Friday, January 25, 2008

Georgia DCH Statement Regarding Kool Smiles Investigation

DCH Statement Concerning Possible Class Action
Lawsuit Regarding Medicaid Dental Services

No child in our Medicaid or PeachCare for KidsTM programs has lost dental benefits or been
dropped from the program due to the contract disputes between Kool Smiles, P.C. and the care
management organizations (CMO), Peach State Health Plan and WellCare of Georgia.

The Georgia Department of Community Health (DCH) will thoroughly investigate all the allegations received from parents/guardians of patients and other dentists concerning poor care delivery received from Kool Smiles, P.C.

The Department will also investigate allegations and concerns reported to DCH including but not
limited to:
o Patterns of “over-utilization of services” and questions raised about the appropriateness of
care delivered
o “Unusual patterns of patient restraint”(such as use of restraining boards for children) and
sedation vs. Traditional Pain Management (usage of Nitrous Oxide or IV sedation)
compared to other dentists and normal averages
o “Over-utilization of stainless steel crowns” in children compared to other dentists and
normal averages
o “Lower use of preventive care” (i.e.: fewer sealants used to prevent cavities per patient
treated) compared to other dentists
o “Over-utilization of X-rays” compared to other dentists and normal averages

The adequacy of the dental networks for both Peach State Health Plan and WellCare of Georgia
are closely monitored and assessed by DCH.

August 22, 2007

In March 2007, the DCH Inspector General began an audit of Kool Smiles, P.C., which precedes
the current contract termination between the CMOs and the provider. Until the audit is complete, the Department will offer no comment on that investigation.

DCH offers no comment during pending litigation. If included in the lawsuit, the State of Georgia
will be represented by the Attorney General’s Office. Inquiries should be directed to the AG’s

According to Georgia Families records:
o 24,000 or five percent of current WellCare of Georgia members have received services
from Kool Smiles, P.C. since implementation of the Georgia Families program
o 20,500 or seven percent current Peach State Health Plan members have received services
from Kool Smiles, P.C. since implementation of the Georgia Families program

The Smile Behind Small Smiles

Meet, Atif A. Abdulmalik, of Bahrain. He is the CEO of Arcapita Bank, formerly Islamic Investment Bank until it changed it's name in early 2005. This is the company behind FORBA, LLC, or at least one of them.

FORBA, LLC is Small Smiles.

I don't know a lot about Venture Capitalist, Holding Companies nor how they all operate change hands, move about or hide.

Here is what I have found out here on the net:

There was The Carlyle Group, American Capital Strategies, and Arcapita Bank who got together and created Small Smiles Holding Company to purchase Sanus Holding who had just acquired FORBA in the fall of 2006.

In a press release found in a Nashville newspaper it states that Sanus Holding acquired FORBA, LLC and moved it's office to Nashville.

Then there is a report in January 2007 "Arcapita Bank, an Islamic Investment Firm and it's affiliated acquired Sanus Holding.

I don't know how all this worked but what I can figure out is that all of the medicaid and other state insurance programs who are billed for work done (necessary and UNnecessary) from Kool Smiles and evidently Small Smiles is headed to Bahrain, off the coast of Saudi Arabia.

Looks like our tax dollars are padding the pockets of another Islamic country via abusive dental care.

Abusive treatment of our kids and their teeth, over billing our medicaid system and no telling what else I've not discovered yet is just a kick in my teeth!

Don't take your Kids to these Dental Chains for heavens sake!

Thursday, January 24, 2008

Wake Pediatric Dentistry-Johnson City, NC

If you live in Johnson City, NC and have children who have an upcoming appointment at Wake Pediatric Dentistry, you might save your child a life of torment if you take a few minutes and check out this discussion.

Shocking and Sickening!
There are a few compliments on the dental practice, some from it's own employees, however the complaints are very very upsetting. Don't miss the first page of this discussion, nor the last one even if you don't read one word in between.

Here are a couple of reviews of Wake Pediatric Dentistry from 2006, they weren't so good either.

