Toothless: Why I Built Restora Journeys

The car was a 1957 Chevy Bel Air, which is a beautiful machine if you are admiring it from the outside and a terrible one to meet face-first at speed. In 1993 I learned that the hard way. The dashboard of that car was made from the kind of metal Detroit used when it believed automobiles should be built like locomotives. It looked elegant from the passenger seat. It felt considerably less elegant when my teeth collided with it. Several shattered immediately. Others cracked deep enough to expose nerves, which is exactly as painful as it sounds and slightly worse than you are imagining.

At the time I was young enough to assume most injuries eventually sort themselves out. Teeth, unfortunately, keep score.

The dentist who took care of me was named Alice Ku Chawang. Alice had grown up in a family of dentists, though she had not started her career that way. Like her husband, she had first become a chemist and spent years working for DuPont. At some point she grew disillusioned enough with that life to leave it behind and go to dental school instead. Her husband followed a similar path of reinvention and eventually became a patient attorney.

Alice’s office was painted a soft mint green, the kind of color people in the 1950s insisted was calming. Apparently she still believed it.

The morning after the crash that small woman took care of me. I was swollen, frightened, and in pain, and she treated me with a quiet tenderness that felt more like something a mother would offer than a dentist. She worked slowly and carefully, explaining what she was doing as she went. The care itself mattered, but the patience mattered just as much.

For a while it seemed possible that Alice might outrun the damage the accident had done. She worked patiently, appointment after appointment, repairing what could be repaired and stabilizing what she could not. Some teeth were rebuilt. Others were patched together in ways that only dentists really understand. The goal was simple: keep everything functioning for as long as possible.

Over the next few months my mouth began to heal, even if my confidence did not.

Before long I found myself spending time in her office after school, helping where I could. Eventually that turned into a job. I learned to be her assistant, developing x-rays, making dental molds, booking appointments, and doing whatever needed to be done to keep the small practice moving through its day.

It was hard work, but she trusted me with it, and that trust mattered more than I understood at the time.

Looking back now, I realize something about that period of my life. It would be many years before I met my wife, and for a long stretch of time no one believed in me quite the way Alice did.

For a while it seemed like her work might hold the line. Life moved forward the way it does when you are young and determined to believe the worst is behind you. School continued. Work continued. The dental visits were still there, but they gradually became part of the background of life rather than the center of it.

But one by one, and sometimes two or three at a time, my teeth were failing. Each crack meant another long night or several of them, waiting for the pain to settle enough to sleep or for the next available appointment with a dentist. What had begun as a single violent moment in the crash slowly turned into years of small failures.

A repair would hold for a while and then give way. A tooth that had seemed stable would loosen again. Another would fracture under the pressure of an ordinary bite.

Each visit to the dentist attempted to hold the line a little longer. There were crowns, repairs, adjustments, and the quiet hope that this particular solution might last. Sometimes it did, for a year or two, and sometimes much less. Gradually it became clear that the accident had not been something that could simply be fixed and left behind. It had introduced a problem that would return again and again, asking for another attempt at repair.

For years the process continued that way, one intervention after another, each one buying a little more time before the next failure appeared. By the time I reached my thirtieth birthday the situation had finally run its course. There were no natural teeth left to repair.

By the early 2000s I was thirty years old and no longer had a single natural tooth left in my head, officially, “Toothless”.  It is an unusual place to arrive at that age. Most people at thirty are worrying about careers, relationships, or how they are going to afford their first house. I was trying to figure out how to live the rest of my life without teeth.

The person who refused to let the situation settle that way was my grandmother. If I am honest, tenacity was the only kind of love she really knew how to give. C. R. Renfroe had spent more than twenty years running a dental practice, and she was simply not about to watch her only grandson—one of the very few people in the world she genuinely loved—drift quietly into a life without teeth.

She approached the problem the same way she approached most things in life: by deciding it would be solved and then getting on with the work of solving it.

Somewhere along the way she found a program at the University of Texas Health Science Center in San Antonio. The dental school there treated patients who otherwise might never have been able to afford the work they needed. Once she found it, the matter was essentially settled. The plan existed. All that remained was for me to show up.

In 2008 I did exactly that.

Around that same time another part of my life had quietly begun to change. Only a few months earlier I had met the woman who would eventually become my wife. In some ways that timing was its own quiet gift. She fell in love with me before the dentures, before the repaired smile. She fell in love with the toothless version of me.

