Dentists React To Small Smiles

These are posts from a Dental Message Board in reaction to Small Smiles/FORBA

1. There is a small smiles clinic close to us and we see a lot of children who have been put through the ringer there. Most times the work is sub-standard and we are re-doing what wasn't done correctly the first time around. Many of the children who are referred are great kids and just need some TSD and patience. Unfortunately, at that point they are pretty traumatized. The thing that worries us here in our clinic is the disregard for max local anesthetic dosages, etc. It's hard to believe you can papoose a 3 year old and do 4 quadrants of dentistry in one sitting, staying within the safety limits for local anesthetic. I'm all for providing needed treatment, but I'm doubtful as to how much training and supervision there are at these clinics.

2. small smiles opened in our town about six weeks ago. a good friend of mine was working as a hygienist there--she quit after two weeks. i don't know how anyone can justify treatment like that. i see kids with medicaid as does another large pedo practice in town, as do several other family dentists i know. access to care isn't an issue in my area for these kids so they can't use the "we're your child's last hope" approach.

look at the aapd guidelines. they (small smiles) aren't compliant and i don't believe they provide the standard of care offered in my area.

previous to this story, i was talking with a friend on the local peer review on how to approach this group because i was concerned about what i was hearing.

I personally LOVED This one!!!!

3. At our SSPD meeting in September AAPD president Keith Morley said to watch out for these FORBA clinics. He said they are on the way to any rural area in which they can treat low socioeconomic children for Profit.

I too see Medicaid children b/c I feel it is my way of giving back to society. The News took the absolute worst parts of the entire story and put that on TV for everyone to watch. I've been in situations in which i've had to use a papoose board while the child screamed away b/c there was no other choice. I would think any of us pedos understand exactly what was going on there. Most of what they do may not be morally right and is against the ethics of the ADA and AAPD however it doesn't break any laws. We need to all band together and keep these clinics from opening in our areas.

4. Just completed 30 years of dealing with Medicaid. It tooks it's toll on me financially (somewhat), but more emotionally and physically (which is why I stopped). The stories I have heard even for adults can be incredible, and then we get to the "access to care" issue. Who in their right mind would like to stand in line for that kind of access?

I know that there are also some incredible providers of care to this population, adults and children. But, at times, it seems that as long as the care is being "provided" by a provider, that the state powers will look the other way. An acquaintance of mine who previously worked at a one of these facilities stated that some of the dentists, at this particular facility, should not have licenses to practice.

5. If providers would treat mediciad patients as a requirement for renewal of our state granted license to make money in this limited area, access issues would greatly diminish.

6. There is one down the street from me called Vital Smiles, formally the Tooth Zone. I used to say "Who else is going to treat these kids" (I take medicaid by the way) From seeing some of the dentistry, and hearing from patients, former staff members, and a former Dr. there, a lot of those kids would be better off if they had not even gone.

7. If the Democrates get the s-chip legislation passed they will providing about 1 million more American kids with the kind of treatment that is getting blasted. S-Chip in most states is lumped into medicaid. I could care less about Dem vs Rep, but this is to make legislaotors (sp?) look good by providing insurance to these poor kids. What kind of care will be provided? Will they have access to care with this insurance?

8. small smiles clinics do not sedate or offer GA. What upsets me is not the use of the papoose per say, but it is how the clinics are run. There are several Kool Smiles clinics in the area where I practice, and they are run in a similar fashion to Small Smiles. they over treatment plan just to do pulp and crowns. I see at least 3-5 patients from their clinics , and the parent shows me the tx plans. many times it is crowns, where simple ONE surface restorations suffice. These clinics do not have a good reputation where I live.