Like I've been trying to point out with the blog, it's not just Small Smiles, Kool Smiles and other dental care chain traumatizing our children for a buck.

There are recounts after recounts of different dentist in this area using these barbaric type of behavioral management techniques.

Here are just a few dentists names listed as Bad Apples in this particular discussion group:
Dr. Horowitz
Dr. Parrish
Dr.Swarr office in Raleigh

Papoose Boards- Not In The UK

According to what I've been able to find out on the net, the General Dental Council in the UK prohibits the use of papoose boards several years ago for normal and pediatric dentistry.

Here is a discussion forum about it.

Tuesday, January 22, 2008

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.


Monday, January 21, 2008

What's Going On At Ocean Dental Corporation?

I don't know exactly what is going on over at Ocean Dental Corporation, in Stillwater, OK but something has them checking out this blog pretty often in comparison to other visitors.

I have to give this some serious thought since guess what... they specialize in child dental care just like Small Smiles and Kool Smiles (check out the comments section) who have been busted for abusing and traumatizing children, using restraints and doing unnecessary dental procedures, as reported by WJLA TV in the DC area, 9News in Denver and 11Alive TV, Atlanta, Georgia respectfully.

They too are proud to announce they accept medicaid patients, which sends up red flags all over the place based on Small Smiles and Kool Smiles in my opinion. But so far, this blogger hasn't found any information on them, complaints or compliments.

Below is a list of Ocean Dental locations across the US.

Click on the address for a printable map.

City Address Zip Phone
Stillwater, OK 510 S. Duck 74074 405.377.7300
Oklahoma City, OK 1610 W. I-240 Service Rd. 73159 405.605.4900
Downtown Oklahoma City, OK 47 NE 23rd St. 73159 405.525.1222
Norman, OK 500 West Main Suite 200 73069 405-321-2349
Moore, OK 2305 S. I-35 73160 405.799.0800
Warr Acres, OK 3919 N.W. MacArthur 73122 405.787.7827
Enid, OK 913 W. Maple 73701 580.242.0300
Lawton, OK 5314 N.W. Cache Rd. 73505 580.595.9492
Shawnee, OK 4409 N. Kickapoo 74804 405.273.7077
Tulsa, OK 6801 E. Admiral Place 74115 918.836.8366
Muskogee, OK 930 A West Shawnee 74401 918.682.6060

East Cleveland, OH 8101 Euclid Ave. 44103 216.229.2500
West Cleveland, OH 3545 Ridge Road 44102 216.961.6860
Columbus, OH 3646 E. Main St. 43213 614.231.4800

Little Rock, AR 3024 S. University 72204 501.565.0606
Hot Springs, AR 221 Airport Rd., Space G 71913 501.321.4963
Fort Smith, AR 1326 S. Waldron Road 72903 479.484.0008
Jonesboro, AR 1810 E. Highland Drive, Suite B 72401 870-934-0339
Fayetteville, AR 745 E. Joyce, Suite 224 72703 TBA

Des Moines, IA 1345 E. University Avenue, #302 50316 515.264.9022

Louisville, KY 3977 7th St. Road 40216 502.447.5699

Corpus Christi, TX 1620 South Padre Island Drive, Suite 250 78416 361-853-3334

El Paso, TX 1166 N Yarbrough Drive 79925 TBA

update: Since posting this comment, there seems to be an email circulating through the company with a link to this comment, and people from Ocean Dental are this blogs best customers recently.

Still don't know what's going on over there, but something on this blog has them stirred up.

Looks like Ocean Dental has contracted with Tulsa School District to bring a mobile dental truck to the schools for dental treatment of children on Medicaid:

Here is the minutes from the meeting in Sept. 2007:

Enter into a contract with Ocean Dental to provide dental services for
Medicaid-eligible students through the operation of the Ocean Dental mobile
clinic during the school year 2007-2008.
There will be no cost to the District.

