Small Smiles Dental Center

Small Smiles Dental Center was a privately-owned chain of dental clinics in the United States, headquartered in Nashville, Tennessee. It originated from a dental office opened in Pueblo, Colorado, in 1928 by the DeRose family. The chain grew significantly, particularly after Medicaid was established, focusing on providing dental services to children from low-income families across numerous states, including Indiana where the Mishawaka location was situated. At its peak, Small Smiles operated dozens of clinics under various names like Children's Dental Clinic and Texas Smiles, employing many dentists and serving hundreds of thousands of children annually. However, Small Smiles Dental Center became widely known for significant controversies surrounding its practices. Investigations by media outlets and government bodies, including a Senate investigation, revealed a pattern of prioritizing profits over patient care. Allegations included performing medically unnecessary and often painful dental procedures on children, overbilling state Medicaid programs, and using restrictive devices like "papoose boards" excessively to immobilize children during treatments, sometimes without sufficient numbing medication. The company was accused of setting daily production goals for dentists and offering bonuses based on the volume of work performed, rather than the necessity of care. Parents were often not allowed in the treatment rooms, contributing to concerns about transparency and consent. These issues led to substantial legal repercussions. In 2010, the Justice Department fined Small Smiles $24 million to settle charges of overbilling Medicaid. Despite changes in ownership and attempts to address the issues, ongoing problems with quality of care and compliance were reported by independent monitors. Ultimately, the Department of Health and Human Services' Inspector General announced in 2014 that Small Smiles would be excluded from participating in the Medicaid program for five years, effectively leading to the closure of many of its clinics. The Mishawaka, IN location, like others, would have ceased operations as part of this broader exclusion.