For families on Medicaid, getting an appointment for a dental checkup can be a daunting task, but a chain of clinics is looking to change that.
Small Smiles of Washington is one of 52 clinics of the same name in 17 states that only accept Medicaid-qualified patients. That makes it the largest provider of Medicaid dental services in the country, according to Dr. Aldred Williams, the Washington clinic's lead dentist.
Many dentists don't take Medicaid at all because of poor reimbursement rates. Often, the only dental clinics that do accept Medicaid patients are few and far between, or perform a limited range of services, and patients can expect long wait times for an appointment.
On the inside, Small Smiles looks like any of its counterparts in one of the surrounding, affluent D.C. suburbs. There is a spacious waiting room filled with toys and decorated with colorful, professional murals, plus a television. The examination rooms are also bright and inviting, and there are plenty of them—nine treatment rooms, plus separate consultation rooms, hygiene rooms, x-ray rooms, and doctor offices. They, too, are outfitted with high-tech, top-of-the-line equipment.
Paradoxically, it is from an outside view that Small Smiles—run by FORBA (an acronym that means For Better Access), a management company based in Pueblo, Colo.—reveals itself. The building resides in a converted nightclub that used to be called “The Black Hole.” Dollar stores and pawn shops abound up and down the stretch of Georgia Avenue where the clinic is located. A security guard, employed by the clinic, circles the block.
But this is a perfect location for Small Smiles. Its patients, after all, aren't coming from the wealthy suburbs. This is their neighborhood dentist.
Small Smiles is one of the few clinics in the area to accept Medicaid. The clinic pays the bills despite Medicaid's poor reimbursement because of its location in an area with a high concentration of Medicaid-qualified patients. Sheer volume—anywhere from 60 to 90 visits per day (150 appointments, 40% of which are cancelled or result in no-shows, for which Small Smiles charges no punitive fee)—keeps the practice financially afloat.
The place is busy, but not overwhelmed. Five front office personnel, five dentists, 12 assistants, and three hygienists keep the clinic running smoothly. The average wait for an appointment at Small Smiles is just 2 weeks, and the practice accepts walk-ins and emergency cases. Its staff—although not necessarily trained as pediatric dentists—is qualified and able to perform complicated pediatric procedures as well as routine cleanings.
Dr. Williams said in an interview that they are paid a competitive wage, and although turnover is high, advantages like regular working hours and FORBA's handling of reimbursement and human resources lure new graduates and former retirees, like himself, to the clinic.
Often, area clinics send their developmentally disabled or autistic patients to Small Smiles, which is trained and equipped to treat these special needs children.
Todd Cruse, vice president of development and government affairs for FORBA, said in an interview that last year there were 697,000 patient visits at Small Smiles clinics around the country. (For a list of locations, visit www.smallsmilesusa.com
In areas without a clinic like Small Smiles, “It is difficult for many low-income families to find or afford a dentist,” said Dr. David Krol, chair of the department of pediatrics at the University of Toledo who listed multiple problems that can arise following lax dental care. “Imagine trying to concentrate in school with a toothache, or trying to eat when it hurts to chew. If a child isn't eating, think of how hard it is to get the calories needed to grow.”
“In older children, especially older adolescents, I sometimes see periodontal [gum] disease. We are learning that gum disease may have effects on diabetes, heart disease, and preterm birth,” he said.
The cheery interior of the Small Smiles Dental Clinic in Washington features state-of-the-art equipment. Denise Napoli/Elsevier Global Medical News