THE UNITED STATES OF AMERICA
DEPARTMENT OF HEALTH & HUMAN SERVICES
PROFESSIONAL REGULATIONS DIVISION
DENTISTRY DEPARTMENT
May 1, 2009
May 1, 2009
RE: Dr. Agostinho Calabras (Portugal), File No. 08-09126G; Applicant for Clearance to Practice Dentistry in the United States.
Dear Dr. Calabras,
You recently petitioned this Department for clearance to practice dentistry in the United States. To support your petition, you enclosed your university performance records, your Portuguese professional licensure documents and several articles you published in Portugal’s leading dentistry journal (Jornal nacional da odontologia em Lisboa). You further certified that the Portuguese government named you as one of the ten best dental scientists in the country. According to the records you provided, you have practiced dentistry for over 20 years with a special focus in pain management, beautification and general oral health. You also noted that you established a charity clinic in Russia to assist low-income children address their dental needs.
Although we applaud your accomplishments, we must refer you to Homeland Security Code § 245(b), specifically: “[A]ll ‘foreign dentists’ must register for and complete at least three (3) years of qualified dental instruction at a certified American institute for dental science (West 2002).” Foreign dentists must receive American dental education in order to obtain professional licensure in the United States. Your materials disclose that you were aware of this rule. Yet you ask this Department to grant an exception in light of your “distinguished record of flawless dental service in Portugal.” You also submitted an essay in which you attempt to justify your qualifications to provide dental care in the United States. We hereby deny your request for an exception.
By law, this Department has no authority to grant exceptions to Homeland Security Code § 245(b). Even if we did have such authority, we are not inclined to craft exceptions to this rule because Congress explicitly intended to protect Americans by enacting this statute. Specifically, Congress noted that: “Foreign dentists pose a realistic danger to all Americans. Dental terror is a genuine threat; only American-born and American-trained dentists can fully be trusted to care for American teeth. Al-Qaeda operatives may disguise themselves as foreign dentists and cause untold damage to American dental enamel and tooth roots. Terrorists may use laughing gas, Novocain, bleaching agents, x-ray machines and dental instruments to disrupt American business enterprise and frighten children. Only strong oversight and strict professional regulations can protect American mouths against invasion by belligerent foreign dental operatives.” Preamble to Homeland Security Act §§ 201-250; Subchapter H : Anti-Dental Terror Act (ADTA). Given Congress’ extremely clear mandate on this subject, we refuse to make any exceptions for foreign dentists. All foreign dentists—whether they hail from Canada or Burkina-Faso—must obtain a full American dental education prior to treating American teeth. This is the only way to ensure that a foreign dentist will not maliciously or negligently destroy the means by which Americans eat, chew, smile and bite. Congress understood that Americans’ teeth are vital. Congress also understood that Al-Qaeda knows that, too. For that reason, they enacted these regulations without provision for exceptions. If Al-Qaeda waged a calculated campaign of dental terror against the United States, the result could be devastating. For that reason, all foreign dentists must first learn how to treat American teeth according to American standards prior to plying their trade on our soil.
You write that there is no functional difference between American teeth and Portuguese teeth. Specifically, you point out that all human teeth share identical biological characteristics. You argue that because all human beings have biologically identical teeth, dental science may adequately treat anyone, no matter their ethnicity, nationality, race or religion. You say that our regulations draw an irrational distinction between American teeth and all other teeth. In conclusion, you argue that we should make an exception to the Homeland Security Act in your case because you already possess the education, training, skill and experience necessary to effectively treat “human teeth,” whether American or Portuguese.
