FRONTLINE: Dollars And Dentists

Dental care can be a matter of life or death. Yet more than 100 million Americans either don’t have dental insurance or simply can’t afford to see a dentist. The result? Severe pain, preventable disease, humiliation, bankruptcy and sometimes even death. In "Dollars And Dentists," a joint investigation by FRONTLINE and the Center for Public Integrity, correspondent Miles O’Brien uncovers the shocking consequences of a broken dental care system.

Millions of poor children rely on Medicaid for dental care, but most dentists won’t see them because there’s no profit margin in Medicaid patients. Now, privately backed pediatric dental chains are popping up to treat these kids at Medicaid rates. Kool Smiles is one of the largest.

But critics say Kool Smiles is actually taking advantage of some of its young patients. Donna Balaski, who heads Connecticut’s Dental Medicaid program, noticed a spike in expensive procedures—particularly the placement of stainless steel crowns—being performed at Kool Smiles. “We saw quite an increase in those crowns, ... a huge increase, disproportionate to the number of treatments that children were getting,” she tells O’Brien.

Kool Smiles is now under investigation by the Texas Attorney General for allegations of Medicaid fraud and federal investigators are scrutinizing the company's practices.

Many adults put off dental care because they simply can’t afford it. Chains like Aspen Dental offer special credit cards and payment plans to help people finance their dental work. The credit cards are provided in the dentist’s office and come with hefty financing rates.

Aspen says it only offers financing when the care is absolutely necessary, but former employees tell FRONTLINE they were rewarded for getting patients to buy—and finance—as much dental care as possible. “Even if they had insurance, we were still required to push the finance options on them, and still proceed with the paperwork,” former Aspen employee Heather Hayes tells FRONTLINE.

Solutions to repair the dental care crisis are elusive. Efforts to reform the system often face fierce opposition from dentists themselves. But in Alabama, a new model is showing hope. It’s a nonprofit dental center led not by a dentist, but by a former corporate CEO.

“The need that I saw when I got here was tremendous. There were more children needing care than there were dentists able to see them,” says Jeff Parker, CEO of Sarrell Dental, where low-income kids are treated at reasonable costs. Alabama’s dental lobby worked aggressively to shut Sarrell down. It was unsuccessful.

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