Closing on oversubscribed Series A

A startup enabling in-office dental surgeries, which saw demand surge when hospital operating rooms closed during the pandemic, has added $1 million from a new VC firm for a total of $6 million this year.

SmileMD has closed the oversubscribed round, the company confirmed after filing an update with the U.S. Securities and Exchange Commission.  AXA Venture Partners, an early stage venture firm with offices in Europe and the United States, is the new investor, the company said through a spokeswoman.

Seattle-based SpringRock Ventures had led the then-$5 million round in January, joined by returning investors Loud Capital of Columbus and individuals.  The seven-year-old company brings mobile anesthesiologists, support staff and equipment to dental practices so they can perform outpatient surgery without waiting weeks or months for a slot to open up in a hospital or surgery center.

After operating rooms reopened, independent practices found the waiting lists were even longer, SmileMD CEO Saket Agrawal said for a recent Columbus Business First package on how small businesses responded to the pandemic.

As with the adoption of telehealth during the pandemic, shifting more procedures out of hospitals when appropriate appears to be permanent, he said then.  “Once you have offices that get used to your services and see the benefits we’re driving – that was the larger impact, introducing our services to more people,” Agrawal said. “It’s been a win-win-win across the board.”

SmileMD moved to Columbus earlier this year from Dublin. It has more than 40 employees and a contract network of more than 100 anesthesiologists and support staff. So far, it operates in Ohio, Illinois and Kentucky.

The investment is in SmileMD Holdings Inc., a Delaware holding company for the Ohio operating entity, OFFOR Health Inc.

Why I joined SmileMD – Anesthesiologist’s Perspective

How Mobile Anesthesiologists Can Help Provide Hospital-Grade Care for Dental Procedures

Peggy Seidman, MD

As someone who has spent most of my career as a hospital-based academic pediatric anesthesiologist, tertiary pediatric care is something I take very seriously. Although I’m no longer practicing in a hospital, I’ve been able to continue my work at the highest and safest standards through office-based anesthesia.

I spent 30 years in academic anesthesia. Throughout those years, I was the division chief at two different institutions—Stony Brook School of Medicine in New York and West Virginia University School of Medicine, in Morgantown—as well as a pediatric anesthesia fellowship director. At a certain point, I burned out and lost the joy in the work. I was old enough to retire, but I didn’t want to retire; I wanted a way to keep contributing to a field I was passionate about without the mounting stress.

When a friend recommended that I start working as an office-based anesthesia provider, it just made sense. I could keep the parts of the job I loved—having control over my schedule and working with pediatric patients, and eliminate the parts I didn’t—administration, paperwork, scheduling and insurance checks.

Now, I’m able to provide care to more patients while keeping safety the No. 1 priority. And I’m able to do this by working together with teams of local dentists and third-party clinical support staff.

Access to Anesthesia Care

The reality of hospitals is they have the capability to provide top-quality care for the patients who need it, but the flip side is the hospital is meant for patients who need it most urgently. Due to high acuity, hospital-based care has traditionally resulted in longer wait times to book a procedure, longer case times and higher costs for dental patients. With limited OR space, it’s not uncommon for dental patients to have to wait six months or more for a procedure. Once scheduled, day-of-surgery delays also are common.

As we work to bring health care access to all, issues such as the physical distance and accessibility of location can limit families’ access. There is a huge population gap that can’t be adequately served through a traditional OR, and as a result, these patients are not receiving needed care.

The good news is there are many patients who also don’t need the acuity of the hospital. For example, children who just need treatment for unhealthy teeth can be appropriately served in their local dental office with the assistance of a certified anesthesiologist. And more often than not, the ability for pediatric dental patients to stay out of a hospital is a better choice for the children and their families.

Reducing Risks, Slowing Disease Progression

When it comes to safety, the goal is to provide care that is equal to that of a hospital OR. To that end, I have found that mobile anesthesia teams are able to maintain standards of care that match an OR experience. The teams I work with ensure that all necessary medical resources—emergency drugs, tools, protocols and relationships with local emergency rooms—are secured before a patient will ever undergo anesthesia at any site where we provide care.