The dentures that came from that program changed more than the way I ate. They restored something deeper than chewing. They restored the ability to speak without hesitation, to smile without calculating angles, to walk into a room without wondering who had already noticed what I was trying to hide.

Confidence has a quiet way of changing everything.

Not long afterward I entered funeral service as a profession, work that places you close to grief and teaches you quickly that steadiness matters more than most other qualities. People do not expect you to fix what has happened. They simply expect you to stand beside them while they move through it.

In 2014 my wife and I moved to Connecticut with our young son and purchased a funeral home. Over time that single business grew into three. Somewhere along the way we also welcomed two more children into the world, and the house filled with the ordinary noise and unpredictability that comes with raising a family.

The dentures did what they were meant to do. They allowed me to eat, speak, and move through the world without constantly thinking about my mouth. When you have spent time without teeth, even a temporary solution can feel like a kind of miracle.

For many years that was enough.

Over time, though, there were signs that the dentures were aging. They had lost the brightness they once had and taken on the dull look of something that had been used heavily for many years. Chewing required more effort than it once had. Biting into certain foods became less reliable. None of it felt urgent, but it was clear that the appliance was becoming less effective than it had once been.

For years I had known that implants were the logical next step. I had simply chosen not to think too hard about it. Surgery meant time away from work, time spent recovering, and a financial commitment that was difficult to justify while life was moving along well enough as it was.

The moment that finally forced the issue arrived quietly.

I was standing at the bathroom sink when the denture slipped from my hand and fell into the basin. It struck the porcelain with a sharp crack. In the instant I heard that sound I understood something had changed. The denture had cracked, but what I heard in that moment was the quiet end of the long postponement I had been living with.

Life, it seemed, had just signed me up for a surgery I had been avoiding for years.

My wife examined the denture carefully and managed a repair that allowed me to continue wearing it, but the repair did not change what I already understood. The appliance was nearly eighteen years old, and even if it continued functioning for a little while longer, the larger decision could no longer be delayed.

What lay ahead was not the return of my teeth. That was never going to happen. The best that could be hoped for was a more permanent solution to living without them.

And so the search began.

At first it felt like the obvious place to start was close to home. Dentistry in the United States has a reputation for sophistication, and I assumed that if implants were the solution, the answers would be found somewhere nearby. What I did not yet understand was how different the experience of learning about implants would feel compared to the careful, patient attention I remembered from Alice’s office years earlier.

One of the first consultations I scheduled took place in a clinic that looked more like a modern spa than a dental practice. Everything about the place suggested confidence and success. The waiting area was polished and bright, and the staff moved through the office with the quiet efficiency that comes from repeating the same routine many times each day.

When I was called in, however, the first person I met was not a doctor.

Instead I was introduced to a tall, striking woman who carried herself with the polished ease of someone accustomed to presenting things. She spoke clearly and confidently about the procedure I was considering, describing how implants could replace an entire arch of teeth in a single day.

The conversation moved quickly through the benefits and the process, and before long we were looking at a treatment plan that involved placing four implants and attaching a permanent zirconia prosthesis.

A doctor entered the room briefly during the appointment. He spoke with a heavy Eastern European accent and confirmed the general outline of the plan before moving on to the next patient.

The number that followed was the part that stayed with me.

The cost of the procedure approached one hundred and twenty thousand dollars.

It was not delivered dramatically. In fact, it was presented in a tone so calm that it almost suggested the number should not surprise anyone. Financing options were mentioned, along with the advantages of completing the entire procedure in a single visit.

I left the office with the strange feeling that I had just been shown something impressive without quite understanding how it worked.

Over the next weeks I scheduled several more consultations. The experiences were not identical, but they shared a similar rhythm. The offices were modern, the staff were professional, and the proposed solutions arrived quickly. Each clinic had a slightly different variation on the same idea: implants, permanent teeth attached at some different but very specially decided interval that made choosing them over their competition vital for my dental health.

The prices, however, remained in roughly the same range.

Somewhere in the process I began to notice something that made me uneasy. The conversations often moved quickly past the details I was most curious about. I wanted to understand why a particular number of implants was recommended, how long the prosthetics would last, and what recovery might actually feel like. Those questions weren’t so much answered, as acknowledged, as if this were less important than the broader promise of the procedure itself.

None of this meant the doctors were unqualified. In fact, many of them were clearly experienced. But the tone of the conversations left me with the feeling that I was being introduced to a product rather than guided through a complicated medical decision.

The more I heard those numbers repeated, the more I began to wonder whether the problem I was trying to solve had quietly become part of a much larger system.

