Inmigrantes pagan doloroso precio por dentistas ilegales

Serious health problems haunt victims of botched procedures

When the pain in Liliana Moreno's tooth became unbearable, she did what many recent immigrants to Atlanta do. She called an unlicensed dentist's office she'd heard about from friends. A busy practice operated out of an aging apartment complex off Buford Highway, the area's most ethnically diverse strip.

In Apartment H-4, they'd pull your teeth cheap, friends said. The dentists had real chairs, drills and lights in the back bedroom. They stayed open late and took cash.

Moreno went to the apartment on a Friday night and had a molar pulled. Three days later, her mouth was so swollen she couldn't talk, eat or sleep.

"I was pale," said Moreno, 32. "My head hurt so much."

It is a felony to practice dentistry without a license in Georgia, but backroom dentists are seldom reported or caught. No one knows how many there are, because they operate below the radar of the state's regulatory board.

Dentists and hygienists who speak languages other than English are in big demand to serve the state's booming immigrant population, which almost quadrupled from 1990 to 2003, according to census data.

Many immigrants with no papers, no health insurance and little money tend to end up in a dental chair in someone's living room, apartment or trailer.

If everything goes well, the work is done correctly and the pain goes away.

If something goes wrong, there's little recourse. The dental offices are open one day and closed the next.

Still, many immigrants are lured to backroom dentists because they believe they cannot afford a regular dentist, said Mario Ortega, Moreno's boyfriend.

Immigrants feel more comfortable dealing with someone who speaks their language. They want flexible office hours and lenient payment terms. The undocumented don't want to call attention to themselves.

"One gets fooled into this," said Ortega, 22. "They say it's more expensive to go to a regular doctor, and that's not true."

Business cards advertising dentists at a house in Norcross and at the Park Villa Apartments in DeKalb County, where Moreno went, appeal to immigrants' desire to save money.

"Dental Work Within Reach of Your Pocketbook," one card promises in Spanish. There's no address, just a phone number.

When Moreno visited the unlicensed dental office in January to seek care for her aching molar, she didn't even ask the names of the dentists.

"I was pretty desperate," said Moreno, who came to Atlanta from Peru four years ago. The dentist first treated the wrong tooth. Moreno went back the next day. This time the dentist gave her anesthesia and pulled her molar.

She soon developed a serious infection in her gum and returned twice to have it treated. A female dentist scraped her gum and tried to clean the wound.

By the third day, Moreno didn't want to go back. "I'm scared," she told her sister.

Moreno paid the illegal dentist $115 for the tooth extraction plus an envelope of antibiotics and painkillers.

On the fourth day she went to Dr. Judith Finkelman, a licensed dentist in Alpharetta, who cleaned the pus out of the gaping hole in her mouth, packed it with medicated fillings and sewed it up. The trip to Finkelman, plus antibiotics and painkillers from CVS, cost only $2 more.

Patty Donehoo, 50, lives at Park Villa Apartments, where people have knocked on her door over the years looking for the dentist. She always had doubts about her neighbors.

"Let's just put it this way: I needed dental work and I chose not to go up there," she said.

The Georgia Board of Dentistry regulates dentists and has disciplined more than 200 in the past five years, public documents show. Most of the cases involved dentists who were duly licensed but made mistakes: letting their licenses lapse, doing a poor job on root canals and bridges, cheating insurance companies, or writing drug prescriptions for themselves.

The underground dentists who have never been licensed, haven't graduated from dentistry school, and have no intention of operating a legal practice usually don't fall under the purview of the board, said Mollie Fleeman, division director of the state's Professional Licensing Boards. "We refer those to law enforcement."

Over the past 4 1/2 years, the board has worked with police on 20 unlicensed practice cases, Fleeman said. Four involved jewelry stores that sold gold caps or decorations for teeth; the rest dealt with unlicensed dentists who catered mostly to poor clients around the state. Seven cases were in the greater Atlanta area.

Fleeman could not say how many involved immigrant clients, although one case in Dalton did involve an immigrant dentist.

Marta Patricia Vasquez was charged with two counts of practicing dentistry without a license. She worked out of a house and left a man with a swollen brain, said Kermit McManus, district attorney for Whitfield and Murray counties. She skipped bail last year before her hearing.

Her office "was as busy as McDonald's," patient Kenneth Smith said. A Mexican friend who works construction referred him to Vasquez.

Smith said the infection that resulted from the visit left him with symptoms of a stroke and permanent problems with his leg muscles, for which he has to take expensive medicine.

"I would give half of what I make for the rest of my life not to have gone to this dentist," Smith said.

Practicing dentistry without a license is punishable by a fine of between $500 and $1,000 and two to five years in jail.