FURTHER RECOMMEND the attorney for the School District prepare the
appropriate contract and the proper officers of the Board of Education be
authorized to execute the contract on behalf of the District. Contact person-
Taylor Young.

RATIONALE: These services will be available to TPS schools that enroll
30 or more students. Routine and preventive services will be performed
within the scope of the clinic. These services are available to interested
schools meeting the criteria for participation.
The mobile clinic is totally self-contained requiring no District services.
Parent/guardians must give authorization to Ocean Dental to provide these
services. Students will not be placed under anesthesia which results in them
being unconscious. Services which require complex procedures will be
performed at Ocean Dental facilities.
The mobile clinic will be staffed with a dentist, an assistant and a staff
member who escorts children to the clinic on school property. A mutually
agreed upon schedule will be developed to prevent disruption of the
educational process.

Mothers Comments RE:Smiles High Clinic, Kool Smiles

"OnTipToe" from Colorado reported the following story:
January 2008

If you are relying on medicaid coverage and seeking dental care for your child, who is insured, watch out for this! One company, called "Small Smiles" and in our city they were called "Smile High" has been known to have this type of BAD practice!
(blogger note: Smile High's Lead Dentist was Dr. Tu Tran, the founder of Kool Smiles in Georgia.)

I took my twin daughters there for their first visit to the dentist when they were 18 months old. Main reason for going there was it's close proximity to my home. We are in a poor part of central Denver.
Strangely, and for the sake of my girls, I was involved in CNA clinicals at a local hospital at this time. The very day, I spent several hours in a class at the hospital discussing the federal laws governing restraint of patients in hospitals and LTC facilities. So, I was educated on this and it's ethical and moral issues.
When I got to the dentist, the first thing I had to do was read and sign a consent form for treatment which listed the 10 ways that the dentist might restrain my child for treatment. This threw me, given the class I'd just had. I was very surprised, this being my first experience taking kids to dentist, that this was a regular part of their practice. When the clinician came out to call one of my daughters back, I got up and started gathering everyone up. She said, "You can't go back." I was aghast! What do you mean? Don't you see this is just a baby? I will go with her, as well as her twin! Well, none of the dentists will treat the child with the parent present, I was told. I couldn't believe it!
So, I asked for the records that I filled out and signed, as well as that restrain form. I left. Not before hearing a young dentist tell me that ALL pediatric dentists were trained in this practice of restraint and disallowing parents into exams. He warned me that I would not another dentist in this city who would allow me to accompany my child into the exam. I told him that my child would just not have dental care then!
Next day, I took that form into class for my instructor to see. She told me that EVERY form listed there was patently illegal practice with ANY patient in the US, by FEDERAL law. So, my advice: if you or your child is subjected to this practice when going to the dentist, call them on it. Tell them you'll report them to the Dental licensing board for illegally using restraint.
Thankfully, we have found a great pediatric practice here in Denver which has wonderful doctors and staff. They always allow me to be present for exams and NEVER use restraint or scare tactics for treatment. They are clean, bright and have a great attitude. And all my children, the twins are 9 now, son 6 and daughter 3, enjoy their visits to the dentist without fear. It's called Primary Dental and they are located in Wheatridge, CO.
I have heard some horrible news reports about children subjected to numerous root canals on their baby teeth in one visit. These are primarily done on children who have medicaid coverage. And it's been found that these dental practices are using any way they can to overbill medicaid. Some ex employees interviewed told of promotions and expectations of employees to add services to pad the bills to the government. Adult practices won't even do more than two at a time! Another report about a 6 yr old boy who was so severely restrained that the dentist broke his leg! So, please, you owe it to your children to find another practice, if this is happening to them. LISTEN to them about their fears if they are distressed about visiting the dentist!
Good luck and take care.

Jen in Fairmount, GA says this about Kool Smiles
August 2007

I don't know the reason, but I am so happy to know no one else who has Wellcare will be fooled into going to Kool Smiles again! I wish they had pulled them a month ago so we would not have taken my grandson. I hope they do go out of business!!! I don't know what kind of dentists they are (we weren't allowed to know) but they did provide one of the most traumatic events of my daughter, grandson, and my lives. We had no plans to ever go back, anyway, but I wish it had not been an option in the first place!

