A lawsuit filed on behalf of hundreds of children in 20 states is only the latest in a series of disturbing events associated with Small Smiles / Access Dentistry, a national chain primarily caring for low-income populations. According to Roger Sanger, MS, DDS, a DOCS Education faculty member specializing in pediatric care, the chain’s abuses raise troubling questions about the treatment of the smallest and most vulnerable dental patients. Problems with Small Smiles—which operates under the parent company FORBA—first captured national attention two years ago. The ABC News program 20/20 profiled the chain using shocking images of screaming children strapped to dental chairs, their parents deliberately kept from view. The show underscored not only concerns about the company’s treatment of pediatric patients but its financial practices, irregularities which culminated in a $24 million fine. A prolonged federal investigation concluded in early 2010 that Small Smiles had habitually and fraudulently performed such unnecessary dental procedures as tooth extractions and pulpectomies on kids. That constituted an abuse of the Medicaid program, the government said, and thus the record financial penalty. Dr. Sanger operates one of California’s largest children’s dental clinics. He calls Small Smiles’ use of restraints on children without sedation and for the sole purpose of elective treatment “absolutely abhorrent.” Dr. Sanger explains that only in very rare instances would such an approach be warranted. “This is only justified where there is severe dental infection or trauma and sedation is not an option, for example in the case of immediate emergency care.” Dr. Sanger believes that sedation can be an extremely valuable option for children, just as it is with adults. “First there is the issue of relieving discomfort, which any patient deserves.” Sedation is also helpful when children must undergo extensive treatment or are unmanageable, Dr. Sanger adds. “But sedation must always take place where staff have been carefully trained and where there is proper protective and positioning equipment and continuous monitoring.” As a faculty member at DOCS Education Dr. Sanger has trained “hundreds” of dentists to perform pediatric sedation. “Our goal is to train dentists to be competent and safe in providing sedation for children needing dental care where normal management through nitrous oxide oxygen analgesia and local anesthesia is not sufficient.” DOCS Education also offers equipment, products, education and mentorship through membership. “Holding a child down with either human or other physical means is an outdated behavior management technique that was contraindicated by organized dental societies and dental teaching institutions years ago. Unfortunately, it still exists. Maybe this lawsuit will be a wakeup call for those who still consider this abusive practice acceptable.”

The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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