"We have to find these people," said Dr. Peter S. Trager, a Marietta dentist who served as president of the Georgia Board of Dentistry. He has heard of cases in the state's Hispanic and Asian communities. "Someone has to tell us who they are. We don't have police going out and looking for this."

At Park Villa Apartments, unit B-2, a young Hispanic man dressed in a short-sleeved T-shirt, blue work pants and a baseball cap rings the doorbell and enters the apartment. He takes a seat in the living room. The apartment is sparsely furnished, and the beige carpet is dirty. There are no diplomas on the walls, no hint of a license. A television sits in a fake wood entertainment center. It's turned off.

Outside, peddlers hawk Mexican snacks door to door and women chat by the laundry room.

In the kitchen, a slender man in a button-down shirt, talking in Spanish on a cellphone, invites a client in.

Down the hallway, a young boy reclines in a dental chair under a bright light while a man drills inside his mouth. He comments about "dientes cochinos" ? dirty teeth.

A woman who says she is from Argentina wears headphones and takes phone calls in another room, booking appointments.

Across the hall is another bedroom, fully equipped with dental chairs and instruments. The lights are off. It's not rush hour yet.

This is the same operation that months before worked out of Apartment H-4. At the old location, a sheet of paper with pull-off tabs directs clients to call a phone number that will lead them to the new location.

When a reporter identifies herself, the receptionist says she and the dentist can't talk. All questions must be referred to the boss, who will call later. Within an hour, the office is closed and locked.

In the front hallway, a couple from Bolivia arrive looking for the dentist. When questioned, they say they've never been there before and don't want dental work. They leave immediately.

That night, a Mexican man calls from a pay phone to ask why the reporter visited the dental office at the apartment complex.

At each turn in the conversation he first denies being part of the dental office, but then he explains why his group is practicing dentistry out of a three-bedroom apartment.

"We do it for necessity, for the community and for ourselves," he says.

He claims that all the dentists have studied dentistry in their homeland but don't have licenses here.

"We're not killing anybody," he says. "We have a sterilizer and disposable syringes and drill parts."

When told that one patient suffered a bad infection, he says he is sorry and wishes that hadn't happened.

"Nobody's perfect," he says.

Cristela Riggins, 42, once packaged chicken wings at Tyson Foods near her home in Preston. Two years ago, when her teeth ached, the Honduras native wanted a Spanish-speaking dentist.

There aren't many in Preston. A friend suggested a Colombian woman who performed dentistry out of her house in LaGrange. The Colombian woman convinced Riggins that she would make her teeth beautiful with a brilliant white porcelain partial plate.

She charged $2,100, payable in installments, and began the first procedure ? a root canal. Riggins woke the next day with terrible pain caused by a partially exposed nerve.

She called for help, but the woman told her to go to an emergency room. Riggins too ended up in Alpharetta, at Finkelman's office ? a three-hour drive away.

Finkelman, originally from Mexico, attends many Spanish-speaking patients. Every so often she sees patients like Riggins and Moreno who have gone to unlicensed dentists.

Immigrants who work as unlicensed dentists are partially trained or may have been lab technicians in their home country, Finkelman said. They don't know enough to work on someone's mouth, she said.

Becoming a licensed dentist in the United States is difficult and expensive. Prospective dentists must speak English, pay for school, pass board examinations, and run their office in accordance with strict standards of cleanliness and safety, she said.

Finkelman studied dentistry in Mexico but had to repeat several years of dental school in the United States to become licensed here.

"The immigrants, they figure, hey, I can make money, and if something happens, I can go back to my country," Finkelman said.

Dr. S. Joseph Pausa, who also practices in Alpharetta, treated a young Hispanic man a few years ago whose gums were flapping in his mouth. An unlicensed dentist had left the bone exposed during a fumbling attempt to extract a tooth, Pausa said.

Pausa is American, but his parents are from Cuba. He switches with ease from a soft Southern drawl to Spanish.

"To have these types of dentists doing this is undermining the work we do here and the standards we have in Georgia," Pausa said.

When the Colombian dentist learned Riggins had gone to another dentist for work, she called and insisted Riggins still pay the full amount for the dental care she had agreed to.

"She had a way of convincing me. The ones who talk real sweet, they're the dangerous ones!" Riggins said.

"I think many Hispanics need to learn to lose this fear we have and tell people, 'I want you to prove you are professional.' "

Riggins alternated between Finkelman, Pausa and the unlicensed dentist for a year and a half, trying to save money. In the end, the unlicensed dentist damaged most of Riggins' front teeth and finally pulled them.

Riggins now wears dentures.

She makes the trek to Alpharetta every time she wants dental work.

"My cousins says, 'You go all the way there?' and I say, 'Yes!' I still have some teeth left.' "