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Small Smiles Dental Centers

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Adapted from the English Wikipedia article Small Smiles Dental Centers, available under CC BY-SA 4.0Updated 25 July 2025
Small Smiles Dental Centers
Company typePrivate
IndustryDental services
PredecessorForba Holdings LLC
Founded1928
FounderBruno DeRose
Defunct2015
FateFiled for Chapter 7 bankruptcy; most locations closed
SuccessorChurch Street Health Management (parent company)
Headquarters
Nashville
,
United States
Area served
United States
Key people
Michael Lindley (CEO), Stephen Adair (Chief Dental Officer)
ProductsPediatric dental care, orthodontics, adult dental services
OwnerChurch Street Health Management (formerly Forba Holdings LLC)
ParentChurch Street Health Management (CSHM)

Small Smiles Dental Centers was a privately held dental clinic network in the United States, primarily serving children from low-income households. Its parent organization, Church Street Health Management (CSHM), was based in Suite 520 of the Castner-Knott Building located in Nashville, Tennessee. By 2010, Church Street, previously known as Forba Holdings LLC, had become the nation’s largest dental management firm and, for a period, the leading dental provider for children across the country. As of March 2014, Small Smiles operated 53 facilities, delivering care to hundreds of thousands of pediatric patients annually. However, by September 2021, only a single office remained operational in Reno, Nevada.

The chain encountered major legal issues related to accusations of performing unnecessary dental treatments and improperly restraining young patients. In January 2010, FORBA resolved allegations under the False Claims Act with the United States Department of Justice by agreeing to a $24 million settlement. On January 1, 2011, FORBA adopted the name Church Street Health Management to align with its corporate headquarters’ location. Subsequently, the company filed for Chapter 7 bankruptcy on February 5, 2015.

Small Smiles clinics operated under multiple brand identities such as Children's Dental Clinic, Indian Springs Dental Clinic, Oklahoma Smiles, Small Smiles Dentistry, Texas Smiles, and Wild Smiles.

Origins as a family practice

The roots of Small Smiles trace back to a dental office established in 1928 in Pueblo, Colorado by Bruno DeRose, an Italian American dentist and founder of the enterprise. The DeRose family continued managing the practice over the years, with Michael DeRose—an alumnus of Creighton University and business executive—joining in 1982. Early on, the clinic accepted Medicaid patients, positioning itself within an underserved demographic.

Expansion began in 1995 with a second location opening in Colorado Springs, Colorado, soon followed by three additional offices across Colorado and New Mexico. Michael DeRose also invested in Medicaid Dental Centers based in North Carolina, which operated under names like Smile Starters and Carolina Dental Center. The year 2000 marked a pivotal moment with the creation of FORBA, LLC (FOR Better Access), aimed at providing dental services nationwide and initiating substantial growth.

By May 2004, the DeRose family held financial interests in 21 clinics spanning eight states: Arizona, Colorado, Georgia, Indiana, Kansas, New Mexico, North Carolina, and South Carolina. These locations employed around 70 dentists and generated significant revenue streams. Within Colorado alone, Small Smiles maintained clinics in Aurora, Colorado Springs, Denver, Pueblo, and Thornton—dominating Medicaid dental services within El Paso County. The company also established promotional partnerships with local school districts to enhance market penetration.

The use of papoose boards was widespread at Small Smiles facilities—documented nearly 7,000 times over an 18-month span—to manage pediatric patient behavior efficiently and optimize patient flow. This approach attracted regulatory attention and led to new state legislation mandating documentation and behavioral protocols prior to employing restraints. Comparable concerns emerged at Medicaid Dental Centers in North Carolina regarding intensive dental procedures.

Financial records indicated that Medicaid dental claims exceeded $16 million over a fourteen-month period ending May 2004. Numerous children underwent extensive dental treatments per visit, including multiple crown placements. In light of regulatory investigations and public criticism, the DeRose family and affiliated parties pursued removal from professional disciplinary records.

Within six years following its nationwide expansion starting in 2000, Small Smiles had grown rapidly to operate 47 clinics across 16 states. This swift expansion reflected an assertive business strategy focused on delivering pediatric dental care to low-income populations through Medicaid programs.

Post-DeRose

In 2006, the DeRose family divested their stake in Small Smiles. That same year, a consortium of investors, spearheaded by the Carlyle Group, Arcapita Bank, and American Capital Strategies, acquired the assets of Forba Dental Management. This acquisition led to the establishment of Sanus Holdings, LLC—later renamed Small Smiles Holding Company, LLC—at a purchase price of $435 million. The company headquarters were moved to Nashville, Tennessee, and a revolving credit facility was arranged with CIT Group.