At some point during that process the idea of looking outside the United States stopped feeling unusual and began to feel practical.

I had business that occasionally took me to Guatemala, and it occurred to me that while I was there I might speak with a few surgeons and simply see what they recommended.

What I did not expect was how confusing those visits would become. 

By the time I arrived in Guatemala I still believed that finding the right surgeon would mostly be a matter of careful comparison. Dentistry, after all, is a profession built on training and precision. My assumption was that if I met with several doctors and listened carefully, the right path would eventually make itself obvious.

The first clinic challenged that idea almost immediately.

I had scheduled the appointment several weeks in advance. My assistant and I arrived at the office at the agreed time and sat on a small, hard sofa in the hallway outside the still-closed clinic. The hallway was quiet, the kind of quiet that comes from waiting for a day to begin. We waited for someone to arrive and unlock the office.

Eventually someone answered the phone.

Once they did, it became clear that no one in the office had any record of my appointment.

There are inconveniences that are merely frustrating and others that carry a kind of unintended humor. This one leaned toward the latter. I had traveled to another country for the consultation, and the consultation itself had apparently vanished.

The second clinic appeared less promising the moment I walked in. The office was small and oddly vacant feeling, not unlike a government office in some subtle way. The rooms felt sparse and the atmosphere quiet, though the equipment itself looked modern enough to offer a small measure of reassurance.

After a short wait I was brought into an examination room where the dentist began evaluating my situation.

Very quickly, however, another problem emerged. The imaging machine that would normally have been used to scan my jaw was not functioning that day. Rather than rescheduling the appointment, the doctor chose to proceed with a visual examination and a brief external assessment.

Within a few minutes he explained his conclusion.

He invited me into his office and began to drawn with dry erase marker on his glass topped desk in an apparent attempt to makeup for the radiology he didn’t have. According to his judgment, I had almost no bone left in my jaw and the only viable solution would be a subperiosteal implant, Aere A subperiosteal implant is a metal framework that rests on top of the jawbone instead of being drilled into it. Dentists sometimes recommend it when a patient has lost too much bone for traditional implants to be anchored in place.  are two sentences that explain it clearly while 

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which is a metal framework that rests on top of the jawbone instead of being drilled into it. Dentists sometimes recommend it when a patient has lost too much bone for traditional implants to be anchored in place. 

At the time I had not yet learned how dramatically treatment opinions could vary between practitioners. I listened carefully as the doctor sketched his explanation on the glass surface of his desk with a dry-erase marker. Something about the certainty of the diagnosis made me uneasy. Determining the amount of bone in someone’s jaw without imaging struck me as an unmitigated pile of nonsense. At the same time, somewhere in the back of my mind, I knew it was possible—maybe even likely—that the situation really was that bad.

A third clinic I visited seemed more organized at first glance. The facilities were clean, if small, and the staff were attentive. The process moved efficiently enough that I began to feel cautiously optimistic that I might finally be in the right place.

The optimism lasted until the conversation turned toward photographs.

Before the examination had really begun, members of the staff were eager to take pictures of me for what appeared to be social media. The request felt presumptive enough that it bordered on hostility, though I tried not to let the moment derail the visit entirely. I had come for a medical consultation and suddenly felt as though I might also be part of a promotional campaign.

The follow-up visit the next day introduced another surprise. I had been told that I would meet the lead surgeon and owner of the practice, the person ultimately responsible for my care. When I arrived, I was shown into an examination room and asked to wait.

Forty minutes passed.

During that time I could hear staff members discussing the finishing touches on some recent office renovations, which appeared to be occupying much of the doctor’s attention that morning. When he finally entered the room it became clear that he had not yet reviewed my records. He simply told me that I was free to ask any questions.

I had only one.

Would he call me back to schedule another appointment when he had actually prepared to discuss my treatment?

To be fair, the visit was not a total waste of time. One of his younger associates repaired my badly broken denture without charging me for it, and I left with a digital copy of the CT scan they had taken.

None of these moments were catastrophic on their own. Each could have been explained away as an ordinary complication of running a busy practice. Taken together, however, they left me with the growing sense that I still had not found anyone who was willing to sit down and simply explain my situation.

The final clinic I visited on that trip may have been the most honest of the group, at least in hindsight. The doctor spoke enthusiastically about the procedure and emphasized how quickly everything could be completed. If I agreed to the price, he explained, the surgery could begin almost immediately.

On the surface the message was reassuring.

But once again the conversation moved quickly past the deeper questions.

