Airport dentist treats passengers, employees, immigrants

Robert Trager, DDS, has a million stories about the patients he's treated over the years at New York's JFK and LaGuardia airports -- almost as many as the throngs of passengers, airport workers, and illegal immigrants that stream through the city's bustling airports.

Mujahedeen fighters wearing beards and turbans, illegal immigrants from all over the world trying to gain entry into the U.S., drug dealers, prostitutes, United Nations ambassadors, National Guard soldiers carrying automatic weapons, airport workers, passengers with dental problems, or those simply experiencing flight delays -- the "airport dentist" Dr. Trager has seen and treated them all.

JFK airport has had a small dental office since the days it was called Idlewild, and when the dentist who owned it retired in 1985, Dr. Trager, who had a nearby practice, saw an opportunity.

"I got it for next to nothing and expanded and remodeled it," he told DrBicuspid.com. "A lot of airport workers were already patients, and I became known as the airport dentist."

An unexpected twist

But after the first bombing at the World Trade Center in 1993, his practice took an unexpected twist.

Immigration officials decided to monitor foreigners entering the country more closely, and they needed a way to determine their age. An immigrant's age can be critical to his or her effort to gain entry to and residence in the U.S. Unlike adults, minors who enter the U.S. are exempt from immediate deportation and are automatically released to family members living in the country. This is where Dr. Trager's expertise came in.

Robert Trager, DDS, examines an airline passenger. Image courtesy of the Nassau County Dental Society.

Robert Trager, DDS, examines an airline passenger. Image courtesy of the Nassau County Dental Society.

"Immigration officials asked if I could determine their age by the eruption sequence of their third molars," Dr. Trager recalled.

Third molars typically erupt during the late teens or early 20s, he noted. But while researching the issue at the ADA library, he found the eruption sequence too variable to determine age accurately.

But he also found that endocrinologists can determine a person's age and development by analyzing bone scans of the wrist to see if the epiphyses of the radius and ulna bones are fused. He obtained a Greulich and Pyle atlas with radiographic pictures of males and females showing different stages of bone fusion up to age 20.

"This became my guideline," Dr. Trager said.

Now, when immigration agents suspect immigrants of being older than their paperwork indicates, they bring them to Dr. Trager, who takes x-rays of the third molars and wrists.

"It's really fascinating," he said of the dual-verification process. "I have one of largest portfolios of wrist x-rays from people all over the world."

Global diversity

Over the years, he's noticed that immigrants from West Africa often have precocious eruption of their third molars, sometimes when they're only 14 years old. "That's why wrist x-rays are much better," Dr. Trager said.

For immigrants, the stakes are high. "Most of these people lie [about their age] because they know the rules," he pointed out. "They know every excuse and every way to do it. It's just amazing what I've seen over the years."

Dr. Trager next to a mockup of a Boeing 707.

Dr. Trager next to a mockup of a Boeing 707.

Dr. Trager recalled two lovely young girls from the Dominican Republic who said they were 15. "One girl looked at me and said, 'Dr. Trager, you have the most beautiful blue eyes,' and I said, 'Regina, you have the most beautiful 20-year-old wrists,' " he laughed.

His findings have at times been challenged, however. Dr. Trager recalled a youth who was brought in after being arrested in a money-laundering case.

"I examined him and said, 'This individual is well over 18,' " he said. However, the young man's lawyers argued that he was 16 and appealed to a federal court, saying they would bring in a renowned forensic dentist to confirm that his client was a minor.

But Dr. Trager had some news for the attorney. "I said, 'He's a friend of mine and you got one of the best forensic dentists around, but there's one problem: He's an expert on dead people. I deal with living people.'"

The judge ultimately threw out the case. "I've never had an interpretation overturned," Dr. Trager noted proudly.

However, he acknowledged the impact of his decisions.

"You really don't want to have someone deported if they're minors, especially if they're from impoverished areas. They've had a terrible life; they've seen terrible things," Dr. Trager explained. "So I want to give them the benefit of the doubt, but I have to do the right thing. When I make a diagnosis and the documents eventually prove I was right, it makes me feel good."

All in a day's work

Other times, immigrants are anxious to prove they're adults and actually want to be deported, he noted.

When one young man was busted for dealing drugs, he insisted he was 18 and the immigration agents wondered why.

"I said, 'If you deport him, what is he going to do? He's going to get another load of drugs and sneak back in,' " Dr. Trager recalled. "But if he's under 18, you're going to lock him up and take away his trade."

It's all in a day's work for Dr. Trager. "I call it a forensic chess game," he observed. "My slogan is: The bones don't lie, but detainees do."

Along the way, Dr. Trager has picked up bits of many languages. For instance, he knows enough Chinese to tell patients to open their mouth.

"If someone speaks Arabic, I'll say, 'Give me money,' and they can't believe it," Dr. Trager said, adding that he has Farsi- and Spanish-speaking dentist associates. "Patients love to feel they can talk to somebody."

For example, he added, "Today I was doing denture work for a Costa Rican who's a regular patient, and I said I was 'bebo,' which is slang for slick. He laughed and said, 'How do you know that word?' I get to see people from different backgrounds, races, cultures."

Airport opportunities

After Dr. Trager did a recent television interview in New York, an Atlanta dentist called and said he's thinking of opening an office at the airport.

"I'm surprised more dentists don't open offices in airports," Dr. Trager said, noting that they usually choose places like shopping centers. "Remember, airports aren't going out of business." JFK has 30,000 employees and LaGuardia has 25,000 workers, and ramp workers and baggage handlers often need treatment for facial and head injuries if they get hit with luggage, he pointed out.

"JFK has thousands of people who come through," Dr. Trager said. "It's an enclosed city."

Passengers are always surprised to see a dentist's office at the airport, but if their flight is delayed, they'll often stop in.

"They have nothing to do and think, 'Let me get my teeth cleaned,' " Dr. Trager said.

He recalled a U.N. ambassador from Canada who had a weather delay.

"She came in, and I did a filling and cleaning and she loved it," he said. "When she comes back to the U.N., she said she'll come back in."