It was one of the most elaborate offices investigators have ever seen. She had the full setup, they said. Two chairs, an X-ray machine, lab materials and all the tools needed to start messing in a mouth. What she was missing, though, health officials say, is the most important part: a license.
It's a dangerous and alarming practice, officials say, of people cleaning teeth, filling cavities, fitting dentures and making crowns in homes, garages or other buildings without a dental license. Typically seen in South Florida and in migrant communities, unlicensed dentists have also been a problem in Central Florida, said Chilo Casas, an unlicensed-activity liaison with the Florida Department of Health. And his agency is doing everything it can to try to stop it before it gets out of hand, he said.
Data released by the Department of Health show the statewide number of unlicensed-dentist investigations has remained fairly steady: 47 during the 2011-12 fiscal year, 50 during 2012-13 and 44 during 2013-14. The agency couldn't immediately provide a county-by-county breakdown. But Casas said it seems like a growing problem in Central Florida. That's likely, he said, because of Central Florida's growing immigrant communities, where the unlicensed dentists are most often found.
In his 15 years of investigating unlicensed activity in Florida, Casas said he can only think of one case with a person who wasn't targeting those communities. Casas said most illegal dentists claim they're licensed in their home countries, such as Brazil, Colombia and Peru.
They come to Florida, and for various reasons — typically money, time or language barriers — they don't get a state license, Casas said. But they continue to practice, targeting people of the same nationality. And the people, varying from unauthorized immigrants to middle-class workers, usually without insurance, risk their health by getting a quick dental fix out of someone's home, Casas said. But avoiding that risk isn't easy when an illegal dentist is the only choice.
Olga Molina, a social work professor at the University of Central Florida, said she grew up going to an unlicensed dentist in New Jersey. He was Cuban, her family is Cuban, they got a good deal and they trusted him — among the main reasons people go to unlicensed dentists, she said. At the time, her family didn't see any problem with it because he did good work, she said, and they knew had been licensed in Cuba. He just wasn't able to get licensed in the U.S.
"It's a sad reality of coming to live here in the United States," she said. The dentists have no easy way of transferring their license and the immigrants have no affordable dental care available, so the business thrives here, she said.
But what people don't realize, Casas said, is the risk they're taking by having someone not licensed in Florida work on their teeth. That risk could be anything from paying hundreds of dollars for shady orthodontic work to permanent nerve damage, he said. It's a risk he said he hopes people won't take.
"Forget about saving money," he said. "Think about your health."
From the outside, it appeared a normal home, set back and partially hidden by trees. The average passerby probably wouldn't have known what was going on inside the modest house on the 2500 block of Good Homes Road in northwest Orange County. But following a tip, investigators started watching more closely.
According to documents released by the Metropolitan Bureau of Investigation, investigators found used surgical wear, including masks and latex gloves, in the trash outside the home. They also found in the trash boxes that once contained toothbrushes, cement dental impressions, dental instruments and notes with names and phone numbers written on them.
At one point, an investigator attempted to pose as a patient and knocked on the front door but never got an answer despite hearing people inside, according to the documents. The investigator also noticed a surveillance camera, metal bars on the door and the only visible window tinted too dark to see inside, according to the report.
Finally, after 15 months of investigating, officials with the Department of Health and MBI got a search warrant to go inside. In there, they say they found one of the most complex unlicensed-dentist setups they've seen so far in Central Florida. There were prescription antibiotics and drugs for numbing patients' mouths, both apparently ordered online, MBI Lt. Doug Goerke said.
There was an old X-ray machine and a full dental lab, with shelves of dental impressions, apparently used to make dentures and retainers, along with other orthodontic equipment. There was a dental textbook describing how to perform a specific procedure open on a desk, he said. And there was 60-year-old Carmen Dierks, wearing a surgical mask, shuffling a mother and child out a side door of the house, according to an arrest report.
Dierks, a native of Brazil and a licensed dental hygienist in Florida, said she practiced dentistry back home. However, investigators couldn't verify that. But Casas said even if she was licensed in Brazil, what she's accused of doing is still illegal in Florida. "A lot claim they're licensed back home, but the thing that matters is they're not licensed in Florida," Casas said. "They know what they're doing is wrong."
Dierks is facing charges of practicing unlicensed dentistry and operating an unregistered dental lab, according to Orange County court records. Orlando lawyer Eric Barker, who is representing Dierks, said recently he could not comment on the case. According to the arrest report, she told investigators she was only trying to help.
Dierks' arrest is only the latest of several seen recently in the area — and across the state. Last July, Gustavo Hernan Aranguren was arrested on charges he was practicing dentistry without a license at his Buenaventura Lakes home, according to court records.
An Orlando woman was ordered to cease and desist last November after investigators found she was cleaning teeth and providing orthodontic work out of her home.
And one of the most prominent cases in recent years was in 2012, when a woman reported she received permanent nerve damage and lost a molar after being treated by Jorge Romero-Paredes of Hollywood. Romero-Paredes made house calls and was arrested after the woman came forward. He reached a plea deal about a year later that put him on 18 months of probation and ordered him to pay the woman back, according to reports.
Unlicensed-dentist cases, especially ones like Romero-Paredes', where someone was seriously injured, are a "top priority" for the Department of Health, Casas said. The department recently launched a campaign with commercials, bus ads and signs outside gas stations urging anyone suspecting unlicensed activity to call an anonymous tip line at 1-877-HALT-ULA, or to email information to MQA.EnforcementULA@flhealth.gov.
Florida law requires anyone applying for a license to have graduated or attended a school accredited by the American Dental Association Commission on Dental Accreditation for at least two years. The person then has to take several examinations and provide proof of several other certifications. That process can be cumbersome and difficult for many immigrants who struggle with a language barrier, or who might not have attended an accredited school.
Mercado said she's heard of people traveling back to their home countries for cheaper dental care to avoid the illegal aspect. She's also heard people praise the work of some unlicensed dentists because without them, they wouldn't be getting the dental care they need. "The Latino communities have their own resources a lot of times because they can't access the resources for the mainstream communities here," Molina said. "That's just part of the culture and I doubt that's going to change."
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