What I was looking for at that point was not speed. What I wanted was understanding. I wanted someone to walk me carefully through the options, to explain why one approach might be better than another, and to speak frankly about what the process would actually involve.

By the time those consultations were finished I understood something I had not known when the trip began.

Finding a surgeon was not going to be a matter of choosing the most convenient clinic or the lowest price. It was going to require finding someone who understood that the conversation itself was part of the treatment.

At that point, I still had not met that person.

But not long afterward I would.

I had business interests in Costa Rica and was planning to spend some time there anyway. While arranging that trip I came across a clinic in Tamarindo and scheduled a video consultation with the surgeon, Dr. Josué Jiménez. At that point I had already spoken with enough dentists to understand that the consultation itself often revealed more than the treatment plan. What I was hoping for was not a sales pitch or a promise of speed. I simply wanted someone who would explain what was actually going on inside my jaw.

From the beginning the tone of that conversation felt different.

Dr. Jiménez spoke calmly and directly. There was no sense that he was rushing toward a conclusion or trying to close a decision. He listened to my questions carefully and answered them in the same measured way, taking the time to explain the reasoning behind his recommendations. The discussion moved slowly enough that it felt like a genuine consultation rather than a presentation.

Early in the conversation he addressed something that had already caused me a fair amount of concern. One of the clinics I had visited in Guatemala had suggested that I had almost no bone left and would require a subperiosteal implant.

His assessment was very different.

After reviewing the imaging, he explained that I actually had plenty of bone available for standard implant placement. There was no need for exotic procedures or specialized hardware. The situation, as he described it, was relatively straightforward.

It was the first time during the entire process that someone had taken the time to walk me through the problem in a way that felt both honest and unhurried.

By that point I had already learned to be cautious about first impressions, but the contrast with the earlier consultations was difficult to ignore. The conversation did not revolve around how quickly the surgery could be completed or how attractive the result would be. Instead we talked about the practical details: how many implants might be necessary, what the surgery would involve, and how recovery would likely unfold.

When the call ended I realized something simple.

The decision was no longer about geography or price. It was about trust.

The surgeon I had been looking for was not the one with the largest clinic or the most polished presentation. He was simply the one who seemed willing to speak plainly and treat the situation as a medical problem rather than a sales opportunity.

A short time later I boarded a plane to Costa Rica.

Traveling for surgery creates a strange kind of quiet in the days beforehand. Most of the practical work has already been done. The consultations are finished, the appointments scheduled, the flights booked. There is very little left to arrange. What remains is simply the knowledge that something significant is about to happen.

For me the anxiety was not centered on the surgery itself.

I have always been a somewhat anxious person, and I had expected the prospect of surgery to provoke the familiar fight-or-flight response. Instead the uneasiness came from something else entirely: my wife was not there.

Our lives had grown around each other in the years since we met. She is the warm center around which the rest of my world tends to orbit. When something is wrong, she is the person who steadies it. When something is uncertain, she is the person who reminds me that it will eventually make sense.

This time she was home with the children while I was preparing to have my jaw rebuilt in another country.

There was nothing unusual about the decision. Someone had to stay with the kids, and life does not pause simply because one person needs surgery. Still, the absence created a quiet dislocation. I found myself wishing that the one person who always tells me everything will be fine was in the room to say it.

Costa Rica itself did little to amplify the anxiety. If anything, the country has a way of slowing things down. The pace of life there feels softer, less hurried than the places I was used to living. They have a phrase for it—pura vida—a kind of shorthand for the idea that life should be lived a little more easily than most of us tend to allow.

The clinic was in Tamarindo, not far from the ocean. It was not the largest or most elaborate facility I had seen during my search, but it had the reassuring feeling of a place that knew exactly what it was doing. The staff moved through the rooms with quiet efficiency, and the surgeon greeted me with the same calm clarity that had come through during our earlier consultation.

By the morning of the procedure I realized that the fear I had expected never really arrived.

The anesthesiologist spoke with me for a few minutes beforehand, explaining what would happen and answering the few questions I still had. There is something about a calm professional voice that settles the body even when the mind is still busy imagining possibilities.

Soon afterward the anesthesia took hold.

What had originally been estimated as a two- or three-hour procedure eventually stretched to nearly six and a half hours. Once the surgery began it became clear that extensive alveoloplasty would be necessary to reshape the jawbone before the implants could be placed properly. The work was more involved than anyone had expected at the outset.

My own memory of those hours is, naturally, limited.