We profoundly disagree with your position. There is a fundamental difference between American teeth and all other teeth. Congress has a right to draw a distinction in this regard. Specifically, American teeth face unique dietary dangers. Unlike the Portuguese, who eat hayseed, mulch and strange fish, Americans eat processed cheeseburgers, curly fries, cotton candy, microwave insta-Lasagna, canned meatball soup, Wonder® bread and liverwurst-flavored muffins on a regular basis. These foods present unique dental hazards that do not exist in Portugal. Americans do not pick through scant meals like mice. They engulf large amounts of food and drink, including chili dogs, hush puppies, double Big Mac® burgers, fried mayonnaise cookies, Filet-O-Fish® sandwiches with extra tartar sauce, whole Dominos® pizza pies, sugar-coated corn puffs, grape soda, super-sweetened iced tea, Royal Crown Cola®, Lucky Charms® marshmallow breakfast cereal, and pork sausage melts. At times, they consume these foods and drinks without chewing or breathing. In a word, Americans consume foods in different quantities and qualities than the Portuguese. They eat and drink in a different manner than the Portuguese. These differences necessitate education in American dental health prior to practicing dentistry in the United States.
American breath smells considerably different than Portuguese breath. Your training in Portugal will not prepare you for the smells you will encounter in American mouths. For instance, in order to repel terrorists, Congress recently authorized Americans to eat both onions and tuna salad during the same meal. Before 9/11, it was forbidden to simultaneously eat tuna and onions because these two foods lead to noxious odors when combined in an American mouth. But Congress rightly believed that a terrorist would retreat if faced by several Americans breathing rancid tuna and onion vapors toward him. Bad breath can be a potent deterrent. In Portugal, however, you do not face the same issues. Your citizens do not constantly worry about terrorism, nor do they deliberately poison their breath with tuna, raw eggs and onions in order to ward off would-be assassins. In that light, you are incorrect to conclude that your dental experience in Portugal will easily translate into dental expertise in the United States. Here, you will encounter completely different teeth because Americans eat completely different foods—in much larger amounts than the Portuguese. We face unique dental threats. Our breath is substantially different. With all respect, your Portuguese dental education has not prepared you for the tremendous challenges American teeth face every day at every meal. We must reject your essay’s reasoning on these points.
American teeth are different than foreign teeth for several other reasons. Unlike European and African teeth, American teeth are enterprising and ambitious. They make their own way in the world; they do not receive free government insurance. American teeth bite, chew, tear, rip and grind on their own; they do not need anyone else’s help. In the centuries since our country was born, American teeth have helped great Americans consume food, propelling them to success. American teeth have helped great Americans speak and communicate, since the English language requires a special interplay between throat, lips, palate and teeth. Without teeth, Americans would not be able to properly enunciate English words; and without proper enunciation, Americans would not communicate effectively. Americans pride themselves on excellent communicative skills. Business and commerce depend on communication. American teeth help make that communication possible. Only dentists who understand America know how to properly treat these American dental issues. If you wish to practice dentistry in our country, you must learn the values that keep American teeth strong and healthy. We are proud of our teeth because they are the best. You must learn why before you treat them.
In closing, we note that you strike a particularly defiant tone. You seem to think that your intelligence, training, education and dental skill entitle you to practice dentistry in the United States. You voice contempt for our regulations as “superfluous,” “unnecessary,” “irrational,” “bigoted” and “nationalistic.” Although we praise you for learning English, we do not approve your tone. In our country, professionals are not critical. They merely provide client service, bill their time and go home at night. They do not voice unwarranted opinions, nor do they criticize popular Congressional legislation. You may think that our regulations are “irrational,” but we have reasons for our laws. We do not trust defiant foreigners like you to care for our teeth. For all we know, you could be Osama bin Laden’s dentist. You might be coming to America incognito to train an elite cadre of terrorist dentists to sow dental panic amid the population. Do we not have a right to protect our borders from such attacks? Put simply, we believe our regulations are fair. They do not bar all foreigners from practicing dentistry in America; they merely require foreigners to receive American education prior to thrusting sharp instruments into American mouths. We will not make an exception for you, no matter how qualified you may be to treat Portuguese teeth. We invite you to receive instruction concerning acute Kool-Aid® stains, corndog molar spurs and Whopper®-related extractions at an American Dental Academy. We also welcome you to receive instruction concerning Dental Practice Billing Management and profit fund distribution plans. But until you receive the required instruction, we cannot grant you professional licensure to practice dentistry in the United States of America.
Very sincerely yours,
Mr. Bartholomew D. Kaye
Associate Licensure Executive
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