A sticker on the front door welcomes guests with the word "SMILE."
But that's the only resemblance between a legitimate dentist's office and the Falls Church apartment at the top of a neglected stairway where people lined up for dental work recently. Instead of a shiny linoleum floor that taps underfoot, there is cream-colored carpet dull with stains. In place of a waiting room lined with identical chairs, there is a sparse living room with furniture indifferently mismatched.
Yet 10 people, maybe more, flocked here March 25 to receive dental services from an unlicensed couple visiting from El Salvador, Fairfax County police said. Officers found a man receiving work in a chair. Others were waiting their turn.
Police arrested the Salvadoran couple, and within days, any sign of a clinic was gone. Many from the Hispanic and dental community say the incident underscores a larger problem in getting affordable medical and dental services to those who exist most on the margins -- adult immigrants who fear the system and lack insurance. What other choices did the 10 people waiting that day have, dentists and Hispanic activists ask.
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Law enforcement officials struggle to remember another case like this. Records show the charge "performing invasive procedures without a license" has been issued only twice before in Fairfax, nine years ago. But some say rumors of clandestine clinics have existed for years.
"It was just hearsay that this was happening in some basem*nts in some homes in the Culmore area," said Tom Wilson, executive director of the Northern Virginia Dental Clinic. "My first thought was that's a disaster that's waiting to happen."
His clinic, the area's largest provider of dental care for low-income, uninsured adults, answers about 4,500 appointments a year. Still, hundreds of names fill waiting lists.
Resources Scarce
Marina Lopez, 37, sat at the playground of the Olde Salem Village apartments on Culmore Court one warm recent evening. "Tony," she called repeatedly to her 4-year-old, who sprinted between the blue-and-yellow monkey bars to where the grass meets the parking lot.
"Many people don't have resources," Lopez said in Spanish. The children born here, such as Tony, qualify for Medicaid, the Honduran native said. "But for me? The problem is for me."
She has permission to work in the country but no insurance, she said. She last visited a dentist's office three years ago, run in a New York apartment much like the operation that was shut down just yards from where she sat. She said she paid $70 to have a tooth extracted. She doesn't know whether the dentist was licensed.
"It was necessary," Lopez said. "Many people went."
She remembered walking into the apartment, where a line had formed.
"It was a horrible stress," she said. "It's not a 100 percent clean what they use."
Many things can go wrong with a botched dental procedure, said William V. Dougherty, president of the Northern Virginia Dental Society. A nonsterile area could lead to a fatal infection in the head, as in the recent case of 12-year-old Deamonte Driver in Prince George's County. Roots can be broken, jaws fractured. The wrong anesthesia could be deadly.
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Just a few weeks ago, Dougherty and others cared for 550 patients at the fifth Mission of Mercy Project, in which dental workers volunteer to treat the uninsured. Among the 75 dentists and 40 dental hygienists were 12 Spanish-speaking translators.
On Culmore Court, the majority of residents come from Central America, with many having just arrived, property manager Manuel Azmitia said. Because many of the men work construction and other seasonal jobs, he said, it's not unusual for residents to fall behind on rent.
"This is the first time I heard of someone taking chances with a business like this," he said.
Outreach by Center
Lidia Maguina sits behind a desk at the Culmore Family Resource Center, a cheerful avocado-colored room operated by the county just doors away from the apartment where the dental setup was discovered. As the human services coordinator, she answers a variety of questions for the community.
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One recent morning, a woman came in asking for help with immigration forms. Then a man with a faded Harvard sweat shirt and bloodshot eyes asked for substance abuse guidance. Three Mexican women in their 20s walked in, carrying two babies and searching for diapers. There were none.
In Spanish, Maguina asked the women one by one what they would do if they needed a dentist. The first woman, who has lived in the area four years, said she would call a group that she heard provides consultations for $40. The second woman, who had been here a year, said she would take a pill. The third just shrugged.
"It's very hard," Maguina said. "There are some places we can refer them to, but many of them have waiting lists that are very long. Sometimes the only thing we have left to do is get the Yellow Pages and go down the list and see how much they charge."
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Her office usually refers people to Northern Virginia Community College, where students work under the supervision of a dentist. But most of those services are preventive.
They are not for someone such as Joseph Muñoz, 30. The Peruvian man's gums have bled for five years, he said, but each time he visited a dentist, he would be quoted a price he couldn't afford.
"I would tell them I'll be back next week, and because I didn't have the money, I didn't go back," he said. "In order to fix my mouth, I had to sell my eyes."
A few weeks ago, driven by the pain, Muñoz asked the Loudoun County Department of Family Services in Leesburg for help. They referred him to the Northern Virginia Dental Clinic, where April 6 he received his sixth treatment. "It was very hard for me," Muñoz said. "I'm not used to asking for help."
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Although many argue that undocumented immigrants should not be entitled to health care, Wilson said the alternative could be more costly. A toothache could lead to missed work and a visit to the emergency room.
The clinic, where an appointment costs $40, is "only one answer to a very large problem," he said. The clinic takes referrals from 14 agencies and at just one, the waiting list has 120 names.
St. Anthony's Catholic Church, across the street from Culmore Court, handed out health questionnaires in 2002 to those sitting in pews. When 2,300 forms came back, the number one need among Latinos was dental services, said parish nurse Georgine M. Redmond. At least 70 percent said they needed help.
Details About Couple
Little is known about the two people arrested. Wendy Carolina Granada de Serrano, 30, and Ramiro Serrano Cardona, 39, told police that they live in El Salvador, and police confirmed that they had visiting visas. In court documents, the couple provided a Wheaton address, but records show that it does not exist.
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Fairfax police spokeswoman Shelley Broderick said authorities do not know whether the couple worked as dentists in El Salvador. Both are charged with performing invasive procedures without a license, a felony, and possession of controlled paraphernalia, a misdemeanor.
Residents of the apartment say that the couple usually did not work out of it but that the lease holder had allowed them to use it that day.
"It was over here," a young female resident said in Spanish a few days after the arrest, pointing to a black plastic chair where the procedures took place. The chair occupies a corner of the scantily decorated living room. A bookshelf is empty, and small stuffed animals, such as Tweety Bird, dangle from the walls as makeshift decorations.
Above the television hangs a blue poster board, reading: "Justicia y Dignidad para todos los immigrantes" -- Justice and Dignity for all the immigrants.
Staff researcher Meg Smith contributed to this report.
