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More than 1/3 of the medical tourism industry in Costa Rica is made up of dentists. Will this lucrative San José-centered market be able to maintain its current rate of growth, or is it that just a fable?

Telma Rubinstein greets all her visitors with a friendly smile, as dentists are prone to do. She wears immaculate white dental scrubs and a red flower in her hair. The white walls and freshly washed windows of the Prisma Dental office project purity, sterility.

For 28 years, Prisma built up a reputation as one of the country's premier dental tourism offices. The majority of its patients are foreigners, primarily from the United States and Canada, who fly to Costa Rica to undergo procedures for a fraction of what it would cost back home. Even before the arrival of the Internet, Prisma took requests from abroad. "In the beginning I remember they started to come in with the fax and then the telephone," Rubenstein said. "It was amazing."

Almost three decades later, Prisma Dental is not alone in the business. Other dentist offices have popped up targeting a similar clientele just down the street from them in Rohrmoser, just west of San José. After the recent boom in vacationers looking for cosmetic procedures, the broader dental community has caught on to the allure of medical tourism, and they want a share of the business.

This multimillion-dollar market is now saturated with dozens of clinics – mainly in the capital – advertising for the precious tourist dollar. For example, U.S. tourists can receive top-quality dental work for 60% cheaper than what it would cost in their home country.

Competition is at an all time high. Prisma promotes contests for free cleanings on their Facebook page. Some list cutthroat prices on their website. Everyone brags about their services – you name it: crowns, implants, veneers, full-mouth restorations, laser whitening, braces, surgeries to reduce sleep apnea. A mouthful, for sure.

At an annual medical tourism conference in San José, it was noted that dentistry comprises about 40% of the country's lucrative medical tourism industry. Many work with facilitators and travel agencies to coordinate vacations that patients will take as they recover from surgeries. One day you're receiving novocaine and undergoing a root canal. The next you're relaxing on a beach in Guanacaste.

Costa Rican dentists have avoided serious setbacks despite global recession. With so many dentists in one profitable niche market, everybody tries to outdo each other, racing to obtain more certifications from fancy acronym organizations. However, word of mouth seems to work best. Natalia Demianko, one of 33 dentists working in a rented office at San Jose's CIMA hospital, said sometimes it feels like "one patient can bring you a thousand more."

Alberto Meza takes a glamorous Hollywood approach to attracting travelers. Meza Dental Care is one of the few medical tourism destinations that caters to 99 percent foreigners (about 300 a year). While in dental school at the University of California, Los Angeles. He trained under doctors who perfected the smiles of movie stars like Tom Cruise and Matthew McConaughey. Meza met with cosmetic dentist Bill Dorfman, who is featured on the TV show Extreme Makeover, to talk business. "If you were looking for high-end dentists with affordable prices that's the market we were going to target," Meza said.

The go-for-broke strategy paid off. Meza Dental eventually earned its own starring role on TV after it was named a top 5 dental tourism destination in Latin America by the Discovery Travel and Living channel. In the upcoming months, Meza Dental will air television commercials in Houston, Texas.

The competition also serves to benefit the quality of Costa Rica dentistry. It keeps prices low and forces the best-established dental clinics to constantly be on guard and in search of the best equipment, technology and instruction.

Lasso requires his staff to attend at least one seminar in the United States a year. He'd like to see the dental tourism industry do more to regulate itself. One huge mistake by a single dentist could damage the entire industry.

The dentists at Prisma agree with this notion. “How can you do anything (about other dentists)?" Rubenstein said. "Of course I'm afraid. It took us a very long time to get where we are."

Rubenstein and Cordero just returned from a summit in Kentucky in the eastern U.S. Cordero chatters about his "new toy" they'll be bringing down from the U.S. soon – a sleek tomagraphy machine that gives detailed 3D X-rays of patients. The device will help Prisma keep up with the competition. In addition, the machine allows the dental office to give patients the same modern services they'd receive in the United States.

"Whatever you can imagine," Rubinstein said. "From seminars on the basics to types of anesthetics...whatever you can imagine, we train for it."