Another patient of Dr. Howard S Schneider recalls being restrained

Another patient of Dr. Howard S Schneider recalls being restrained.  Yet some of “experts”  have testified children do not remember. ( I have to wonder if Dr. Schneider went to the Eddie DeRose School of Papoose Board training at some point.)

Who are on these committees and subcommittees making these guidelines? Who are they cozy with?

 

2011 Behavioral Management Guidelines

The link above contains the latest version, according to the American Academy of Pediatric Dentistry (AAPD). It’s written and revised by the AAPD Clinical Affairs Committee – Behavior Management Subcommittee. I want to know who is on this committees, don’t you?

In fact, I think it is extremely important to know who is on each of these committees and subcommittees. They are setting guidelines and standards that our federal and state government rely heavily on. Most of the time these guidelines are 100% relied upon.

We certainly demand to know who is making our laws and just who these lawmakers are all cozied up with, well, what’s the difference?! NONE!

I’ve found a helpful little website where you can check guidelines for various healthcare professions. It’s at the Agency for Healthcare Research and Quality (AHRQ). It’s the National Guideline Clearing House.

I’ve not tried it, but it appears you can compare guidelines, now isn’t that cool.  Well, if it works anyway.

You can check past guidelines going back to 1997, that seems handy: browse by Organization,Topic,Guidelines in progress, get expert commentaries and much more.

Of course in checking this place out I got fired up over reading all the guidelines for Behavioral Management (D9920). Various terms for it are used; Behavior Guidance, Behavior Management, Behavior Control. The latest term, “Guidance” sounds so much nicer doesn’t it.

I don’t care what they call it, it’s worse than a straight jacket. In a straight jacket you can at least have use of your legs, but not in the papoose board, rainbow wrap, blankets or whatever cuddly term is thrown at the damn thing.

FORBA Financially Stressed: Maybe A Papoose Board Is In Order

As I suspected, FORBA/Small Smiles is a bit financially challenged and unable to open any more clinics at the present time. According to reports no monies are being paid out during the Medicaid fraud investigation which is really putting a crunch on them financially.

How is this bad? Well that means they need to push their production on who they can when they can and that's spells trouble for the children being tied down in the papoose boards also known as pedo's in the biz, as in pediwraps, not Pedontists.

That means more children are going to have to use the combs, brushes and blow dryers the assistants keep in the back to clean the children up before they give them back to their parents.

Small Smiles Clinic Investigation Report, Methods Crticized-Wichita, KS

In Kansas, Corporate Dentistry is Illegal and that is exactly what Small Smiles, Operated by Forba Management is doing. Other dentists wants these people gone and have filed complaints of Corporate ownership against Small Smiles Clinics in Kansas.

Forba is saying someone else owns the clinic in question, and they just "manage it" but the Kansas Dental Board is looking into this as we speak.

At the Forba website they do not list the clinics locations in Wichita, Topeka or Kansas City, However, job opening for these locations are listed at Forba. Obviously, Forba Small Smiles is trying to operate under the radar of Kansas Law.

Want to take a guess as to what shined the light on these crooks, Using Papoose Boards on Children!

They better be looking into Ocean Dental, as they have clinics in Kansas as well!

Read the FULL and eye opening story below.

What have I been trying to tell everyone!

