Profit Over Patient? Small Smiles Accused of Mistreating Children

Nov. 7, 2007 — -- The national dental chain Small Smiles is facing allegations it allowed its smallest patients to suffer in order to turn a profit.

Small Smiles dental clinics treat some of the nation's poorest children. But, a five-month investigation by ABC News' Washington D.C. affiliate WJLA and investigative correspondent Roberta Baskin uncovered frightened children who were separated from their parents and cried for their mothers while they were strapped into restraining devices.

The restraint procedure is just one way Small Smiles does business. The clinics do business that most dentists won't handle — treating children on Medicaid. The government reimburses less for dental care than private insurance, but Small Smiles makes up for that by seeing a large volume of patients.

"We've submitted so many claims to one particular management care organization that they threw up the white flag and said, 'OK, you don't have to pre-authorize anything. Just do the work.' So, we flooded the system," said Aldred Williams who manages a Small Smiles clinic.

Four-year-old Miguel is one of the patients Small Smiles has treated. During his visit, a dentist restrained him on a device called a papoose board. Miguel's mother was not allowed to watch because that is the policy at Small Smiles.

"[It's]not that we are doing anything wrong, but as a parent you wouldn't want to see your child strapped up like that," said Williams.

Williams said he used the board on small children about half of the time.

"You could potentially spend two hours on a kid who's not stabilized and moving around. That's not cost productive for us," Williams said.

But the restraints weren't the only disturbing thing about patients' treatments. The dentist treating Miguel pinched his nostrils in order to force his mouth open. It's a practice most dentists abandoned years ago.

And even Williams said the pinching treatment was not acceptable.

"I don't personally use it, but some dentists do," he added.

FORBA, the company that owns Small Smiles, said its dentists and staff are sent to its Colorado offices for training.