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Letters: Cut ER visits with education

October 20, 2014 The tower of higher education truly is a protected womb of idealism that is unfazed by realism and pragmatism. The author ("Emergency Room Is No Place For a Toothache" Aug. 18 ADA News) refers to a number of studies that show the uninsured and low-income populations increasingly visit the emergency room for dental problems. I do not doubt these studies are true. However, we are left with the question: why are the low-income populations and the uninsured increasingly visiting the ER for dental problems?

The entitlement mentality and waning of personal responsibility coupled with the culture of instant gratification (high speed Internet, order ahead restaurants, hospital highway billboards advertising four- to 10-minute ER wait times, and overnight package delivery) means many are no longer accustomed to thinking ahead, especially about something like a toothache. Almost without exception, the patients I see on an emergency basis admit that they ignored the warning signs of dental infection and denied their condition. They were not making a conscious choice "between food on the table or visiting a dentist," as the author states.

The author also states that "oral health care isn't a privilege; all of us deserve it," by stating, "We can push for dental coverage for all state residents." This is fallacious reasoning. With the evolution of dental insurance, third party payers bilk the actual providers of dental care and restrict necessary treatment options. It is a cause of the above problem, not a cure.

A fanciful misconception is that universal health (or dental) insurance equals universal care. It does not. To find a solution to the access to care problem, we need to first examine human behavior. The poor and uninsured often make bad decisions, and visiting the ER for acute dental disease is the end point in a series of bad decisions. We need an honest discussion regarding human vice, and to acknowledge that a change in public policy alone cannot change human behavior — only financial incentives or disincentives are capable of doing so.

A necessary solution is to start full service 24-hour dental care clinics in our dental schools across the country and begin a national public education campaign stressing the importance of seeing a dentist for dental problems. In this way, dollars set aside in safety net state Medicaid programs, insurance premiums, personal funds and health savings accounts can go directly to the dental schools providing the actual care and are not lost in hospital ERs or the leviathan bureaucracy. As an added benefit, the magnitude and value of dental education will rise exponentially, as it exists in our medical schools.

James G. Loeser, D.D.S., M.D.
Park Ridge, Illinois