Frm Kool Smiles Employee, Virginia Beach, VA
August 2007

I believe your news station may want to look into this matter on a deeper level. I resigned my employment with Kool Smiles due to the type of care the children were receiving and the way in which the corporate leaders were managing/reporting the billing of such dental care to Peachtree/Medicaid.
Several months ago Medicaid entered many of the Kool Smiles offices, unannounced, and seized dental records - including x-rays. It is clear now what the audit revealed. The children's dental needs are the most important issue here and by Peachtree/Medicaid pulling their contract the results of the care the children were truly receiving had to have been clear in the records/x-rays.

Whib101, Roswell, GA.
August 2007

You folks do not have a clue.. I am very familer with the corp ops of Kool Smiles. They operate a medicaid mill. Those poor kids have multiple dental procedures performed at one visit. How may adults out ther get a extraction, root canal and crown work done at one sitting. For Dr Strange to say these 71,000 kids would be without a dental home is a joke. There is no continuity of care in this operation the kids do not even see the same dentist on follow-up visits. The dentists practicing at these locations are not even board certified pediatric dentists.
Its no wonder they only serve govt funded patients... private insured patients would not tolerate the substandard practices this operation conducts
Thank God those two managed care providers through clinical audits recognized what these profit maximizers were doing !
Sharon, Gainsville, GA
August 2007

I personally took my children to a Kool Smiles office where they were given a total of 6 crowns that their current dentist has now said were completely unnecessary. Also, I filed a lawsuit against Kool Smiles for damage and injuries that my the 3 year old daughter received during her treatment. In my opinion, no responsible parent should ever settle for the lack of care received at Kool Smiles. Many private offices accept Wellcare and provide much more personalized, quality service.

This blogger could just go on and on with these type of complaints, opinions and thoughts. This is just an example of the type of complaints out there about Kool Smiles, Smiles High, Small Smiles and the like.

Wrapped In A Rainbow

Telling a child he/she will be wrapped in a rainbow sounds wonderful doesn't it, but here is the real truth.

It's still a straightjacket, papoose board, pediwrap, no matter the pretty colors.

At here is the info on the "Rainbow Wrap". Note at the bottom it tell the dentist/user to check with their state laws on using one of these.

On the website this is the "fine print", I made it the Large Print.

The Rainbow® Stabilizing System is the most flexible and comfortable system available to prevent sudden and unsafe movements. The mesh wrap is breathable to reduce patient overheating and the soft padded board provides greater patient comfort.

The NEW Rainbow Wrap is made of "sport-mesh," which is strong, but less rigid, making it more comfortable for your patient.

The Rainbow Wrap is now 'coat-length,' meaning that it stops above the knee. A wide, 6-8" velcro strap is provided to stabilize the legs and knees and to prevent kicking. With this strong strap, the legs can be stabilized first, so the patient will be better controlled as the Wrap is secured.

The Rainbow Wrap can be used as a one-piece or a two-piece wrap. Velcro strips lock the top and bottom halves of the wrap together, for those who prefer a one-piece system. Just remove the Velcro strips to have the flexibility of two-section Wrap.

The Rainbow Stabilizing System now comes with a Laundry Panel. When this panel is placed over the 'hook' Velcro on your Rainbow Wrap prior to laundering, it will help prevent lint and other materials from sticking to the Velcro, thus extending the life of your Wrap.
Head stabilizers are sold separately.
Important: Consult the appropriate authority in your state for regulations on the use of stabilizing devices.

Thursday, January 17, 2008

Interview with the Journalist Who Broke This Story in Washington DC Area

Interview with Reporter, Roberta Baskin from WJLA-TV, in Washington DC who brought the use of Papoose Boards to the attention of the public.

