"It's a competition throughout the country to see who can convert the most patients, not give the patients the most care," said Trina Crosby, another former Small Smiles employee.
The pressure to convert patients may come from FORBA. In fact, every morning Williams and his staff review the production goals set by the managers in Colorado.
One Maryland dentist said he worried Small Smiles performs unnecessary baby root canals when simple fillings would work.
"It does no good for anybody but the dentist, I guess, who's looking for a bonus," said Robert Camps, a nationally recognized authority on pediatric dentistry whose Maryland practice serves mostly patients on Medicaid.
Small Smiles detractors said the way the clinic handles its business may be traumatic for its young patients.
"They're sweating. Sometimes they urinate on themselves. They'll throw up," Crosby said.
When Camps saw video of Miguel's dental visit, he was disturbed deeply.
"It's traumatic for me to watch. I can only imagine how traumatic it is for Miguel," he said..
But despite the assembly-line feel at Small Smiles, Williams insisted it's providing a vital service to children who often don't get regular checkups.
"We aggressively treat these children to eliminate disease in their mouth. Small Smiles makes no apologies for that. I'm not going apologize for being aggressive," Williams said.