First, though, it starts with patient screening, a step that—although it may sound tedious—can never be taken too seriously. It is the first and possibly most significant step toward assessing and reducing individual patient risk. A specific person who understands the ins and outs of anesthesia risks is required for proper screening. They must understand what it means to have a patient who was born as a premature twin and now has asthma, or they must know what questions to ask when a child is presented as obese on paper. These are nuances that are picked up through exposure and training in the field.

There are compounding risks and variables, and for every anesthesia provider, there are risks that are too great. I know my boundaries, and I will raise my concerns if I’m brought a patient who is not a good candidate for office-based care and instead should be treated in a hospital or an ambulatory surgery center setting. I want to provide them efficient care, but more importantly I want them to be safe.

Once we make the appropriate candidate selection, we can begin the preoperative discussions. Even then, as we work with the families to set up appointments, if we uncover anything that’s cause for concern, we are always able to stop the process and refer them to a higher acuity setting.

This is where my expertise as an anesthesiologist is critical. Day in and day out, dentists see children who are miserable, children who are in pain with oral abscesses or rotting teeth. Naturally, they want to help. As the anesthesiologist, I help weigh the risk versus reward of scheduling the procedure sooner if they’re a healthy candidate, or scheduling later for an appointment in an OR if they are at greater risk for complications with anesthesia.

Establishing a Hospital-Grade Environment

After appropriately vetting a patient and having everything in place in case of an emergency, the next crucial step toward meeting the safety standard of a hospital OR is the staffing and setup.

I always work in a three-person team: a dedicated nurse for pre- and post-op, a certified paramedic and myself, a certified anesthesiologist. The security of having a paramedic on hand cannot be overstated. We’ve done everything we can to reduce the chances of an emergency, but we never truly know which patient will require emergency care. A paramedic is trained to handle emergency situations in the least ideal of environments, making them a critical part of my team, and one that I am not willing to work without.

There are some lobby groups who believe that dentists/OMFS [oral and maxillofacial surgeons] can be safely trained to play the role of surgeon and anesthesia provider in their office. I am of the firm belief that a person cannot—and ethically should not—divide their attention between procedure and sedation. It is not safe. It’s possible to get away with it, but that dual practice is dangerous and gravely irresponsible. Having a dedicated anesthesiologist—even better when they are supported by additional anesthesia health care providers—optimizes safety and decreases the risk for complications.

To set up the physical operating space in a dentist’s office, flexibility is required because every office is different. It’s important to make sure that not only is the operating space private, but that there’s also an isolated area for pre-and post-op patients. Although it isn’t always possible, having as much physical space as you can between procedure operations and regular dental practice patients helps keep things running smoothly, while also giving your sedated patients the privacy they need.

Aside from the space, I try to need very little of the dentists and offices we work with. My team and I use their chairs that are used for dental care, and we bring our own essential equipment, including an anesthesia delivery system, full monitoring, all medications and gases, IVs and fluids, even blankets to keep patients warm. We do such extensive patient vetting and office setup approval prior to any cases, making the last step of working together in the space much smoother.

Every part of this process, no matter how tedious or trivial it seems on paper, is a critical step in ensuring a safe procedure for the patient. Having the confidence that the teams I work with have performed their due diligence to set up a safe system that protects both patients and providers has allowed me to continue to do a job that I love.

Seidman is a board-certified pediatric anesthesiologist in Cleveland. She partners with SmileMD, a mobile anesthesia services company founded by anesthesiologists, to provide anesthesia services for local dental procedures.

Editor’s note: As with all Commentaries, the views expressed in this piece belong to the author and do not necessarily reflect those of the publication.

Link to Article

TechOhio video with our CEO

See the video (

For people who have simple access to their dental care providers, appointments and logistics can be easy to take for granted. But for patients who have to travel from rural areas or to specialty doctors, the process of receiving important care can be much more difficult, especially when children are involved. And anyone who has experienced tooth or mouth pain can tell you that those particular procedures often cannot wait. So to close those gaps and improve patient care, a team of co-founders launched SmileMD in Columbus, which began specializing in the delivery and logistics of anesthesia and similar specialty medicine.

