This Philly couple traveled to Romania for cheaper dental work. Should you, too?

His gums duly numbed with painkiller, Michael reclined in the cushioned chair as dentist Raluca Gurban appeared overhead with a whirring drill in her hand. Michael was about to start dental implant surgery to replace a broken tooth, a fairly standard procedure, except he was in a dental office in Bucharest, Romania. How did we end up there?

Two years ago, we practically had to scrape Michael off the floor when he learned he needed a dental implant that would cost approximately $6,000. We'd gotten crowns and had root canals in the past, but never anything that rivaled the price of a decent used car. The high cost prompted us to explore less-expensive options. This endeavor proved to be more difficult than we expected.

It's not easy to find published prices from most U.S. dentists. The U.S. practices we found advertising "discount" implants priced only the implant itself; they didn't include the extensive prep work, including removal of the broken tooth and often the need for a bone graft, in the total cost.

We recalled that during a vacation in Bucharest a few months earlier, we had noticed many billboards — in English — advertising dental services. Upon further investigation, we learned that Romania is a popular destination for European dental patients; the quality is top-notch, and  the prices are very low. Would we actually consider dental work outside the U.S.?

According to Patients Beyond Borders, a guide and website for medical tourists,  more than 150 million Americans lack dental insurance and are increasingly seeking dental work abroad. Currently, the majority of Americans traveling outside the country to see  dentists venture to Mexico from the border states of Texas, Arizona, and California.

"Dental tourism has been going on for more than two decades," said Amid Ismail, dean of Temple University's Kornberg School of Dentistry.

Ismail had no statistical data — good or bad — regarding U.S. patients who had work done overseas. From our research, we learned it's important to perform your own due diligence on any overseas provider.

"There is quality dental care everywhere, but the range is wider overseas, so you must be careful who you choose," Ismail said. "Cheap care is most often not equivalent to good care."

Which left us still pondering the value — and risks — of getting dental work done in Romania. We knew from our previous visit that English is commonly spoken  in Bucharest, so communication would be easy.

As part of our research, we contacted the U.S. office of Romania Tourism. Its website addressed dental tourism and provided links to several Romanian dental practices. We homed in on Intelident for several reasons. Its website was in English and provided detailed information about the education and work experience of the dentists. In addition, it is part of a network that provides dental services to U.S. employees of American companies (such as Citi and Oracle) that maintain offices in Bucharest.

By law in Romania, dental practices must post their prices prominently in their offices — something we wish American practices would do. Intelident also posts them online, which made our research easier.

We communicated extensively with the manager of the practice by email and clarified prices and approximate timelines. We learned that pricing in Romania is more of an a la carte model, whereas many U.S. dentists price the procedure in total, so it's important to understand exactly what is required for a complete procedure. (All cost comparisons here are as "apples to apples" as possible.)

The total cost to install Intelident's most expensive titanium implant, made by highly regarded Swiss manufacturer Straumann, was approximately $1,500. Was a saving of $4,500 enough for us to fly to Romania? Perhaps not. But what if we considered additional work?

We both had several metal-based crowns that were nearing the end of their useful lives; the replacement cost of a nonmetal zirconium crown in the U.S. was estimated at $1,400. The cost in Romania for a similiar crown would be only $350; root canals were similarly priced. If we got a significant amount of preventive work done, the trip would be worth it.

Our first appointments entailed a general examination, including a review of new X-rays. The dentists then prepared a complete treatment plan for each of us. Michael focused on getting his new implant, and  Larissa addressed replacing her old crowns, some of which required root canals. We were given specific pricing upfront. They even said we should defer some work they didn't feel was necessary, so we never felt "up-sold."

X-rays are taken in another office, about a mile away, saving the dentist the investment in equipment that is not often used. The excellent prices ($18 for a full set of digital X-ray bite wings, $6 for a single tooth) at the state-of-the-art imaging facility offset the slight inconvenience of an extra errand for the patient.

Throughout all our work, the Romanian dentists used sterilized equipment and sealed products that they opened in front of us.

For Michael's implant, his dentist even shared the packaging materials to demonstrate their authenticity. Straumann implants come with a unique serial number, and Michael was able to verify his through the company's website. Tomas Konrad, a Straumann representative, agreed that best practices include sharing the package with the patient.

A verification document with details about the implant also ensured that Michael could have follow-up work performed by any dentist around the world trained to use Straumann implants — which includes the dental clinic at Temple.

"That's a good [standardization] model," Ismail said.

To date, there have been no complications with the dental work we had done.

In the end, we saved more than $18,000 by seeking work outside the U.S. Of course, travel expenses must be deducted from that amount, which is a different variable for everyone.

By European and American standards, Bucharest is an inexpensive city. We found a fully furnished apartment in the heart of downtown on Airbnb for $850/month. The dentist's office was within walking distance, so there was no need for a car. There are no direct flights from the U.S. to Bucharest, but Delta's SkyTeam alliance offers several connections through European gateways. We flew from New York to Bucharest via Amsterdam.

Dental tourism is not right for everyone, but with the increasing costs of dental procedures in the U.S., it's an option worth considering if you are facing extensive work. The ideal candidate is someone without comprehensive dental insurance who has an open mind and time to travel abroad.

If you choose to explore this option, it's essential to do your research. Consider the following:

Even with satisfactory answers to these questions, there are still risks involved. If there is a problem with the work, the burden of extra costs falls to you. We acknowledged that if there were any problems, we'd have to take care of them in the U.S.

"Health tourism in a global economy is a reality of life, but we prefer that patients stay in their home country for continuity and follow up care," said Ismail.

Prospective patients also need to verify the timing of their procedure to determine how long they will be overseas. One or two weeks are usually needed for a crown; an implant might require two separate short visits. Michael had already had his tooth removed in the U.S., which allowed several months for the bone to grow back before having the implant procedure performed in Romania.

We planned a month for our work in Bucharest, which also gave us plenty of time to explore the city and surrounding area. Overall, our experience as dental tourists was pleasant.

Philadelphia natives Larissa and Michael Milne write about global travel on their blog at ChangesInLongitude.com.