the letter has a basis in law

By Maxwell Rotbart

Parents who don’t schedule a required dental visit for their child don’t typically expect to be accused of child abuse.

But that’s what happened recently in a Pennsylvania township near the New Jersey border, where one dental practice is accused of weaponizing a state law to strong-arm parents into scheduling appointments.

On March 14th, Smiles 4 Keeps Pediatric Dentistry – with offices in Bartonsville, Scranton, and Wilkes-Barre – sent a form letter to local resident Trey Hoyumpa, whose two sons are - or rather, were - treated at the practice. In the letter, Smiles 4 Keeps explained that a Pennsylvania law, Act 31 of 2014, states that “failure to bring your child for dental care is neglect…” and that, therefore, “[we] must report your failure to bring your child to the dentist for evaluation and care.”

Frustrated parent, Trey Hoyumpa (Facebook photo)
Frustrated parent, Trey Hoyumpa (Facebook photo)

The threat wasn’t an idle one.

Smiles 4 Keeps told WNEP-TV, the local ABC–affiliate station, that it had reported the parents of 17 of its patients to Pennsylvania authorities in the previous year.

Beside herself with frustration, Ms. Hoyumpa – who had switched her children’s dentist – took to social media to raise awareness of Smiles 4 Keeps’s controversial letter, even drawing the attention of well-known national political columnist Michelle Malkin, who opined that the Pennsylvania law is further evidence of the encroachment of socialized medicine into the lives of everyday, private citizens.


Claims of Fraud and Extortion

Ms. Malkin may have been the most prominent of voices jumping to Ms. Hoyumpa’s defense, but she was far from the only one. On both Facebook and Twitter, angered parents berated the apparent maliciousness of Smiles 4 Keeps; Ms. Hoyumpa herself referred to the letter as an attempt at “fraud and extortion.”

Dr. Ross Wezmar, Co-Owner, Smiles 4 Keeps
Dr. Ross Wezmar, Co-Owner, Smiles 4 Keeps

With the spotlight on her, Ms. Hoyumpa also took the opportunity to explain why she had quit Smiles 4 Keeps well before receiving its threatening letter, complaining that she was not allowed to remain with her children during dental visits; was not allowed to consult with the dentist - only with hygienists; and was prevented from scheduling both of her children for appointments on the same day.


Smiles 4 Keeps Responds

Smiles 4 Keeps eventually posted a response to its critics on Facebook, outlining its justification for sending the letter to Ms. Hoyumpa. Following are some of the points made by Smiles 4 Keeps:


  • American Academy of Pediatric Dentistry guidelines require dentists to report dental neglect to child protective services
  • Letters like the one sent to Ms. Hoyumpa are sent only after parents don’t respond to earlier communication attempts
  • Families who miss multiple appointments are told that they can’t schedule their children for the same day to prevent too many cancelled slots in the dentist’s schedule (Ms. Hoyumpa wrote on Facebook that “I have not received a single voicemail, not one text, and certainly not an email from Smiles4Keeps since I left their office.”
  • “We remain responsible for the patient until the parent relays the name of the new dentist.”
  • Untreated tooth decay can be fatal

(Read the Pennsylvania Dental Association post related to the Pennsylvania law cited by Smiles 4 Keeps and related State Board of Dentistry CE requirements, here.)


“Dear parent,”

The AAPD guidelines cited by Smiles 4 Keeps require that, before a neglectful parent is referred to child protection services, the parent must be informed “about the nature and extent of the child’s condition, the specific treatment needed, and the mechanism of accessing that treatment,” all of which were omitted from its letter to Ms. Hoyumpa.

In fact, the letter that Ms. Hoyumpa received (see photo) was addressed only to “Dear parent,” and did not include a diagnosis, prognosis, or even identify which of her two children the dentists considered at risk.


Did Smiles 4 Keeps Overreact?

The Smiles 4 Keeps letter has ignited a debate concerning what responsibilities parents have toward maintaining the oral health of their children, and how dentists should respond when they believe that a child’s oral health places him or her at risk of more serious complications.

Ms. Hoyumpa has stated that, between her two sons, they had seven cavities. She also says that she was in the dental office with her sons (though it is unclear if it was for an appointment or to schedule a visit) in December 2017, when she alerted Smiles 4 Keeps that she intended to change practices.

Whether the Smiles 4 Keeps letter, sent three months later was demonstrating sincere concern for the fate of the two pre-adolescents with dental cavities or was a crass attempt to force an already frustrated parent to remain with the practice is debatable.

Polarized Facebook users have alternated between blaming Ms. Hoyumpa for failing to properly care for her children’s oral health on the one hand versus accusing Smiles 4 Keeps of unethical practices on the other.

One practice, Spencer Family Dental in central Massachusetts, even wrote Ms. Hoyumpa - after she reached out to them - to explain how they practice dentistry differently from Smiles 4 Keeps, especially by always allowing parents to be with their children during visits.

Another dentist, Dr. Rich Grossman from nearby Wilkes-Barre, PA, told WNEP-TV that he views the letter as a “scare tactic actually, to scare parents to bring their kids to those offices.”

Regardless of the legal and ethical aspects of Ms. Hoyumpa’s parenting, and Smiles 4 Keeps’s actions, it seems clear that the public relations fallout from the March 14th letter will have dental practices rethinking when and how they alert parents whose children need to be seen.


Contributing writer Maxwell Rotbart specializes in covering business, education, and history-related topics. He is the author of The State of Israel: Prime Ministers, available from

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