Thanks to Poynter's Online
An Investigation

WJLA-TV investigative reporter Roberta Baskin aired a story Monday night about the nation's largest chain of for-profit dental clinics. With 66 clinics nationwide, Small Smiles makes a good living off Medicaid. (Watch the story. Warning: It is hard to watch.)

WJLA said it found x-ray technicians who were not licensed to perform the work they were doing, and the station said young children were sometimes children-strapped to "papoose boards" that kept the kids immobile during uncomfortable procedures that their parents were not allowed to witness.
The station said the clinics also quoted former clinic workers who said they were pressured to push baby root canals as treatment because such treatments are lucrative.

I interviewed Baskin via e-mail to learn more about the investigation:

Roberta Baskin
Q. How did you find this story?

A. It began with picking up the phone and listening to a random caller. She was a dental assistant who said she'd been fired for complaining about how her clinic treated Medicaid kids. She went on to describe a bonus system, with daily financial goals, which she believed provided an incentive to do unnecessary procedures for more Medicaid money. At first she complained to the Maryland inspector general's office overseeing Medicaid. But they referred her to the Better Business Bureau. That riled her enough to call WJLA.

Q. What surprised you the most?

A. It surprised me most that the small policy clinics have a policy to separate children from their parents and say it's a privacy regulation under the Health Insurance Portability and Accountability Act (HIPAA). It surprised me even more that they let our cameras in the back, when they wouldn't allow parents in. It also surprised us how much access we got and how much video we were allowed to shoot of questionable practices. The dental staff is so used to doing what they're doing that they didn't seem to think there was anything unusual about their treatment of Medicaid families. It's just the way those Small Smiles clinics we videotaped do business.

Q. How did you get access to patients?

A. We brought patient consent forms in English and Spanish and asked for permission. Some families said yes, others declined.

Q. How were you able to prove the story to be true, given that you are dealing with HIPAA, Medicaid and medical board oversight?

A. It's a complex system. In addition, there are managed care agencies between the clinics and the state, each with their own rules of engagement. We interviewed more than 100 people: dentists, associations, dental boards, inspectors general, Medicaid, dental assistants, on and on. There are other former employees of Small Smiles we interviewed who were afraid to go on camera, but their stories laid out the same issues.

Q. Just the topic of dentistry, little kids getting root canals and being tied up in "papoose boards" all sounds disturbing. Did you have any concerns that people wouldn't watch it?

A. Yes. It's not a pretty subject. A newsroom employee outside editing was in tears just listening to the children cry. Another production staffer was sobbing after seeing it. We had an extraordinary response in e-mails and calls from viewers. Most were angry at the practices, some were upset by what they saw. And yes, a few were angry at me. We needed to show what we saw so people would see what they otherwise couldn't. We also made an effort not to show shots in the mouth or too many faces. The photojournalist purposefully shot Miguel's feet because that told a lot of the story.

Q. What did you learn when investigating this story that other journalists should know?

A. The most important stories are always the hardest. This one was a challenge on many levels. But tenacity and patience eventually pay off. Also, you don't have to shoot on hidden camera. Going through the front door is always best. A child had died in Maryland from a brain infection caused by untreated tooth decay. It highlighted the fact that four out of five dentists refuse to take Medicaid kids. Small Smiles has a business model that exclusively handles those kids. We just asked to see how they do it.

Dental Treatment Agreement-Papoose Board Used

WARNING-Carefully Read The Insurance and Consent Form Prior To Dental Care For Your Child.

You may be consenting to strapping down your child for minor dental care.

Here is a copy of the standard paper work filled out prior to treatment I located on the Net. Note the section in red below. After reading over the paper work and it mentioned using restraints, this is one dentist I would have serious reservation about taking my child for dental care. But of course that's just me. He may be a very well trained dentist, I don't know. All I know is in his consent forms, he wants you to sign a consent to strap down your child. This is typical for way too many dentists. What I'm saying is be very careful as to what you are agreeing to have done to your child.