“The challenge we saw was that there were all these pediatric patients that needed to come into the hospital to get access to safe and quality anesthesia,” said CEO Saket Agrawal. “They were facing six- or nine-month wait times for procedures that needed to be done quickly. Our idea was that if we could bring safe, quality anesthesia to the dental office, we could eliminate that backlog and treat these patients in a timely manner. Our goal is to drive better outcomes for our patients and reduce health care costs by delivering better access to care in a timely fashion.”

While SmileMD’s services are helpful for people of all ages, they’ve made their biggest impact among young patients. Unlike adults, who can drive themselves somewhere they need to be, make their own decisions and schedule their own time, treating children often complicates matters, especially in rural areas. By bringing care to their youngest patients, SmileMD has its best demonstration of the difference they can make.

“Dental pain is one of the most common reasons kids miss school,” Agrawal said. “Having to wait months for a procedure is just not conducive to quality health care. If we can eliminate those wait times, we can get them their treatment faster. Oral health affects nutrition, the ability to sleep and behavioral health of a child. By treating it sooner, we can help that child get back to a better place. So by bringing the procedure to them in their local communities, we eliminate those barriers. About 3 percent of children in America need this type of care, so when you scale that across the country, millions of children need this service.”

While the team places their emphasis on dental care at the moment, they aren’t stopping there. SmileMD has launched an umbrella platform called OFFOR Health that will serve as a way to bring their methods to other services in the health industry.

“When we launched SmileMD and started developing the business around delivering care in dental offices, we saw that there was a big impact on patients,” said Agrawal. “We were able to save over 300,000 miles driven for our patients and over 30,000 months of waitlist time. As we built this infrastructure for specialists, we thought about how nurses and paramedics could use our infrastructure of delivering care, and OFFOR Health is an extension of that. While SmileMD is very focused on the oral health space, OFFOR Health is now a method to deliver this in the medical space, too.”

Amid the medical innovations and infrastructure in Ohio, SmileMD and their plans for OFFOR Health are growing rapidly. As they continue to expand SmileMD’s adoption, the platform will serve as a proof of concept for OFFOR Health, which has already drawn major investment and has the potential to expand across the country. And for those lofty goals to come to fruition, the team says they’re in the ideal location to make a lasting impact.

“Our co-founders all grew up here in Ohio and a majority of us went to Ohio State,” said Agrawal. “Columbus has been very welcoming to us as we’ve identified the need for this type of care. Beyond that, Ohio is very innovative in enabling new methods of care delivery. The state has been great to work with, and sees our vision and what we’re trying to do in delivering value to patients. With its expertise, infrastructure and support, Ohio has created an environment that allows us to figure out how to deliver this type of service and do it on a large scale, which is what has enabled us to grow. Without the support of Ohio, we wouldn’t be where we are today.”

SmileMD Brings Dental Services to Patients Who Need Them Interview with SmileMD CEO with TechOhio
SmileMD CEO interview with TechOhio video

Provider Perspective – Anesthesia Guidebook Podcast

Paul Samuels, MD is a pediatric physician anesthesiologist who works with SmileMD to provide mobile anesthesia for dental offices. We talk about the unique characteristics of working in a mobile anesthesia setting for pediatric dental cases.

You can hear the overwhelming enthusiasm Dr Samuels has for caring for healthy pediatric patients in an outpatient dental setting. His years of experience as a pediatric physician anesthesiologist in a large tertiary care center not only gives him a wealth of experience to bring to an outpatient setting, but also sets him up for a really enjoyable day taking care of healthy kids for dental procedures. Click link for podcast below to listen now!

Great podcast from our very own Dr. Paul Samuels, a well known Pediatric Anesthesiologist, who shares his perspectives on treating patients in a mobile/on-site setting and in working with us to provide the care.