Illegal Dentistry, Hight Cost Dental Care and United States Broken Health Care System

The for-profit healthcare system has driven many Americans to take desperate measures to secure health services. A few of these desperate millions became the patients of 71 year old Ukrainian native Vladimir Mandzyuk.

Until he was raided by local law enforcement this week, Mandzyuk operated an illegal dentistry clinic in the basement of his Sugar Hill, Georgia home. While the spotlight of the healthcare debate remains focused on access to basic healthcare services, the high cost of dental care is driving increasing numbers into the murky waters of black market dentistry.

The Crisis in Dentistry

The Office of the Surgeon General estimates that some 108 million children and adults in the US have no dental coverage. One key determining factor in who can secure dental coverage is the source of their overall healthcare plan. 8 out of 10 people with employer provided health insurance had some sort of dental coverage while only 3 out 10 people who self-purchased health plans included dental coverage.

Not surprisingly, the burden of this lack of dental coverage is heaped onto the poor. The Surgeon General reports that tooth decay remains the single most chronic disease for children, poor children suffer from twice as many cavities as the children of the affluent and 51 million school hours are lost each year to dental-related illnesses. A shocking 50 percent of poor children have not even been seen by a dentist before entering Kindergarten.

Inequity in healthcare also produces staggering social costs. An estimated 164 million work hours are lost each year due to dental related issues. The costs for public budgets is estimated to be around $70 billion dollars annually and the Surgeon General’s Office suggests that even this large number underestimates the real costs.

Despite this growing health crisis, the recently passed Patient Protection and Affordable Care Act, does little to address access to dental care. No surprise since the National Association of Dental Plans (NADP) has been both an active campaign contributor and lobbying presence in Washington, D.C. The Center for Responsive Politics reports that NADP’s lobbying budget has increased sharply from a low of $80,000 in 2006 to nearly $400,000 in 2010. Such activities served to keep the legislative focus off of the looming dental crisis.

Dentists Go Underground

Illegal dentistry is a direct outcome of allowing corporations the right to ration dental care based on the ability to pay. In the early 1990’s instances of these illegal operations were mostly confined to communities such as the Amish who wished to avoid interactions with the general society. However, as the crisis in access increased sharply, so too did the illegal operations.

Recent immigrant communities were the first to be forced in this direction. They often drew on the experiences of their home countries where informal doctors were a common strategy used to deal with a health care system shaped by steep income inequality.

A good example of this came in 2007 in Somerville, New Jersey, when a female undercover officer, acting on an anonymous tip, searched out an illegal clinic run by someone named “Roberto.” The investigation led her to Ignacio Alberto Ortiz a 41 year old Paraguayan, who claimed to be a dentist. When the police raided Ortiz’s apartment they discovered a fully operative dental practice which included the records of more than 100 patients. (The Star Ledger, March 17, 2007) Similar cases were prosecuted in the last few years in Salt Lake City among the Salvadorian community, in Passaic, New Jersey inside the Polish community and in the Latin American community in Miami.

And the negative consequences of these illegal clinics are also coming to the surface. The prosecution of an illegal dentist in Charlotte, North Carolina came as the result of a string of patients suffering from complications from faulty or unsterile dental practices. Key information in the case came from a man with a poorly executed tooth extraction that resulted in serious jaw and facial infections.

Immigrants point to the fact that few licensed dentists speak English, that the costs are lower in the informal practices and that most of the illegal practitioners were trained in their home countries. Indeed, licensed dentists who are immigrants often describe a frustrating process where they are forced to repeat dental classes already taken in their home countries. This, in addition to the high costs of licensing form a barrier for illegal dentists to transition to legal practices.

Georgia at the Center of Healthcare Crisis

Georgia is a likely candidate for the practice of illegal dentistry to cross over into the general population. The Kaiser Family Foundation reports that the state currently ranks as the 47th lowest in the country in terms of the ratio of dentists to the general population at 0.444 per 1,000 people. Georgia is also 23rd with only 71.8 percent of the population reporting having visited a dentist for the year of 2008. Similarly, only 73 percent of children are reported to have been seen by a dentist in that time period.

Police officials reported raiding seven illegal dentistry outfits in the Atlanta area alone. Only one of these catered primarily to immigrant communities. Local emergency rooms and licensed dentists reported treating an increasing number of cases produced by illegal dentistry involving deep infections, gums flapping, and bones left exposed through faulty extractions.

All of this leads to the 11,000 person town of Sugar Hill, Georgia where Mandzyuk set up his illegal practice. This is the third fake dentistry raid by the police in the Gwinnett County area since 2007. The first two served mainly Latino residents. The police were tipped to Mandzyuk when a resident became concerned that the practice was being run out of a residential house. Police officials stated that the 71 year old now faces felony charges for operating without a dental license which could result in a $1,000 fine and two to three years in jail. (Gwinnett Post Daily, February 7, 2011)

Will Sugar Hill Multiply?

Sugar Hill will certainly not be the last place in which an illegal dentistry clinic will set up shop. As the crisis continues to escalate, with millions more thrown out of dental coverage, the desperate, and sometimes illegal, adaptations to a for-profit system will continue. Only a comprehensive publicly administered national medical plan that insures cradle to grave coverage for all necessary procedures, including dental coverage, can put an end to such madness. Time to renew the fight for a healthcare system based on human needs.

By Billy Wharton
The article originally appeared on examiner.com, permission for re-posting granted by author. Billy Wharton is a writer, activist and the editor of the Socialist WebZine.