Welcome to Larry Caldwell, DDS
Dentistry for Children
15200 Southwest Freeway, Suite 320
Sugar Land, Texas 77478
(281) 565-5437
Fax: (281) 565-6446

Be sure to complete front and back and bring with you on your first visit. You may mail
them if you like and we can get your insurance verified before your appointment. Please
call if you have any questions.

The packet includes the following:
Welcome Form
Office Policies
Behavior Management Policy
Dental Insurance Considerations Letter
Acknowledgement of Receipt of Notice of Privacy Practices

Tell Us About Your Child
Today’s Date_______________
Last First MI________________
Preferred Name
Male Female (Circle One_
Child’s Birth date ___/___/___ Child’s Age_______________
School Grade_______________
Child’s Home#___________________
Child’s Home Address____________________________________
City State Zip________________________________________
Who is Accompanying the Child Today?___________________________
Do you have legal custody of this child? Yes No
Is your child adopted? Yes No
How did you hear about our office?____________________
Other family member(s) seen by us___________________________________
Parent’s Marital Status Single Widowed Married Divorced Separated (Circle One)
Primary Dental Insurance_____________________
Insurance Co. Name___________________________
Insurance Co. Address________________________
Insurance Co. Phone__________________________
Group # (Plan, Local or Policy #)__________________________
Insured’s Name___________________________________
Relationship to Patient_________________________________
Insured’s Birth date ___/___/___ SS#___________________________
Insured’s Employer__________________________
Orthodontic Coverage? Yes No

So that we may better serve you, please provide us with an email address:____________
Person Responsible for Account________________________
Billing Address____________________________
Work# Ext Home#_________________________
DL# SS#_____________________________
Name of Nearest Relative___________________________

Work# Ext Home#________________________

Mother’s Information Step-Mother Guardian
Work# ________________Ext Home#_______________
Cell#_____________________ SS#_____________________
Date of Birth_________________

Father’s Information Step-Father Guardian
Work# _______________Ext Home#__________________
Cell# __________________SS#____________________
Date of Birth____________________________________

We would like to welcome you and your child to our office. Our goal is to make every child’s visit pleasant and educational. Our practice is based on preventive care. We strive to teach good oral care that will enable your child to have a beautiful smile that lasts a lifetime.

Larry Caldwell, D.D.S.
& Associates
Medical History

Has the child ever had a bad experience with dental work? Yes No
Is the child Delayed Average Advanced in social development? Please circle one.
How would you describe the child’s personality/temperament? Circle all that apply:
Cooperative Uncooperative Sensitive Apprehensive Well-adjusted Aggressive Shy

Previous dentists’ name and phone number_____________________________
Last Date Seen____________________ X-rays_____________________
Is your child’s drinking water fluorinated? Yes No
Is your child taking vitamins with fluoride supplements? Yes No
How many times a day are your child’s teeth brushed?
Is the child currently using a bottle? Yes No How often?
Current dental habits. Please circle:
Thumb or Finger Sucking Use of Pacifier Lip or Cheek Biting Nail Biting
Previous or current TMJ (jaw) pain, tenderness or popping? Yes No
Does the child have or ever had recurring headaches? Yes No
Has the child ever had any of the following medical problems? Please circle all that apply.
Y N Cancer/Tumors Y N Hepatisis
Y N Tuberculosis
Y N Asthma
Y N Rheumatic Fever
Y N Sight Impairments
Y N Congenital Heart Defects
Y N Liver Or Kidney Disorder
Y N Lung or Respiratory Problems
Y N Gastro Intestinal Problems
Y N Convulsions/Epilepsy
Y N Diabetes Y N Endocrine System
Y N Hearing Impairments
Y N Frequent Infections
Y N Hemophilia
History of blood transfusions? Yes No
Does the child have a heart murmur or condition that requires Prophylactic Antibiotic coverage for dental work? Yes No
Please list any serious medical problems that the child has had:

Hospitalizations or injuries

Please list all drugs the child is allergic to Other allergies____________________
Please list all drugs the child is currently taking Dose___________________________
Does the child have seizures? Yes No Are the seizures related to high fever? Yes No
Does the child experience an aura before seizure? Yes No
Are the seizures related to high fever? Yes No