Dental Clinic's Methods Criticized
The Wichita Eagle (Wichita, Kan.)
2008-03-16

By Karen Shideler, The Wichita Eagle, Kan.
Mar. 16--A Wichita dental clinic that serves mostly low-income children is drawing criticism from some parents and other dentists, in part for using procedures that the critics say traumatize its young patients.
They say Small Smiles Dental Clinic of Wichita routinely restrains children during treatment, does not allow parents to accompany their children to treatment and does work that doesn't seem necessary.
In addition, the dentists are concerned that Small Smiles tries to give the impression it is staffed by dentists who are specialists in children's care. And, they say, it is corporate dentistry, a practice not allowed in Kansas.
Small Smiles dentist Reza Akbar, in an e-mailed statement, said, "We are proud of the high-quality, compassionate care we provide.... Last year, we served more than 11,000 children, and the feedback I have received has been overwhelmingly positive. I am unaware of any concerns raised by parents."
Akbar is the owner of the clinic, according to a Small Smiles spokesman.
Small Smiles, which opened in 2005, turned down requests for interviews or visits. An out-of-state spokesman for Small Smiles, who asked not to be named, said by e-mail, "This is a concerted effort by the company to focus on patient care in the midst of recent scrutiny."
In November, ABC News and an affiliate ran stories about Small Smiles offices in the Washington, D.C., area. The stories told of frightened children, the use of restraints and the prohibition of parents in the treatment area -- the same concerns echoed by parents and dentists in Wichita in interviews with The Eagle.
Many Medicaid clients
Small Smiles' advertising notes that it serves Medicaid and HealthWave children. The Small Smiles spokesman said 98 percent of Small Smiles' Wichita patients have Medicaid or HealthWave, programs that provide medical and dental coverage for low-income children and some others who meet income guidelines.
Many dentists do not accept Medicaid patients or accept only a few because the reimbursement for their care is less than what is paid by private insurance. But Crystal Walker, a pediatric dentist, said four of the five pediatric dental practices in Wichita do accept Medicaid patients. Some general dentists also take those patients, and dental care is offered to Medicaid patients at GraceMed and some other clinics.
In 2007, Small Smiles got more than $4.5 million in Medicaid and HealthWave dental payments from the state, according to the Kansas Health Policy Authority. The clinic declined to say how many dentists it employs.
The clinic uses what amounts to assembly-line dentistry, some say.
"They go in, they do the cleaning, they do the diagnostic, they get everything done that they can in one day," said pediatric dentist David Brown.
"It was like an assembly line," said Shelbi Meisch, whose daughter was a Small Smiles patient. "There was just nothing about the experience that felt like you were getting good care."
Restraining patients
Though parents said they were not allowed to accompany their children into the treatment area, the Small Smiles spokesman said that's not policy: "Parents decide in consultation with their dentist whether or not to be present during their child's care," his e-mail said.
Jeff Davis said he and his wife were asked to sign a consent form giving Small Smiles permission "to do everything from yell at the child to physically restrain them to tie them down."
Meisch, as well as Delicia Akbar, whose children also were Small Smiles patients, said uncooperative children -- including theirs -- are immobilized in a "papoose board." Akbar isn't related to the Small Smiles dentist.
The Small Smiles spokesman provided a copy of a consent form used at Small Smiles in Rochester, N.Y., and said the one in Wichita is similar.
It asks parents to agree to "protective stabilization," described this way: "The child is wrapped in the device and placed in a reclined dental chair." Pictures on the form show a child with what looks like a blanket and a shaped back piece.
Medical suppliers describe a "papoose board" as a rigid board with wide fabric straps that have Velcro fasteners. Separate straps hold limbs inside the wrap, providing a snug-fitting restraint that immobilizes the patient.
The Small Smiles spokesman said, "Our records indicate that protective restraint was used in fewer than 3 percent of all patient visits in Wichita last year."
Akbar took her three children to Small Smiles. She read and signed the consent form "but my understanding of the restraint was not something.. to strap them down." She said the papoose board was used on her 9-year-old.
"I didn't even think anything negative until the kids came out and told me what happened," she said.
Papoose boards have a limited place in dentistry, three Wichita pediatric dentists said, and may be appropriate for special-needs children, for example. But there are other ways to get children to cooperate, they said. They don't use papoose boards.
Walker said she uses a "tell, show, do" approach to familiarize a patient with treatment. But she said that nearly every former Small Smiles patient "will not even lay in the chair" at her office because they're so frightened. Many need sedation for routine care because of their fear, she said.
Concerns about care
Another pediatric dentist, David Brown, said his main concern is "the patients that leave there absolutely terrified." In addition, he voiced concerns about the care provided. He said he has had parents who were told at Small Smiles that their child had seven cavities, "and I personally have not been able to find seven cavities."
Meisch said Small Smiles dentists wanted to put crowns on several of her daughter's teeth, including two front baby teeth that were loose. She said she asked that those two teeth be pulled -- and the dentists pulled others as well, including a molar that has necessitated a dental spacer. "They didn't listen very well," she said.
The Small Smiles spokesman said the clinic provides care according to the guidelines of the American Academy of Pediatric Dentistry. "The appropriate treatment plan is determined by dentists and is based on the dentists' professional judgment," he said in the e-mailed statement.
Small Smiles' advertising says it provides care to "children from their 1st tooth through age 20."
Only dentists who have had extra training may call themselves pediatric dentists.
"They do seem to market to children," said Betty Wright, executive director of the Kansas Dental Board. But by noting at the bottom of its ad that its dentists are general dentists, Small Smiles complies with Kansas law, she said.
Corporate connection
Nationwide, Forba, a dental management company based in Nashville, Tenn., owns Small Smiles. Its Web site does not list the clinic in Wichita -- or the ones in Topeka or Kansas City -- among its locations. But job openings for all three sites are posted on the Web site.
The Small Smiles spokesman said Akbar owns the Wichita clinic.
"The clinic receives assistance regarding marketing, human resources, policy, information technology, collections, and other administrative functions under a management services agreement with Forba," his statement said.
Kansas law prohibits corporate dentistry, in which a practice is owned by someone who doesn't practice there.
Wichita orthodontist Kendall Dillehay said he had filed a corporate ownership complaint about Small Smiles. He was told his complaint would be investigated and that he'd be informed of the results.
Dental complaints are investigated by the Kansas Dental Board. For action to be taken, Wright said that she would need to see evidence that Small Smiles is not owned by Akbar.
Wright said no disciplinary action has been taken against Small Smiles or its dentists, nor were there any pending disciplinary orders.
Investigations are confidential, she said, so she would not say whether any were or weren't under way.
Reach Karen Shideler at 316-268-6674 or kshideler@wichitaeagle.com.