Following this transition, Small Smiles pledged adherence to both state and federal healthcare regulations. In 2007, they formed a Pediatric Dental Advisory Board under the leadership of Chief Dental Officer Stephen Adair to enhance care quality.

Investigative journalism in 2007 exposed controversial practices at Small Smiles locations, including frequent use of papoose boards and performing unnecessary treatments to meet production targets. Former staff members disclosed that unlicensed personnel were conducting X-rays. These findings sparked legal proceedings and widespread media attention.

In April 2008, former proprietors Michael A. DeRose and Letitia L. Ballance resolved False Claims Act allegations tied to Medicaid fraud through a $10 million settlement without admitting fault. Concurrently, blogger Debbie Hagan’s "Dentist the Menace" criticized Small Smiles’ papoose board usage; FORBA Holdings initiated a copyright infringement lawsuit against her but withdrew it in 2009.

In September 2009, FORBA filed suit against prior owners alleging breach of contract; however, the case was dismissed with prejudice in February 2010.

January 2010 saw FORBA Holdings reach a $24 million settlement plus interest with the US Justice Department over claims involving medically unnecessary or inadequate dental services billed to Medicaid. This agreement incorporated a corporate integrity pact with the Department of Health and Human Services. CEO Michael Lindley noted that the settlement prevented prolonged litigation without any admission of wrongdoing.

Soon after, a class action lawsuit was initiated against FORBA in Ohio. By October 2021, operating under federal supervision as Church Street Health Management (CSHM), the organization continued providing care for low-income families while expanding its offerings to include orthodontics and adult dental services.

In February 2012, CSHM sought Chapter 11 bankruptcy protection. By December that year, Small Smiles was serving roughly 500,000 children annually. Investigations by NBC News revealed persistent allegations regarding unnecessary treatments and poor-quality care. Senator Chuck Grassley condemned the company for exploiting vulnerable children and misusing taxpayer funds. CEO David Wilson reaffirmed the company’s dedication to delivering quality care across one million patient visits each year.

Following an investigation by WTAE-TV, a bipartisan Senate report recommended revoking Small Smiles’ Medicaid participation due to wasteful expenditures and rapid administration of unwarranted procedures. The report advised excluding entities employing such deceptive business practices from Medicaid programs. CSHM disputed the report’s portrayal of their current operations.

In 2014, the Office of Inspector General prohibited Church Street Health Management from participating in Medicaid, Medicare, and other federal health programs. Subsequently, CSHM filed for Chapter 7 bankruptcy protection in February 2015.

Governance

The Pediatric Dental Advisory Board of FORBA included distinguished specialists such as Paul Casamassimo, who serves as Chair of Pediatric Dentistry at Ohio State University; Joe Bernat, Chair at SUNY-Buffalo School of Dental Medicine; Arthur Nowak, Professor Emeritus at the University of Iowa; and Anupama Tate, Director of Pediatric Dentistry at Children's National Medical Center in Washington, D.C.

See also

Further reading

  • "JOINT STAFF REPORT ON THE CORPORATE PRACTICE OF DENTISTRY IN THE MEDICAID PROGRAM." 113th U.S. Congress, 1st Session. Senate Committee on Finance and Judiciary. June 2013.
  • "Dental committee suggests regulation of child restraints." The Colorado Springs Gazette. September 19, 2004.
  • "State will tighten rules for dentists to restrain kids." The Colorado Springs Gazette. October 20, 2004.
  • Burkhalter, Eddie. "Corporate dentistry criticized for unethical practices, unnecessary procedures." The Anniston Star. July 28, 2013.
  • "Four Women Sue Santa Fe Dental Clinic." Associated Press at the Albuquerque Journal. September 26, 2006.
  • "Clinics boost access to dental care." Worcester Telegram & Gazette. July 19, 2005.
  • Heath, David (Center for Public Integrity). "Senate Report Faults Children’s Dental Chain for 'Fundamentally Deceptive' Care." Frontline. July 25, 2013.
  • Letter from Senator Chuck Grassley to Michael G. Lindley, CEO of Church Street Health Management.
  • Caher, John. "Lawsuit Proceeds Against Dental Chain That Left Child in Pain." New York Law Journal. August 20, 2013.

External links

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