Small Smiles Dental Center

Small Smiles Dental Center was a privately-owned chain of dental clinics in the United States, headquartered in Nashville, Tennessee. The clinics, also operating under names like Children's dental clinic, Indian Springs Dental Clinic, Oklahoma Smiles, Small Smiles Dentistry, Texas Smiles, and Wild Smiles, primarily catered to children from low-income families, with a significant portion of their revenue derived from Medicaid and the State Children's Health Insurance Program. The origins of Small Smiles trace back to a dental office opened in 1928 in Pueblo, Colorado, by Bruno DeRose. His son and nephew, Edward and Michael DeRose, continued the family business, which became one of the first dental practices to accept Medicaid after its establishment in 1967. By 2004, the DeRose family had a financial stake in 21 dental clinics across eight states, employing 70 dentists. The business model focused on volume, serving a large number of Medicaid-eligible children. However, Small Smiles Dental Center became widely known for significant controversies surrounding its practices. Reports surfaced in the mid-2000s and intensified around 2008, detailing allegations of medically unnecessary and often painful dental procedures performed on children, liberal use of "papoose boards" (restraint devices) to immobilize young patients without parental presence, and a focus on meeting daily production goals for dentists, which allegedly incentivized overbilling and poor quality of care. Investigations by news organizations and government bodies highlighted cases of children undergoing multiple root canals in one sitting, sometimes without adequate numbing medication. These controversies led to numerous lawsuits and government actions. In 2010, the U.S. Department of Justice fined Small Smiles' parent company, FORBA Holdings LLC (later Church Street Health Management, or CSHM), $24 million to settle charges of overbilling state Medicaid programs for unjustified procedures. A Senate investigation further criticized the chain's business model, finding that management, rather than dentists, held control, leading to production-based bonuses and compromised patient care. Despite a change in ownership and claims of implementing reforms, the company faced ongoing legal challenges and ultimately filed for Chapter 11 bankruptcy protection in February 2012. Many of the Small Smiles clinics have since ceased operations or been rebranded under different management.