-----




Here are just a few comments from parents who have been to the Small Smiles Dental Assembly Line Clinic:

1. I worked at Small Smiles when they first opened in Wichita. It was no less than hell on earth for children. They do everything and more to the kids that is mentioned in the article. I quit within 2 weeks because it broke my heart to work there. I would never recommend anyone to take there child to this office.
2. This sounds like child abuse to me. They should be thoroughly investigated like Tiller was. Where is the justice in supporting unborn babies? Why don't they support those whom are already born? Nola Foulsten needs to look into this business. Whether parental consent was given or not. Kudos to the previous poster for quitting. When my daughter got braces she told me she had friends who had went there and that the people there were extremely mean. I'm glad I took my kids both to Dr. John Hullings he's the greatest orthodontist in town. Front office staff isn't so nice, but the ones working on your teeth can't be beat. I've never been not allowed to view any and all treatment my kids' received.
3. Reza Akbar??? It sounds like third world dentistry to me, where abuse and a lack of civil rights are a way of life. And if, as they say, "And, they say, it is corporate dentistry, a practice not allowed in Kansas", why is it being allowed. This place of torture needs to be shut down. The trauma the children are being subjected to will follow them the rest of their life. I am 65 and still don't like to go the a dentist because of bad dental experiences as a child. WAKE UP WICHITA!!!!
4. So Small Smiles takes medicaid, a govt. program. It looks like the govt. and medicine are great together. It will be wonderful when the government takes over health care via Obama or Clinton.

There are many other Small Smiles complaints at the Wichita Eagle, you can read them here.

Dr. Mohammad Akbar, Peublo, CO. in the name of Small Smiles of Wichita Health Care contributed to State Representative Candidate Bob Bethell 2006 Campaign. See Here

Think maybe Mohammad Akbar and Reza Akbar are related or one and the same person?

Children Dental Clinic, Does Not Mean Pediatric Dentist

Over the course of the last few days I looked into, read, reread, watched reports from news organizations across the Internet on some of these Dental Clinics designated for treating children and some even taking children on medicaid or state insured children only.

Some have sweet websites with smiling children splashed on each page and show the kid friendly decor and the happy smiling faces of the dentists and staff.

Small Smiles, Kool Smiles, Smile High, and Ocean Dental are the main clinics I've looked at in recent days.