I remember waking slowly and feeling the strange confusion that follows deep anesthesia. The first thought that surfaced was the vague suspicion that something might have gone wrong. I recall asking the staff whether I was supposed to be awake yet.

The following day I discovered a photograph on my phone that I had apparently taken during that foggy moment of waking. A selfie, captured somewhere between anesthesia and clarity, staring back at me like a small piece of evidence from a time I barely remembered.

The surgery itself was finished.

What I knew—and what I had prepared myself for—was that the more difficult part of the journey was just beginning.

When I returned to my small Airbnb that evening and finally settled into bed, the anesthesia had begun to fade enough that my tongue started to understand just how much work had been done inside my mouth. I could feel stitches everywhere. There were more of them than I could possibly count, many buried beneath tissue that was already beginning to swell.

Along the ridge of my gums I could feel the sharp tips of what I assumed were the implants themselves rising slightly above the surface.

Not long after I arrived, the nurse came by with one of the doctors to check on me and make sure I was settling in properly. They looked at the surgical sites, reviewed the medications I would be taking, and made sure I understood what the next few days would likely feel like. After they left, exhaustion finally took over and I fell asleep.

Around twelve-thirty in the morning I woke suddenly.

It didn’t take long to realize what had happened. At some point during the night I had slid down the pile of pillows that had been keeping my head elevated. Without the elevation the swelling had begun to increase, and the pressure inside my mouth had built to the point that sleep was no longer possible.

That hour—twelve-thirty in the morning—became the quiet witching hour of the first few nights.

I sat awake for a while watching reruns of M*A*S*H, waiting for the swelling to settle enough that I could drift back to sleep again.

Morning brought its own adjustments. Waking up seemed to arrive with a fresh wave of discomfort each day, the kind that needed both medication and patience before it would settle down. Breakfast that first morning consisted of iced coffee and a small bowl of Greek yogurt. Later in the afternoon I managed a protein shake. Most of the day was spent resting, though actual sleep was hard to come by.

The following day the clinic attached small rubber healing caps to the implants that extended through the gums. By the day after that, the temporary denture was ready.

Ironically, the day the temporary teeth were installed was also the day when the swelling was at its worst. Fitting the denture into place felt something like trying to force your foot into a shoe two sizes too small. Everything was swollen, tight, and resistant to the idea.

Two more days passed that way, moving slowly between medication, ice packs, and brief visits from the nurse who had been arranged to check on me.

Throughout those early days the care from the clinic itself was attentive. The nurse visits I had arranged helped a great deal, and the doctors were available whenever something needed to be checked. Under the circumstances I was as comfortable as I could reasonably expect to be.

But the same question kept returning to me: How does everyone else do this?

Most patients traveling for surgery do not have nurses checking in on them or doctors nearby. They are sent back to a hotel room or an Airbnb with a set of instructions and a bag of medication, and from that point forward they are largely responsible for managing the experience on their own.

Lying there in the quiet of those long recovery hours, it began to feel strange that such a complicated and physically demanding procedure had no real system designed to support patients once the surgery itself was finished.

For all the quiet the place offered, recovery also gave me more time to think than I was accustomed to having.

Most of life had been moving at a pace that left little room for reflection. Running businesses, raising children, and keeping a household moving tends to fill every available hour. The days in Tamarindo were different. The body was healing, the schedule was simple, and the long stretches between nurse visits and medication created an unexpected kind of stillness.

During those hours I often found myself thinking back over the path that had brought me there.

Even before the surgery I had understood that the procedure itself would not be the entire story. The operation would be dramatic and complicated, but it would also be contained. A beginning, a middle, and an end inside a single day.

Recovery was something else entirely.

In my case I had been fortunate. A nurse checked on me regularly, the doctors remained accessible whenever something needed attention, and the small place where I was staying made it possible to rest properly. The rhythm of the days, simple as it was, allowed the body to do what it needed to do.

But lying there during those quiet hours, I kept returning to the same question.

How does everyone else do this?

Most patients who travel for procedures arrive in another country, undergo surgery, and are then sent back to a hotel room with a set of instructions and a small collection of medications. From that point forward the process belongs largely to them.

The pattern felt strangely familiar. Modern medicine has become extraordinarily skilled at intervention. It can repair damage that once would have been permanent and perform procedures that earlier generations would have considered impossible. But once the intervention is complete, the responsibility for recovery often shifts quietly back to the patient.

The surgery is treated as the event.

Everything that follows is assumed to work itself out.

Spending those long hours in Costa Rica, moving slowly through the days of swelling, medication, and gradual adjustment, simply made that reality easier to see.