A Dutch man dubbed the "dentist of horror" and the "butcher" went on trial Tuesday after allegedly causing horrific injuries to the mouths of more than 100 patients in France.
Jacobus van Nierop, 51, ripped out healthy teeth and left dozens of patients in a remote French village with broken jaws, recurrent abscesses and septicaemia.
He is charged with aggravated assault as well as fraud over claims that he tried to rip off patients and insurance companies, and faces up to ten years in prison and a €150,000 ($165,000) fine if found guilty.
Although he is not required to offer a plea under French law, Van Nierop has previously sought to deflect responsibility, saying he suffers from "psychological problems" including gender identity issues and suicidal tendencies.
He hid his face under a blanket as he arrived at the court in Nevers in central France, near the rural area of Chateau-Chinon where he came to work in 2008.
He has already been detained for 18 months in the case.
Van Nierop (see photo below), who went by the first name of Mark, was hired by a head-hunter in 2008 and was initially welcomed by locals in the rural area of Chateau-Chinon, who were sorely lacking in medical services.
Sylviane Boulesteix, 65, visited the dentist in March 2012 to have braces fitted.
"He gave me seven or eight injections, and pulled out eight teeth in one go. I was gushing blood for three days," she said.
An 80-year-old, Bernard Hugon, said the dentist left "pieces of flesh hanging everywhere" after tearing out a tooth.
"Every time, he would give us what he called 'a little prick' and we were asleep, knocked out," said Nicole Martin, a retired teacher who lost several teeth to abscesses caused by the horrific operations.
"When it was over, we would find a Post-it note saying to come back for an appointment the next day or the day after," she added.
Martin set up a victims' group in early 2013 to press charges, and it soon swelled to 120 members.
In June of that year, police arrested Van Nierop but left him free pending trial, and he fled the country the following December.
In September 2014, after being contacted by members of the public, The Local revealed that Van Nierop had been tracked down to a small Canadian town in New Brunswick and arrested under an international warrant.
According to those who witnessed the arrest, Van Nierop tried to take his own life by cutting his own throat when he realized police had tracked him down.
“There was a trail of blood in the hallway of our building. He cut himself really bad. It's horrifying. Everyone is in shock. All the folks in town are talking about it," one neighbour told The Local.
"No one had any clue. He was dating someone from the local community. Other than his obvious accent, he seemed pretty average.
"Everyone is wondering how he managed to slip into Canada with no one the wiser," the neighbour said.
Van Nierop tried to block his extradition, first to the Netherlands and then France, claiming to suffer from "psychological problems" including gender identity issues and suicidal tendencies. But he was eventually placed in a prison psychiatric unit in the Loiret department, south of Paris.
"He claimed to have killed his first wife, he played crazy, he said he was trans-sexual. He tried everything" to avoid extradition, Martin said.
According to Dutch media, Van Nierop had already come under investigation at home over his working practices before coming to France.
The trial in Nevers is due to last until March 18th.