Something I thought was a bit misleading to parents and the children treated is even though they are geared toward children, designed specifically for children does not mean they employ Pediatric Dentists or owned by Pediatric Dentists. Most I've looked at are only trained in General Dentistry.

Now I'm not saying by any means they don't have a clue about dentistry. Nor am I saying they took correspondence course to get their licenses. Many may well have attended wonderful dental colleges. I'm just saying because the clinic/office is decorated in cartoon characters doesn't mean they are Pediatric Dentists.

For example there are job ads online for Ocean Dental looking for dentists, assistants, office and administrative personnel. However, the critiria for the dentist do not ask or require them to be actual Pediatric Dentists, with the 2 extra years of training for treating children dental issues.

In their ads they never say they are Pediatric Dentists-(Pedodontist) they say something like "General Dentistry For Kids and Young Adults" so they are not breaking any laws to my knowledge.

It's just the whole set up makes you think you are getting a pediatric dentist to treat your children, so buyer beware.

It's not hard to find out if they are licensed in Pediatric Dentistry. All I had to do was check out the company sites, see the names of the dentists at different clinics or who owns the clinics and check to see if they hold a Pediatric License or a member of the AAPD. Pretty simple really. Many of them will list the dentist's name, where he/she went to school, what association he/she's a member of..etc.

I'm getting a bit off subject here though messing with this kind of information.

My complaint is "STOP STRAPPING DOWN CHILDREN FOR DENTAL CARE"

Papoose Boads For Dental Care-Are You Kidding Me!

There's just something about the Papoose Board that seems ... unfair, really really sneaky and a betrayal, and a ruthless display of dominance.

Dental procedures rooted in child intimidation include parent separation, use of papoose boards and negative verbal manipulation.

Although an intimidated child may be a compliant patient, the long term needs to establish a confident and trusting relationship can too easily be compromised.

From reading the reports on the web, I'm not the only one to feel this is just wrong. Some states such as Colorado have passed strict guidelines for the use of these for mentally and physically handicapped children and only as a last resort.

But many dentist are using them as standard procedures to get the job done as quickly and easily as possible. One dentist interviewed said it was more cost effect to tie up the child rather that another method or a combination.

Caution This Video May Be Very Distrubing:



On January 2, 2008, this particular Dental Office as now changed it's policies! THANK GOD!
See more here.

Update: 5-6-2008
But have they changed their ways? NO They Haven't! As of today, there are still report after report across the Internet saying this practice at Small Smiles, Kool Smiles, Smile Starter as well as private practice dentists that suggest it's status quo!

Even companies selling this things clearly state they are for use as a "Last Resort".

There are laws to stop the restraint of our elderly what on earth makes anyone here think it's ok to do it to our CHILDREN!

Imagine a visit to a dentist office where you walk back to your room for you own dental care and see a child strapped down, struggling for his life and the dentist, office personnel and the child's parents look up with a smile. (I didn't look back with any thing close to a smile!) I wanted to call Child Services!

Dentist's now have a new little gadget called a "dam" they put in your mouth to make it easier to get in and work. It restricts air flow from your mouth and all you are left with is what you can manage to breath through your nose.



Now we adults can manage that, but a child has a bit more trouble. Especially when they have been thrown in the basic flight or fight emotion and screaming is more important that anything.

Please tell me how a child is supposed to communicate to a dentist tied down, hand, feet and body restrained and this contraption in their mouth supposed to tell a dentist that they are not numb, that they have hit a "hot" nerve or they are about to choke. I would say that any dentist that does this to a child really doesn't care about anything other than drilling some hole, real or not, and making some fast bucks.

Add to the crying hysterically from the event, the nose becomes clogged and now the child can't breath nor move, so it's not far from death for the children, as they see it for sure. They certainly have no trust with those around them cause they are clearly the enemy!

The restraints do not do the job alone, so if you think the dentist just gently wrapping your child in a loving blanket for comfort is what's happening you are dead wrong!

It's only a way of gathering up the flying arms and legs making it easier to use other physical force to hold the child still. The child can still thrash around. Sometimes the dentist will enlist the parents to assist but many time they will tell you that the parents distract the child so you are asked to leave.

