The 56-year-old Benicia man went more than 6,000 miles to Hungary in March to get his teeth fixed for less than a third of the $50,000 or more it would have cost in this country.
"Everybody says, 'You're going where for what? What kind of vacation is that?' " Paggi said a few days after returning from two weeks in the central European nation. "I'm saying if you had my smile, you would do it, too."
Paggi is one of a growing number of Americans traveling to far-flung locales to undergo medical and dental procedures at affordable rates.
While statistics on medical tourism aren't available, the trend by all accounts is gaining steam. A growing number of countries, including India, Thailand and Singapore, are marketing medical and dental services to foreigners, boasting of "first world medicine" at cut-rate prices.
Patients from wealthier countries often travel to these destinations for some sun and relaxation, plus a hip replacement, vision correction or perhaps cardiac surgery.
Dental procedures are a common choice because only about 50 percent of Americans have insurance for such care. And those people who are insured often face stiff dental bills. Insurance plans, typically offered through employers, require patients to pay a significant share of the costs of procedures beyond standard preventive care.
Paggi's oral odyssey began in January after he consulted several dentists in the Bay Area and learned that the cost of work to repair his teeth could reach $60,000. Years of neglect and bacterial infections had caused Paggi's teeth to decay, a condition that had accelerated in the past few years.
"When my mom said to brush your teeth and floss your teeth, I never did. She told me you're going to lose your teeth. Slowly but surely, I did," said Paggi, who retired from his job as a UPS driver in August 2004 partly due to embarrassment over his teeth.
He said he has maintained vigilant dental care over the past 20 years but was unable to reverse the damage caused by early inattention.
Dentists had pulled all but two teeth on his lower jaw, and his uppers required bridges and root canals. Paggi wanted dental implants, a relatively new and popular alternative to dentures. But his employer-sponsored dental insurance, Delta Dental of California, didn't even cover his other work, let alone the pricey implants.
Dental insurance rarely covers implants, said Jell Album, spokesman for Delta Dental of California, the state's largest dental managed-care company.
"Dental insurance is not set up to protect those people from those kind of costs. Dental insurance is set up to protect the majority of people from the majority of costs," he said.
Employers generally choose not to cover high-priced cosmetic services, instead offering routine dental coverage as part of a package of health benefits, he added.
With treatment so expensive, Paggi researched options on the Internet and discovered the dental tourism industry. He homed in on Hungary because of the country's reputation for quality dental care and found several companies that specialize in arranging dental tours to that country.
Hungary may sound like an offbeat choice of a place to get one's teeth fixed, conjuring up images of crude, Soviet-style dentistry. In fact, Europeans -- particularly the British, Germans and Austrians -- have long traveled to former Eastern bloc nations to save money on dental care. Other popular dental tourist destinations include Mexico, Turkey and India.
"Hungary is considered to be the dental capital of the world. They've got the biggest dental universities," said Christopher Hall, director of Hungarian Dental Travel, the company that arranged for Paggi's care.
He said Hungary's lower cost of living accounts for the price differences.
Hall said his two-year-old company, which is based in London, typically arranges trips for British patients seeking procedures not covered through the National Health Service, as well as for other European consumers. Paggi was his first American customer.
Hall's company, which screens dentists and ensures that they speak English, lined Paggi up with a Hungarian dentist in the town of Gyor (pronounced "Ju-or"), which is about an hour-and-a- half from Budapest. The dentist, William Hayfron, specializes in cosmetic dentistry.
Paggi, who traveled to Hungary on March 6 with his wife, said he was impressed with Hayfron's professionalism and high-tech dental office. Paggi's top teeth are complete, but he needs to return to Hungary in June to have the implants installed in his lower jaw.
His 24 crowns, seven implants, two root canals and two bridges cost $15,900. Including airfare for him and his wife, plus hotel stays costing $52 a night, Paggi estimated his final tally will still be less than $20,000. He has taken out a loan on his home to pay for the work, an investment he considers more than worthwhile.
The American Dental Association has no position on dental tourism, but the trade organization advises Americans to use caution when traveling abroad for treatments because standards for training, licensing and care can vary widely.
"They really need to know what they do if something goes wrong -- what legal rights they have," said Kimberly Harms, a Minnesota dentist who serves as the American Dental Association's consumer adviser.
Harms said patients should discuss their plans with their regular dentists. She also suggested they find out what dental licensing and accreditation procedures the country requires and how those compare with U.S. standards.
Paggi, who is searching for low-cost airfares for his return trip, is eager to have his work finished. He and his wife plan to spend another two weeks in Hungary and do some additional traveling in Europe.
"He (Hayfron) did an amazing job." he said. "My wife is so pleased -- and she was so scared."
Paggi's wife, Kristy Riedinger, said she was nervous about the unknowns in traveling abroad to seek care. Now she is looking forward to seeing Hungary without snow and to continuing to shop for bargains, like a $30 leather coat she found on the first trip.
But she said the biggest reward is seeing her husband smile again. "Instantly I can see he is returning back to his own self," she said. "For me, I'm getting more out of it than he is. I'm getting him back."
Dental care abroad
If you go abroad for dental care:
-- Check with the appropriate government agency in the destination country about its national dentistry guidelines.
-- Find out what recourse is available if something goes wrong.
-- At the dental office, look for infection-control procedures, including instrument sterilization and use of protective gloves, mask and eyewear.
-- A traveler's guide to dental care is available through the Organization for Safety and Asepsis Procedures at www.osap.org.
Source: American Dental Association.
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