MyView: Emergency room is no place for a toothache
August 18, 2014
By Cecile A. Feldman, D.M.D.
No one should have to choose between putting food on the table or visiting a dentist. That's a decision faced by far too many New Jerseyans who are often delaying dental care until excruciating pain lands them in the emergency room.
In March, the Rutgers School of Dental Medicine collaborated with the Rutgers Center for State Health Policy on a study
of dental ER visits. Researchers found that uninsured young adults, ages 19 to 34, and low-income residents have the highest number of ER visits for dental pain and infections that aren't related to trauma.
It's an increasingly widespread trend. According to a 2012 study published by the American Dental Association, ER dental visits doubled nationwide from 2000 to 2010, rising from 1.1 million to 2.1 million.
Many of these "emergencies" could have been prevented with the help of regular dental visits or treated in a dentist's office for a fraction of the cost to patients and taxpayers. Patients unlucky enough to get a tooth pulled in the ER might be billed as much as $1,500, while a dentist might charge only $150 for an office procedure.
But the most disturbing aspect of the rise in ER dental visits is that treatment is often ineffective. In emergency rooms, there is a lack of diagnostic equipment and tools — such as dental X-ray machines — and ER physicians aren't trained to identify and treat oral health problems. Often, they prescribe painkillers and antibiotics for infections while the underlying problem remains.
For many, a visit to the dentist is unaffordable and inaccessible. More than 85 million Americans have no form of dental insurance. For those who have Medicaid, finding a dentist who accepts it can be challenging. Many dentists don't because the reimbursement payments are a fraction of the cost of care and there is a very high administrative burden.
But the reliance on emergency room dental treatment is symptomatic of a larger problem: a public that is alarmingly uneducated about the severe consequences of inadequate dental care and a system that refuses to acknowledge oral health as a crucial aspect of overall medical health.
There is still the misconception among many that dental care is a luxury, a mostly cosmetic process that helps ensure straight, white teeth. If your teeth don't hurt, and they look okay, what's the harm in skipping those uncomfortable — and, for many, costly — annual cleanings and checkups? Plenty.
Tooth decay, which is almost entirely preventable, is the most common chronic illness among school-age children. Left untreated, it can result in infection, unbearable pain, loss of teeth and acute systemic infection, which in some cases can lead to death. Yet nearly one in four American children have untreated tooth decay. For low-income children, the rate doubles.
According to the U.S. Centers for Disease Control and Prevention, almost 50 percent of Americans over 30 have periodontitis, which affects the gum tissue and destroys the bone that supports teeth. Nearly 9 percent of Americans have a severe form that can cause tooth loss and is associated with an increased risk of heart disease, stroke and diabetes. Regular dentist visits dramatically reduce these risks.
How can we make it easier for more New Jerseyans to have healthy mouths, and, as a result, healthier bodies?
We can push for dental coverage for all state residents. Although the Affordable Care Act mandates all children have dental insurance, the requirement doesn't extend to adults.
Fluoridated water would also go a long way. Nationwide, 72 percent of communities have it. In New Jersey, it's only 22 percent, despite overwhelming evidence that it's the most effective, economical way to prevent dental disease.
New Jersey is also one of the few states without a dental director to advocate for oral health and push for measures such as dental sealants for children.
All of these things will keep toothache sufferers out of the ER. Oral health care isn't a privilege; all of us deserve it, and our public polices should reflect that.
Dr. Feldman has served as dean of the Rutgers School of Dental Medicine for 13 years (formerly known as the New Jersey Dental School, part of the former University of Medicine and Dentistry of New Jersey). Her remarks, reprinted with permission, originally appeared in Newark Star-Ledger.