While trying to stop the thrashing around (since they are fighting for their lives) they put their arms over their face to try to restrain the head further. Sometimes they add HOM-Hand Over Mouth - which further panics the child. The child is sure something terrible is going to be done to him, they see this kind of action in cartoons on tv everyday and it never ends well.

Don't try and tell me that putting your hand over the mouth of a child tied up is ok, and that you can assure me through their thrashing about the dentist will not block the only air way they child has-his nose. In dental lingo it's called HOME method of controlling a child. (Hand Over Mouth Exercise)!


Guess how they get the child to open their mouths, they pinch their nose. So you have a child strapped down and no way to get air! How more cruel is that! They call this little technique HOMAR (Home Over Mouth Airway Restriction)


A dentist in Florida had been prosecuted because a child's arm was broken while trying to restrain a child, and yes, he was using a papoose board.

I admit the device would serve its purpose well for what it is used for (pediatric purposes) saving life and limb, but there is no excuse to use it to work on a child's baby teeth.

Call it what it is…A restraining board. In this current usage it has nothing to do with a Papoose…which by the way is: A papoose (from the Algonquian papoos, meaning “child”) is an English loanword whose present meaning is “an American Indian child” (regardless of tribe). The word came originally from the Narragansett.

Using the term Papoose is supposed to somehow sooth the real idea of the straight jacket for children in hopes that makes it more acceptable to use.

Dr. Frank Carberry has been a dentist for 40 years and has worked with children in Third World countries. He said he's treated children with major tooth decay without ever resorting to restraining devices.

"I've got five grandchildren,” he said. “I can't imagine the psychological trauma on that child.”

I don't know when this practice started, nor who ever thought it was a great idea, but I know I certainly never would ever have considered torturing my children in this manor for a baby tooth!

A recent study among dentists showed that only 14% of them condone restraints such as these for dental care of children. It jumped to 20% if the child was pre-medicated.

Also a study indexed at medline.com showed that adults who experienced HOM or any other kind of restraint for dental procedures were 50% more likely to never see a dentist again!

In Europe, dentistry is now seeing that this type of treatment is uncalled for and abusive.

"Dr. Kevin J. Urbanek has a complete review of this abuse here. He states: In summary, research exists that demonstrate physical restraints are both potentially harmful, and are being increasing rejected by both practitioners and patient guardians. Alternatives such as medications are currently being explored and should be strongly considered instead of using physical restraints."

What needs to be studies is the long term affect on the children who suffered this kind of trauma!

The American Academy of Pediatric Dentistry warns that stabilization devices like papoose boards have potential to seriously harm patients and should only be used in extreme cases where a patient is a danger to himself or his care givers.

One study from the AAPD showed that younger more inexperienced parents would more likely to consent to the use of the PB. (Papoose Board) Where parents 35 years of age and above were much less likely.

Dentists are far too often using the "danger to himself or his care givers". Dentist are not taking in to consideration as to the real urgency of the procedure. Just the cost savings of a quick treatment.

Some dentists use the argument they clearly informed the child and the child agreed to putting on the restraint. Come on, No child thought they would be tied up and tortured when they agreed to this!


Filling 4 year molars on a 5 year old child does not constitute Extreme Case!

Long Term Damage:

Death- A few children have died from being strapped to one of these boards because the dentist could not see the lethal allergic reaction the child had to the lidocane. Here's one story.

One woman says, "now I suffer from mild-moderate claustrophobia. I'm not saying this is always the wrong choice, but I wouldn't wish this upon anyone."

Other children report nightmares, not wanting close contact such as hugs, and one child refuses to sleep with a blanket to cover him.

One little girl told her mother that she dreams every night she is in a coffin and wakes up gasping for air. This has disrupted the entire family to the point they have had to seek professional care with biofeedback to help the child over come these fears.

More than one child has ended up with broken arms and limbs from fighting the restraints.

Many children and been brought into full blown Asthma attacks and seizures due to the trauma of papoose board and pediwrap boards. Your dentist office is NOT equipped to handle this kinds of emergencies.

Read the story of this poor child in Charlotte, NC

Are those fillings this important to you, are you willing to kill, maim and mentally damage your child over a filling, cap or other non emergency dental work??

