March 6, 2009 -- It's a promise many parents make before taking their children to the dentist: Don't worry, it won't hurt too much. But at some dental clinics catering to low-income families on Medicaid, that promise was broken behind closed doors.
Sources say because Medicaid pays low reimbursement rates, some clinics push to make a profit by performing more procedures than necessary.
Parents claim that the Medicaid Dental Center clinics in North Carolina were more concerned about profits than they were about patients. As a result, their children were left with awful memories, even though several years have passed since their visits.
Brandon Dillbeck was 5 years old when he says he was told during a visit to one of the clinics that if he didn't stop crying, he "couldn't see my mom again."
Brandon's mom, Christy Dillbeck, says she waited two nerve-wracking hours for her son to emerge from the dentist's chair.
"He comes walking out of that door with his whole shirt was full of sweat," she said. "And he had blood dripping from his mouth. And all I could see was silver shining through."
Silver, from a mouthful of crowns the dentist had put in all at once.
"He was freaking out," Dillbeck said. "All I could do was just grab him and hold him and tell him it was going to be OK."
Morgan Gough had a similar experience when he was 6.
"I was like crying for my mom and I was crying because they were hurting me," Morgan said. "I wanted them to stop, but they wouldn't stop. I was like bleeding and crying and really swollen."
And Jazmin Gallegos said she was physically restrained during a visit when she was 4 years old. "They just like pulled my arms back and my legs back and then they strapped me down," she said.
Sandra Franklin says she wasn't allowed past the front desk of the clinic while her daughter was being treated. Later the child reported to her that "they turned the radio really loud, so that no one could hear her crying."
But the biggest shock came later, the mothers of the children say. Morgan was subjected to five pulpotomies -- also known as baby root canals -- plus five fillings and crowns; Jazmin had 11 baby root canals done in a single visit; and another little girl named Antavia Diggsby had 14.
Brandon and another child, Hunter Mungo, each had an astounding 16 baby root canals --nearly every tooth in their mouths. Hunter -- just starting pre-kindergarten -- was teased by other children as a "metal mouth" and said "it just made me feel, like, bad."
"I feel like they took my son's smile away," said Lisa Ward, Hunter's mother. Several of the mothers said they feel some guilt about what their kids went through.
"You believed that they were doing what was best for your child," said Melissa Gough, "and you walk out knowing it wasn't." She says she felt trapped because "there are no other options to take your kids."
The reason: Most dentists won't treat children without private insurance because they lose money on Medicaid's reimbursement rates.
Children Strapped Down, Separated From Parents
The North Carolina clinics were partly owned by Michael DeRose. He and his partner were investigated by the Justice Department, which blamed the clinics for "invasive and sometimes painful procedures" that were not necessary, "for the sake of obtaining money."
Two years ago, DeRose paid a $10 million settlement on Medicaid fraud charges, without admitting guilt. And now attorney Darren Dawson of Dawson & Albritton has filed suit against him on behalf of some of the children -- though DeRose has denied their allegations.
DeRose declined to speak with ABC News on camera, but his Colorado home speaks volumes. It's a lavish, seven-bath, 12,000-square-foot residence complete with a pool, a hot tub and a big new extension that'll house a dance studio and a personal gym.
DeRose made a fortune after he and his partners sold another chain of dental clinics called Small Smiles two years ago for $300 million. Now sources say that some of those 70 clinics operating in 22 states have also had problems.
Former dental assistant Debbie Sansbury worked at one Small Smiles clinic until the spring. She says the dentists there too often focused on getting the job done fast.
"[The children] can get so upset they'll throw up," she said. "We stopped the procedure long enough to clean up the vomit, and then returned to it."
The Small Smiles clinic that employed Sansbury denies overusing papoose boards, defends the quality of its treatment and says Sansbury was fired for behavioral issues.
An by ABC News' Washington station WJLA that started in 2007 found that money was a big topic at the daily staff meeting at a Maryland Small Smiles clinic run by lead dentist Dr. Al Williams. CLICK HERE to watch the WJLA series on Small Smiles by investigative reporter Roberta Baskin.
Small Smiles offers the staff up to hundreds of dollars in productivity bonuses and thousands for the dentists. One way to meet those goals is to get the kids in and out of the dentist chair faster, say former employees. And one way to do that is to restrain them.
WJLA's video shows a child at the Maryland clinic strapped to what's called a papoose board, which restrains hands and feet and allows a dentist to keep working, even if the child is hysterical.
"I believe that there were a lot of cases that we could've easily prevented the use of a papoose, just be sparing them five minutes of their time, alleviating all of their concerns, and nourishing and letting them know that they'll be all right," said Sansbury.
The American Association of Pediatric Dentistry allows the use of a papoose board for a child's best interest, but told ABC News they are not acceptable when used only to speed up the work.
Despite that, Small Smiles' Williams told WJLA that "you could potentially spend two hours on a kid who's not stabilized and moving around. That's not cost productive for us."
Dentist Alleges 'a Lot of Unnecessary Work'
Williams also acknowledged that parents were kept away from their children during treatment.
"We don't want them to see what goes on in here," he said. "Not that we are doing anything wrong. But as a parent you wouldn't want to see your child strapped up like that."
Williams has since left Small Smiles and his Maryland clinic closed.
The company claims the boards are used on 6 percent of children up to 7 years old, and only when medically necessary. But current and former employees told ABC News that some clinics have used the boards much more often than that.
A dentist from another Small Smiles clinic, who asked that his identity be kept private, says he felt "sick to my stomach to go in in the morning."
He says he resigned a few months ago, partly because he was traumatized by the children's cries.
"If you didn't look at it in person and you heard it coming out of the room you would think that they're cutting their arms and legs off," he said. "I mean it's… the screams are bloodcurdling, they're terrifying."
He said that he has "no doubt that in many cases" the experience is traumatizing to the children and that he was even more disturbed by the pricey and sometimes invasive work performed when he thought cheaper options would have been adequate.
"I see a lot of unnecessary work," he said. "I see a lot of overtreatment."
After a run of bad publicity, Small Smiles hired respected pediatric dental expert Dr. Steven Adair in the summer. His job is to oversee standards and training in all the company's clinics. One of the things he's been emphasizing to company dentists, he says, is that papoose boards should only be used when necessary.
As for the claims of some former employees of unnecessary care, Adair told ABC News, "I haven't been presented with evidence" of that.
Small Smiles insists that the company's clinics provide a valuable service to hundreds of thousands of low-income kids, including many with severe dental problems and few other dentists to turn to.
Meanwhile, there have been some policy changes. Dr. Toni Adderly, who runs a Small Smiles clinic in Washington, D.C., said parents can now watch their children being treated.
"They're able to … observe what's going on with their children," she said, and "they're told they can come back."
Adderly says she feels no pressure to produce profits, but Sansbury says that was not her experience at a different clinic she left in the spring.
"It seems as if the money situation prevails over what's best for the children in that regard," she said.
Several states and the federal government are looking into Small Smiles for possible Medicaid fraud.