Jun 10 2010
In basements and backrooms across the province, with outdated and unsterilized tools, a cottage industry of illegal and sometimes dangerous dentistry is thriving among immigrant communities, a Toronto Star investigation has found.
Offering cut-rate prices for inferior dental care, these bogus dentists attract patients, overwhelmingly
new immigrants, who share the same culture. Vulnerable, ill-informed and desperate to save money, they have low expectations for care.
And why not? Immigrant patients say that’s the way it was in their home countries, and they don’t expect much different in Canada — where some opt for the cheapest available service, and never mind the credentials. It’s all they can afford. And those who complain of problems — a rarity — are nervous about speaking against community members.
The dental profession’s watchdog is struggling to thwart this underground enterprise with a seven-year, $1 million crackdown that has netted 42 imposters. But where one practice is knocked down another pops up.
The Star went undercover and visited two fake dentists. We found dingy conditions — one with a patient chair in a bedroom, the other in a basement corner — rusty tools, dirty overhead lights, and no diplomas that would identify a properly trained and accredited dentist. Treatment was offered for as low as $20 in this cash business.
“I know it is illegal,” Mikhail Genkin said after a Star reporter posing as a patient identified herself. “I think I help people because my price is very low and quality is quite good.”
Genkin was the subject of an anonymous complaint to the Royal College of Dental Surgeons of Ontario, but he said he has done nothing wrong and has no recollection of the issues raised in the complaint. The college is investigating.
There are plenty of patients for unlicensed dentists to draw from: 32 per cent of Canadians — mostly low-income earners — don’t have dental insurance. And, 17 per cent of Canadians avoided seeing a licensed dentist last year because of cost, according to a recent Health Canada report. In 2008 the province committed money for a dental plan for low-income adult Ontarians, but funding has yet to appear.
The Royal College’s registrar, Irwin Fefergrad, said poor workmanship by bogus dentists can lead to complications, such as infection. Radiation from X-ray machines can seep through unleaded ceilings and walls. HIV and other blood-borne ailments can be transmitted through dirty tools and syringes.
In one recent London, Ont., case, patients of an unlicensed dentist were urged by health officials to use condoms and get tested for fear they may have been infected with hepatitis B and C. Both viruses are found in blood and saliva, and can live on unsterilized equipment for a month.
The college’s mandate is to regulate licensed dentists, not backroom practitioners. But in 2003, after hearing numerous complaints, it went on an expensive mission, dispatching undercover operatives. In 42 cases, the college obtained court injunctions to shut down the bogus dentist or signed an agreement that they would not practise again.
Fefergrad said this is the tip of an iceberg.
“I suspect there are probably hundreds of them out there. They’re dangerous. They’re totally unregulated. What standards do these bogus phonies have? What skills do they have? If someone’s going to put a high-speed drill in my mouth, I want to know.”
Olga Volchenko knew of her dentist in their native Moldova before they both immigrated to Canada several years ago. She didn’t think twice about seeking her services in Toronto when she needed a root canal and other dental work. The woman’s rates were cheap, attractive to someone without dental insurance.
Today, Volchenko wishes she had been less frugal.
She curls a finger around her upper left lip and tugs to reveal a murky gum line of blackened flesh where four molars used to be.
“Look at that,” she says in Russian, with a grimace. Her mouth is only partially healed. “Da. Look.”
Volchenko rents a sliver-sized public housing apartment in the city’s north end and has worked only part time or in temporary jobs since coming to Toronto in 1992.
So far, she has spent close to $15,000 and countless hours in a licensed dentist’s chair to repair the damage.
Working with old equipment in her basement, the practitioner didn’t wear gloves while prepping, Volchenko says, and was stingy with anesthetic while she pulled teeth that didn’t need to come out, filled others that should have had root canals and improperly fitted the 64-year-old woman’s mouth with bridges and crowns.
Volchenko didn’t realize the shoddiness of the work until two years later when she startled awake in the middle of the night with a toothache. A couple days later she developed an abscess and infection so severe it caused her left cheek to swell with a baseball-sized bulge.
The dentist who has since helped Volchenko, Dr. Allen Aptekar, blames the unlicensed dentist for her problems. He said an abscess so severe, if untreated, could lead to blindness, even death.
One of the complications was that Volchenko’s upper jaw bone eroded. Aptekar has had to painstakingly perform bone grafts, extractions and implant surgery.
The cost of the initial work paid to the unlicensed dentist was $6,000.
Volchenko would not give the bogus dentist’s name to Aptekar, fearing he would alert the Royal College. Volchenko would not tell the Star either, saying she was worried about repercussions in her community.
In another case, Peter Krichevsky visited unlicensed dentist Yosef Istzer shortly after immigrating to Toronto from Poland more than a decade ago. And he has spent close to $50,000 over the last four years to repair the dental damage. A licensed dentist is in the midst of extracting all of Krichevsky’s teeth to install a full mouth of implants.
Istzer would not speak to the Star, but his wife, Shifra, denies her 65-year-old husband, a denturist licensed to work in Ontario, is also working illegally from their basement as a dentist. While she said her husband doesn’t work from home, she acknowledged there is a dentist’s chair and paraphernalia in the house.
Wearing a white lab coat, her voice shaky, she said her husband is out of the country even though he answered the phone earlier that day.
“There’s an expression in Polish,” Krichevsky says. “You pay cheap, you pay twice.”
