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Letters: Guidance on emergency care

November 04, 2013

I read with considerable interest two articles in the July 15 ADA News.

There are a number of factors, as pointed out in this well-written and insightful article ("ERs Seeing Increase of People Visiting With Dental Problems") that are responsible for this phenomenon. As pointed out in the companion article ("ERs: 'Cannot Provide Definitive Dental Treatment'"), this is an inappropriate venue for most patients. Furthermore, it is frustrating for physicians to try to manage these dental emergencies.

As an academic endodontist, I see a large number of patients, both my own and those of students and residents, that first go to an ER with a problem. Almost invariably, since the ER physician has very limited training in diagnosis and/or management of odontogenic problems, the patient receives shotgun-approach prescriptions for analgesics and antibiotics.

An emergency room physician and I recently published an article specifically directed to ER physicians. (Hurst K and Walton R. "An Urgent Care Provider's Guide to Managing Dental Emergencies." Journal of Urgent Care Medicine. May, pp 9-18: 2012.)

In this article, we review basics of dental and oral anatomy, as well as pulpal, periapical and periodontal pathoses. We further outline the diagnosis and management of these diseases in a hospital emergency setting. Emphasized is that local anesthesia and analgesics will effectively "tide the patient over" until they can see a dentist, which should be as soon as possible, preferably the next morning. We further emphasized that antibiotics are ineffective and should not be prescribed, unless the patient has a serious cellulitis that likely would require hospitalization and care of an oral surgeon. Another good option with a localized swelling is that the physician could do an incision for drainage.

The ultimate objective is to move these emergency patients out of the ER setting and into a dental office, where they can receive appropriate care, with a less costly load on the hospitals.

Richard E. Walton, D.M.D., M.S.
Professor emeritus
Department of Endodontics
University of Iowa College of Dentistry
Iowa City, Iowa