Rethinking Pediatric Dentistry Through Prevention and Culture
Technology should reduce friction for families. If it adds complexity without improving care or access, we don’t adopt it.
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Dr. Colin Boswell, Dr. Jonny Norris, and Sam Cocke lead operations at Montshire Pediatric Dentistry, a family-owned practice focused on preventive pediatric care. Their team advances minimally invasive dentistry and patient-centered systems designed to improve long-term oral health outcomes for children.
In an exclusive conversation with Medical Care Review leaders at Montshire Pediatric Dentistry shared insights on preventive pediatric dentistry, patient-centered care, and operational strategies that support improved long-term oral health outcomes.
Building a Strong Care Culture
At Montshire Pediatric Dentistry, culture begins with hiring. The organization pays roughly 30 percent above industry averages, which allows the team to be selective and hire people who align with the way the practice works, not simply those seeking employment.
Hygienists and assistants receive bonuses tied to preventive collections, while dentists are compensated for the care only they can deliver. All clinicians follow the same treatment algorithms, designed specifically to prevent overtreatment.
Training is another major investment. Team members are encouraged to practice at the top of their license, which allows the practice to operate efficiently while maintaining high clinical standards. Because Montshire emphasizes minimally invasive care, most appointments proceed smoothly and children leave feeling comfortable and positive about their visit. Internally, the team refers to this philosophy as playful professionalism, a cultural element they actively protect as the organization grows.
Patient Communication & Market Positioning
Technology plays a key role in simplifying everyday interactions with families. Online scheduling, automated reminders, and digital paperwork streamline the administrative side of care, while still ensuring that a real person is available whenever families need direct support.
Marketing is handled internally, allowing the team to respond quickly to the needs of individual locations while maintaining efficient use of resources.
The clinical model itself is often the primary driver of patient growth. Families frequently travel significant distances because the practice leads with minimally invasive treatment approaches accepts most private insurance plans, including Medicaid. For many families, this accessibility makes the decision straightforward, as Montshire may be the only practice willing to provide care. As a result, a large portion of the organization’s growth has come through word-of-mouth referrals.
Prevention-First Dentistry
Montshire’s approach to pediatric dentistry focuses on addressing the underlying causes of tooth decay rather than simply treating cavities after they appear. Tooth decay is the most common chronic disease globally and is fundamentally a bacterial infection. Because of this, it can often be managed and arrested without surgical intervention.
Silver Diamine Fluoride (SDF) allows clinicians to stop the progression of decay painlessly. Glass ionomer materials provide biocompatible restorations, and Hall crowns can often be placed in a single visit without the need for numbing or drilling. Although SDF has been used in Japan since 1969, it only received FDA clearance in the United States in 2014.
The results of this preventive approach have been measurable. The practice has achieved a 90 percent reduction in sedation cases, treatment plans that once cost thousands of dollars are often reduced to a few hundred, and families typically require one fewer dental visit per year on average. These outcomes are currently being examined through a study involving nearly 9,000 patients in partnership with The Ohio State University.
Evaluating Innovation
As pediatric dentistry continues to evolve, Montshire evaluates new technologies through a simple lens: whether the innovation improves patient outcomes or expands access to care while fitting the way the clinical team operates.
Implementing minimally invasive dentistry at scale required significant investment in training and the development of standardized clinical protocols. The same level of scrutiny is applied when considering any new tools or systems.
Operationally, the organization focuses on removing friction for families. Clear scheduling, accessible communication, shorter appointments, and straightforward billing remain priorities. When technology helps support these goals, it is adopted. When it introduces unnecessary complexity without clear value, it is avoided.
Compliance & Workforce Strategy
Operating across four states requires continuous attention to regulatory compliance. Montshire maintains active relationships with each state dental board, monitors Medicaid policy changes closely, and integrates compliance reviews into its operational calendar.
Workforce challenges have been less severe than those faced by many dental practices. Clinicians who are drawn to Montshire’s care philosophy often seek out the organization. The practice offers salary and bonus structures rather than production-based compensation, attracting professionals focused on patient outcomes rather than procedure volume.
Serving both private insurance and Medicaid patients is a deliberate decision. This mix strengthens operational resilience while reinforcing the belief that practices committed to eliminating tooth decay cannot exclude large segments of their communities.
Leadership Lessons
Several leadership principles have shaped Montshire’s approach to operational excellence. First, decisions should be evidence-based. In dentistry, there can be a gap between what research supports and what has traditionally been accepted as standard practice.
Second, practices should prioritize delivering genuine value to patients rather than optimizing solely for reimbursement structures. Organizations built around Second, practices should prioritize delivering genuine value to patients rather than optimizing solely for reimbursement structures. Organizations built around.
Third, the business side of healthcare deserves the same discipline as the clinical side. Compensation structures, scheduling systems, and financial planning should be managed with the same rigor applied to treatment protocols.
Finally, investing in the team is essential. When staff members are treated well and share in the organization’s success, the return often appears through stronger retention, higher quality care, and steady growth over time.
About Montshire Pediatric Dentistry
Montshire Pediatric Dentistry was founded in 2018 and currently serves more than 32,000 active patients across 10 locations in New Hampshire, Vermont, Maine, and Massachusetts. Approximately 60 percent of patients rely on Medicaid, and the practice has achieved a 90 percent reduction in sedation cases. Its outcomes are the subject of an ongoing seven-year study conducted in partnership with The Ohio State University.
Technology should reduce friction for families. If it adds complexity without improving care or access, we don’t adopt it.
