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ERs seeing increase of people visiting with dental problems

July 15, 2013

By Kelly Soderlund, ADA News staff

More people are heading to the emergency room with dental problems, an increase largely driven by young adults who don't have dental benefits, according to the ADA Health Policy Resources Center.

The number of dental emergency room visits in the U.S. increased from 1.1 million in 2000 to 2.1 million in 2010, according to the National Hospital Ambulatory Medical Care Survey. The survey also showed dental ER visits as a percent of total ER visits increasing from 1.06 percent in 2000 to 1.65 percent in 2010—a change HPRC cites as statistically significant.

HPRC cited the survey in a research brief titled “Dental-Related Emergency Department Visits on the Increase in the United States.” Lead authors Thomas Wall and Kamyar Nasseh, Ph.D., analyzed dental utilization data and looked at how different age groups approached their dental care.

“The deterioration in private and public dental benefits coverage for adults has clearly created significant financial barriers to dental care—especially among young adults,” Mr. Wall said. “Our results strongly suggest that the increase in financial barriers to dental care for younger adults could have led to a substitution of dental ER visits for dental office visits.”

More people taking their dental issues to the emergency room, rather than a dental office, creates a strain on the health care system and one that the Affordable Care Act cannot support, HPRC said.

“[Emergency rooms] nationwide are under pressure to provide care for more patients,” Mr. Wall wrote in the research brief. “Inappropriate and continuous use of EDs for nontraumatic dental visits strain the health care system, contribute to overcrowding, increased care costs and longer wait times for patients with urgent health conditions.”

Based on various estimates on the average cost of a dental ED visit, it cost the health care system anywhere from $867 million to $2.1 billion to treat dental conditions in hospital emergency rooms in 2010, according to HPRC. Previous studies have shown that patients who take their dental issues to the emergency room are more likely to be young or middle-aged adults and more likely to have Medicaid or no health insurance, HPRC says. In previous research briefs, HPRC has reported that the percent of adults between the ages of 19 and 49 with private dental benefits declined from 2000-2010.

“Unfortunately, the Affordable Care Act did little to address the issue of dental utilization in emergency departments,” Mr. Wall said. “The ACA does not mandate dental benefits for adults, nor are dental benefits likely to be included in the essential benefit packages in insurance plans sold through most states' exchanges under provisions of the law.”

The ADA's research supports what's happening on the ground. Nicole Singleton, a community dental health coordinator at Morton Comprehensive Health Services in Tulsa, Okla., said she sees patients every day who have waited too long to seek dental care. Often, they've visited the emergency room and received antibiotics as a temporary treatment but haven't followed up with a dentist to completely resolve their problem, she said.

“To me, it's just a true lack of education when it comes to oral health,” Ms. Singleton said.

Calvin Hoops, a CDHC at Esperanza Health Center in Philadelphia, has seen similar behavior at his dental clinic. While he can't track how many patients visited the ER before going to Esperanza Health Center or how many go to the emergency room instead of visiting a dentist, Mr. Hoops said he does see many patients who forgo routine dental treatment, even when they have cavities.

“We just know that the longer patients delay treatment, the more likely something fairly routine can become something like a dental abscess with potentially severe swelling and pain that might cause somebody to visit the emergency room instead of the dentist,” Mr. Hoops said.

HPRC is calling on oral health advocates to find innovative ways to increase access to dental care so that fewer people are taking their oral health problems to the emergency room.

“Without further interventions from policymakers, dental [ER] visits are likely to increase in the future, straining our health care system and increasing overall health care costs,” the research brief said. “Now more than ever, innovative solutions are needed to improve access and oral health.”

The Agency for Healthcare Research and Quality released a report in May that looked at the use of emergency rooms for dental care. Read the ADA News story here.