Find yourself a qualified Dentist, or keep them at home!

Here's another story of Dentist who have lost licenses from this practice.

Here a mother explains the trauma her child experienced:

At 2 1/2 years old, I took my son to the dentist for the first time. All he had done was a brushing and teeth counting. He hated it! He kicked and screamed, and begged to get up.

About 3 months later he had a horrible accident in which he fell and pushed his four front top teeth up into his gumline. He ended up having to have the left front tooth pulled. In order for the dentist to do this she had to place him in a papoose board and strap him down. He freaked out! He screamed like he was on fire, he threw up, he gagged, and he hyperventilated to the point of almost passing out.

You know what really burns my butt, it's these parents worried about the violence on TV, cartoons and children's classic fairy tales, but would take their children to the torture chamber, aka, poorly qualified Dentist!

A Report from California:

A trip to the dentist probably doesn't rank high on anyone's to-do list. Now, imagine if your dentist skimps on appropriate amounts of anesthesia before submitting you to painful procedures.

That's just one of the things California Attorney General Bill Lockyer is alleging in criminal complaints against 20 dentists throughout the state. He's charging them with defrauding the state Medi-Cal System of $4.5 million, health benefits and workers' compensation fraud, conspiracy, grand theft, child abuse, elder abuse, assault and intentional infliction of great bodily injury. (due to using these restraints sweetly called Papoose Boards)

Here is another mother's experience using these typed of dentist, her child busted a blood vessel:

I have a 3 year old and when he went in for a cleaning, the experience was good- probably 4 stars-the nurses were kind but I felt like the Doctor was a little cold. We had to bring my son back for a root canal because of a dead tooth and the experience was traumatic, horrifically scary for my son and we will not go back.
The Doctor did not discuss the possibility of any type of sedative with us for this procedure nor did he tell us in advance that my son would be placed on a board and basically placed in a straight jacket. While that may be necessary to complete the procedure, letting parents know what to expect is critical to a good experience. During the procedure, my son, who was so scared that he literally popped blood vessels in his face and neck was told in a firm voice by the dentist "You are yelling at me. You can't yell at me any more. I can't do my job when you are yelling." While certainly, yelling is going to be difficult to deal with, as a doctor who sees patients this young and chooses to perform these types of procedures on them, a certain amount of empathy is required to be considered a good dentist. If my children were older, I'm sure the visits would all be good ones. However, my fellow is 3 and I am disgusted.

Another outraged mom:

My son had 2 cavities. I took him to my dentist and as soon as he got in the room the strapped him to a papoose board and 4 ppl worked on his mouth. No one tried to comfort him. They just held him down with the papoose board which looks basically like a strait jacket. It made his arms and legs immobile and his head was between two boards. When we left he was hysterical. His lips were bruised. I did not sign any consent form for them to do this. I decided I was not taking him back to get the other cavity filled there ever. This is 2009, and is ridiculous! Clearly it was not for the comfort or safety of my child, it was for the convenience of the dentist.

Here is a quote from a parent on a message board that pretty much sums up my feelings and anger on this issue:

"A cavity is not worth a lifelong traumatic memory like this. If I found out the dentist covered my daughter's mouth and told her to shut-up ...I'd give him the beating of his life right then and there and then warn him if he called the police he'd get 100 times worse when I got out of jail."

Have any of these Pro Papoose Board Supporters even considered the

psychological safety of the patient!

updated: 1-15-2008

This may be one reason some dentist resort to papoose board instead of other types of sedation for persons under 13 years of age. Permits, Education, More Training. Below is from the Kentucky Board of Dentistry.

Dental Anesthesia Permits

Any dentist who wants to administer general

anesthesia, I.V. conscious sedation, or oral

sedation for patients under the age of 13, must

first secure a permit from the Board. To

receive a permit, an application with supporting

documentation of education and experience

must be submitted along with the permit

application fee. An office inspection must also

be done before anesthesia can be performed in

a dental office. A permit will not be issued for

any of the above types of permits until all

requirements have been met. Until a permit is

issued, anesthesia cannot be administered.

University of Louisville is requesting your

participation