Does the child have any behavioral or learning disabilities?
Mental Retardation? Yes No Skill Level____
Handicaps/Physical Disabilities_____________
Any other significant problems or comments

Has the child had any recent infections of bacterial or viral origin? Yes No
Is your child currently under the care of a physician? Yes No
Child’s Physician___________________ Phone___________ Date Last Seen_______

Because your child is a minor, it is necessary that signed permission be obtained from a parent or guardian before any/or all necessary dental treatment is performed. Diagnosis of services needed and financial obligations will be discussed with you by the doctor and/or staff before treatment is rendered.

Your signature authorized Dr. Caldwell and/or his Pediatric Dentist Associate to render necessary dental treatment, to administer anesthetics, to administer medication, to take radiographs (X-rays), clinical photographs, study models and other records necessary for an accurate diagnosis, to utilize behavior management therapy as needed to provide safe dental care for your child and employ such assistance as is appropriate.

Signature of parent or guardian_______________________ Date____________

I verbally reviewed the medical/dental information above with the parent/guardian & patient named herein. Initials_________ Date__________

Doctor’s Comments:

Our office is committed to meeting or exceeding the standards of infection control mandated by OSHA, the CEC and the ADA.

Larry Caldwell, D.D.S.
15200 Southwest Freeway, Suite 320
Sugar Land, Texas 77478

Office Policies
The person accompanying the patient is responsible for the account regardless of who carries the insurance on the patient.

We request that the person accompanying the child not leave the premises until the appointment is over, in the event a question arises regarding the child's appointment.

A broken appointment is a loss to everyone. As a courtesy, please allow a 24 hour notice for any schedule changes.



I am aware that insurance will cover an estimated percentage of most dental procedures and the portion that is not covered by insurance is due at the time services are rendered, unless other financial arrangements have been made prior to the dental appointment.

I am aware that some procedures are subject to a deductible and if it has not been met then I will pay this at the time services are rendered unless other financial arrangements have been made prior to the dental appointment.

If you have secondary insurance (two DENTAL plans), it does not necessarily mean that these combined insurances will cover your services 100%. It is up to you, the insured, to know how the two dental plans will coordinate benefits. We do not file secondary insurance.

I hereby agree to assign all insurance payments to Dr. Larry Caldwell. I am aware that my insurance company may not cover all of the professional fees. I hereby agree to pay, within 30 days, any outstanding balance following payment by the insurance company unless other financial arrangements have been made.

I agree that if the insurance fails to pay Dr. Larry Caldwell within (60) days of the rendering treatment all fees are due and payable at that time.
In the event the insurance company pays you the patient instead of Dr. Larry Caldwell, I agree to forward the payment to
Dr. Larry Caldwell.

In the event a check is returned from a financial institution, a return check fee of $20.00 will be applied.

In the event of default, I promise to pay legal interest on the indebtedness together with such collection costs as may be required to effect the collection of this note.

SIGNATURE:______________________________________ DATE:______________

Larry Caldwell, D.D.S.
15200 Southwest Freeway, Suite 320
Sugar Land, Texas 77478

Behavior Management Policy

Providing quality dental care for children requires expertise in directing child behavior. Our goal is to instill in the child, a positive attitude towards dentistry. Maintaining proper behavior of children while in the dental office demands skill of verbal guidance, prevention of inappropriate actions, and reinforcement of appropriate behavior. These techniques are used only for behavioral modification and not to reprimand or punish a child.

The following are various behavior management techniques used in this office.

•Positive Reinforcement: Social reinforcers such as verbal praise and non-social reinforcers such as rewards (toys, stickers).

•Tell-Show-Do: Explain procedures and instruments to the child with the use of modified terms such as “sleepy juice,” “water whistle,” and “wiggle tooth” rather than “shot,” “drill,” and “pull tooth.”

•Distraction: Use of distraction to divert the patients' attention from what he/she may perceive as unpleasantness.