Phony dentists hail from all corners of the globe: Russia, Colombia, Lebanon, Southeast Asia, Africa. In their windowless, subterranean settings they perform all manner of dental procedures from seemingly routine cleanings and fillings to complex dentures and implants.
Prices vary but are significantly cheaper than what a legitimate dentist charges. A root canal is $250 instead of $900, a filling is $40 instead of up to around $300, and crowns are $175 apiece, compared to between $900 and $1,000 each in an office dressed with diplomas.
Some home clinics are filthy and littered with bloodied gauze. At least one practitioner tried to use a toaster oven to “sterilize” his tools, the college says. Yet others have typical dental office amenities, including business cards and secretaries. In general, most of the illegal dentists make do with tarnished probes and mirrors, dated dental chairs, and spent and rusted lights and drills — all easily purchased on eBay.
Their materials, such as anesthetics and composite resin used in fillings, can only be legally purchased by registered dentists.
Some smuggle their supplies into Canada and others buy materials in illegal, untraceable cash deals with small, local dental supply stores.
Phonies who do bridge, crown and denture work sometimes purchase them from shady dental technologists.
Many registered professionals come into regular contact with a mouth mangled by an unlicensed practitioner. Some are through referrals — the illegals actually send their patients to licensed dentists for second opinions and X-rays — some are by happenstance.
Dr. Samuel Barkin, a dental surgeon who handles serious cases in Thornhill, says he encounters problems at least twice a year. His office is a stone’s throw from Bathurst St. and Finch Ave. W., the epicentre of Russian Toronto and quite possibly this city’s ground zero for unlicensed dentists.
“It’s almost like the (patients) are told, ‘Here, bite down on some gauze and go stand on this street corner,” Barkin says.
The Star went looking for unlicensed dentists and found several easily. In two cases, a reporter visited the fake dentist posing as a patient in need of a checkup.
Michael (Mikhail) Genkin, a barrel-chested 64-year-old clad in stained scrubs, slouch socks and flip-flops, works out of a dank basement in a bungalow near Bathurst and Finch.
The reporter climbed into a green vinyl chair, circa 1970, and stared up into a creaking overhead light while Genkin, who did not wear sterile gloves, examined her mouth. A dented autoclave, used to sterilize tools, was pushed against a wall.
Clutching a dental mirror and probe, Genkin prodded tooth after tooth before proclaiming nothing was wrong. For this consultation he took $20 cash.
When the reporter identified herself, Genkin said he understood what he was doing was illegal, but he believes he has done a good job over the past 15 years, working out of various basements in North York, treating people who cannot afford a real dentist.
Genkin immigrated to Canada from Moscow, by way of Israel, at age 50. His age, he said, is partly why he didn’t bother trying to get registered. Like many illegals, he said he didn’t have the time or money to attend the University of Toronto’s two-year, five-month foreign-trained accreditation program. Tuition and associated fees tally around $100,000 and more than 250 applicants compete annually for up to 28 spots.
The University of Western Ontario also offers such a program and there is a $7,500 fast-track option, Fefergrad said.
If their training and education are up to college standards, applicants who pass written and practical exams can be granted a licence. About 24 foreign-trained dentists have passed since 2007.
Many basement dentists say the licensing requirements are prohibitive, but Dr. David Mock, dean of U of T’s dentistry school, said financial institutions are only too happy to bankroll future dentists and it is usually those who can’t meet the qualifications who go underground.
“Many of them are dental mechanics,” Mock said, adding such individuals are likely to be the most dangerous and inflict the most harm. “They may have some skill, but don’t know why they’re doing a procedure and don’t know what to do if something goes wrong.”
Unlicensed dentists are typically cautious about who they allow into their clinics. When the Star booked an appointment to see Aleksander Zanger, his wife, Ann Shapiro, asked half a dozen times how the undercover reporter got their telephone number.
Zanger, 84, later told the Star he has been practising from the tiny second bedroom in their modestly appointed apartment for close to 40 years since he failed to pass his accreditation exams.
Standing next to a machine that cuts dental moulds, Shapiro denied her husband is working at all. After a few moments she conceded: “We only see friends.”
In a rare case before the criminal courts, Colombian-born dentist Humberto Solano Rosania allegedly operated an unlicensed clinic from his London, Ont., basement for eight years. Members of the local Colombian community said he began his alleged practice by helping the penniless among them, investigators said.
The 46-year-old man was quick and wary of those out to shut him down. He refused to see patients until he could confirm their identities. That is why Joe Passmore, an undercover college investigator and retired Toronto police officer, could never get inside. Eventually, a police department trainee whose mother was Solano Rosania’s patient turned him in.
When Solano Rosania was arrested in March, police seized an appointment book containing more than 600 patient names, said an affidavit in support of the college’s motion to shut him down.
Hiding inside his bungalow, he sent his 28-year-old wife, Vanessa De-Avila to the door when the Star came seeking comment. She said her husband will not speak publicly for fear it will influence custody decisions over her young daughter from a previous marriage.
Solano Rosania, who investigators say earned close to $100,000 cash annually and did not pay income tax, faces four criminal charges, including unlawfully inflicting bodily harm and fraud. He recently consented to a civil order prohibiting him from practising dentistry. Such an order — an injunction — is usually an illegal practitioner’s worst fate.
None of the shuttered unlicensed dentists have resurfaced after they’d been investigated, said Passmore, who has been involved in several investigations. But if caught violating the injunction, Fefergrad said an underground dentist could face jail time.
Michele Henry can be reached at 416-869-4386 or firstname.lastname@example.org