if half or more of the second-tier dentists don't even have an x-ray machine, because as one dentist told me, even a used one cost about a thousand dollars or more, and the portable developing equipment and the chemicals for that stuff
[22:00] is way too expensive too, at least that's what these guys say. Anyway, you gotta be wondering how do these guys drill on teeth without knowing what they're looking at, since x-rays show them where and how deep cavities are, and the extent of abscesses and where bone has deteriorated due to infections and gum disease. Because up in the first world, if a dentist does not take an x-ray to see what's exactly happening inside the mouth and inside a tooth, if something ever were to go wrong with that procedure, just the fact that he didn't take an x-ray would be grounds to automatically lose a malpractice suit. So it turns out, it's because of monetary considerations and lack of finances, and the fact that they can get away with it, that more than half of the second-tier dentists down here don't have x-ray machines. So you might say these guys are really short-changing you, and they're doing 1920s, 30s, and 40s
[22:46] dentistry, which is really a shame, but that's the way things are down here. Now I must say I'm not one for x-rays at all, and I do believe that in the past, first world dentists took way too many of them all too often. But these days, up in the first world, things have completely changed in regard to that. They have these new computerized dental imaging x-ray machines that use one-tenth or less the radiation than they used to use some 20 or 30 years ago. You know what I'm talking about? The kind where they put that x-ray film cartridge in your mouth, and it has a wire leading out of it that goes to a computer screen and a keyboard. Now those things make dental x-rays practically a no-brainer. With such minimal radiation exposure compared to the past, that it's just simply amazing. However, a machine like that costs over $10,000 US, even more. And if a second-tier dentist down here can't even afford a used x-ray machine of the old
[23:34] heavier radiation kind and a mere $1,000, these guys will never be able to afford the new technology. So don't hold your breath. And in fact, these first-tier dentists I've talked about down here, only very, very few of these guys have that new computerized x-ray imaging technology too. But at least some of them are on it. Anyway, you can see now why I don't recommend these second-tier dentists if for the simple fact that they're drilling blind because they don't even have an x-ray machine in the house. And what's worse yet, one of the mainstays of a second-tier dentist's practice is pulling teeth. Because the fact is, 80% of his patients can't afford root canals or crowns when a tooth really goes bad. But here's the rub. When a dentist pulls a tooth, he has to have an x-ray before the fact to see where the roots are, to determine the angle of the tooth, and to see below the gum line if there's
[24:23] going to be any complications as he tries to dig it out. Now in the first world, if you don't take an x-ray before you pull the tooth and something unforeseen happens and you end up in a malpractice case, well, you automatically lose that case and forfeit because you didn't take an x-ray beforehand. So up in the first world, dentists followed that x-ray rule to the letter. But down here, those second-tier dentists skip it almost half the time. And you'll almost never see those second-tier dentists using eye protection or eye loops, which magnify the tooth and give him a much better view of what he's going to do to it. Even though most first-tier dentists down here use loops, and 100% of first-world dentists wouldn't be caught dead without him, because they always help and can't help but force the dentist to do better work, whether he likes it or not. The same reason why a jeweler, a watchmaker, or a diamond cutter would never be without
[25:11] his magnifying loops. And just one more thing about dental floss. Sure, it's available at about $3 to $4 for your standard box, and it's a real shame that 90% to 95% of the population never uses it at all. And that's why my own upper-tier dentist told me that more than half the population of people, including the wealthy, have had one or more back teeth extracted by the time they're 25 years old. And by the time a Latin American is 40 years old, even the wealthy ones have had five or more back teeth pulled already. And that's not including wisdom teeth. And that's because these people just do not use dental floss. And except in the case of the wealthy classes, most of the reason is because of finances. Because when a box of Johnson & Johnson dental floss costs $3 or $4, that could be up to a half a day's work for the average Latin American down here.
[25:59] And for that 30 to 40% of the population living on $3 or less a day, dental floss, whether they knew how to use it or not, is a luxury way beyond their reach. Which actually gives me a pretty good idea. What is dental floss, really, but some reinforced thread, right? And when you think about it, it really is vastly overpriced. A roll of string the same size and consistency of dental floss probably would cost no more than 10 or 20 cents, right? But it comes to you in a special little box, and it's sterile and all that, so they charge you more than a few bucks for it. A hugely outrageous markup, if you ask me. Just think about it. I mean, it's only string, come on. Now suppose a wise expat businessman down here started making a Latin American brand of dental floss for, let's say, 50 cents a box. And I'm sure even at 50 cents, there'd be a huge markup built into it.
[26:47] And guess what? Suddenly the locals could afford it. And we could export it to the first world and undercut Johnson & Johnson and everybody else by double or even triple. How about that for an idea? You see all you expat wannabes up there? Something as simple as cheap dental floss. What an idea. And if you're down here like me, you see opportunities like that all the time. But the thing is, you gotta get off your dead ass and do something about it. Oh, and there's another easy way to spot a second tier dentist down here, the one you don't want to go to. Just look at the dental chair you're going to be sitting in as a patient. If it looks like it's been sitting out on your back porch in the rain for a couple of weeks, he's second tier. And if it's got a few slices and cuts in it and the stuffing is seeping out, second tier. Because down here for 35 bucks, you could get the damn thing upholstered like new. But if you're second tier, you've been listening to The Expat Files, living in Latin America.
[27:41] And don't forget you can email me on anything at all about Latin America. The Expat Files at gmail.com. That's theexpatfiles at gmail.com. See you next time. Nos vemos.