•Voice Modification: Change of voice volume or tone to gain a child's attention and direct his/her behavior.

•Nitrous Oxide/Oxygen Sedation: This is a very safe and effective conscious sedation method which is easily monitored. The onset of this sedation is quick and recovery is fast and complete before the child leaves the office.

•Pediwrap or Papoose: Partial or complete immobilization with the use of a blanket type wrap, is sometimes necessary to protect the child from injury while using dental instruments. This technique is only used in cases when it has been determined that all other forms of behavior management have not or will not be effective.

It is our office policy to minimize the use of more extreme forms of behavior management techniques and to implement them only when necessary.

SIGNATURE:___________________________________ DATE:_____________

Larry Caldwell, D.D.S.
15200 Southwest Freeway, Suite 320
Sugar Land, Texas 77478
(281) 565-5437

Dear Parent,
We accept and file dental insurance as a courtesy to our patients. We try to know all aspects of your dental plan. Any treatment outline that we present to you is just an ESTIMATE and not a guarantee of benefits.

When we call to verify benefits, the insurance company informs us that, “this is not a guarantee of benefits until they actually receive the claim and process it.”

We file a pre-estimate to your insurance for some procedures such as orthodontic appliances, crowns, surgical procedures and large cases. We do not submit pre-estimates for every procedure but, at your request, we will gladly do so. It normally takes 3 to 4 weeks to receive an estimate back from an insurance company.

In-Network versus Out-of-Network PPO Insurance
When you have a PPO you can go Out-of-Network and the insurance will pay our office. What does this mean? In-Network means that we have a contract with your insurance company and we agree to accept their fees. Out-of-Network means we DO NOT have a contract with your insurance and we do not accept the fee that your insurance allows and you are responsible for the difference between our fee and the allowable fee from your insurance. We will not adjust off the difference between the two.

HMO/DMO Insurance
When you have an HMO/DMO, then you have to go to a doctor that accepts your insurance; you cannot go Out-of-Network. The only HMO/DMO that we are on is CIGNA (age limit is under 7 years).

It is very beneficial, as the insured, to know your dental plan.
Common questions to Ask Your Insurance Company
• What is the frequency of exams, cleanings and fluoride?
• Is there an age limit for fluoride treatments?
• Are sealants a covered benefit? If so, what is the age limit?
• Do I have orthodontic benefits?
• Do you have a waiting period with your insurance plan?
Most insurance companies will tell you how they will cover a procedure if you give them the ADA code, which is on the treatment outline.

SIGNATURE:_________________________________ DATE:___________

Larry Caldwell, D.D.S.

**You May Refuse to Sign This Acknowledgment**

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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 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

Wednesday, January 16, 2008

Study Related To Dental Anxiety In Disabled Children

In 2003 the European Journal of Dental Education did a focus study with dental students.
It's aim was to determine which method of behavioral management was most acceptable to the future dentists.

The results were analyzed using ANOVA models. There were significant main effects of intervention method and treatment outcome, indicating that less restrictive methods and good intervention outcome were rated as more acceptable.

Significant two- and three-way interactions were found, which suggested that the use of restrictive methods may be perceived as more acceptable for a child with learning disabilities even when the outcome was poor.
Sad, but true that it appears it is much more acceptable to restrain, restrict, tie down, strap, use papoose boards, or pediwraps in disabled children.

I would like to see a study on how acceptable it is to the same to completely healthy children and a follow up on what effects such trauma had on the child later in life.

This study highlights the importance of empirically (seeing is believing) evaluating outcome and treatment restrictiveness when engaging in behavior management during dental procedures.

J. Timothy Newton, Peter Sturmey (2003)
Students' perceptions of the acceptability of behaviour management techniques
European Journal of Dental Education 7 (3), 97–102.

In another study in the UK revealed that female dentist was MUCH more reluctant to use restraining devices on children that their male counterparts.

Of course female adults are much less likely to abuse, beat, and otherwise display aggression to children as well. Our jails do prove that.