Q and A New dentist on importance of urgent care clinics

Editor's note: Dr. Brandon J. Crivello is an assistant professor and urgent care & oral medicine unit director at A.T. Still University - Missouri School of Dentistry & Oral Health.

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Dr. Crivello
Tell us about the Dental Urgent Care Clinic at the St. Louis Dental Center.
Opening in 2015, the St. Louis Dental Center offers comprehensive dental care and emergency, urgent dental treatment through the Dental Urgent Care Clinic.  In an innovative partnership between the A. T. Still University Missouri School of Dentistry & Oral Health and Affinia Healthcare, the St. Louis Dental Center is one of the first of its kind to provide clinical training and services for underserved and vulnerable populations in a FQHC public health setting. At its inception, Dental Urgent Care was open Monday-Friday from 8:30 a.m.-5:00 p.m. on a walk-in basis, no appointment necessary.

Increasing accessibility to the clinic was a must for our community. Thanks to a collaboration between Barnes-Jewish Hospital and the Missouri School of Dentistry & Oral Health, Dental Urgent Care, hours and services were expanded in February 2019 to be: Mondays and Wednesdays from 8:30 a.m.-7:00 p.m., and Saturdays from 8:00 a.m.-12:00 p.m. This schedule allows patients to seek urgent dental treatment in a dental setting outside of the normal business hours to avoid disruptions in work, school and childcare. 

Describe the practice of dental urgent care.

Dental Urgent Care sees upwards of 30-35 patients on a weekday and 5-10 patients on Saturdays. That equates to 185 patients a week or 740 patients a month, the upper limit of what we can see depending on patient need.

When patients seek emergency dental treatment in non-dental settings like the emergency department, palliative care most often in the form of antibiotic and analgesic therapy is provided. This is problematic for many reasons and is likely to delay definitive dental treatment altogether, potentially leading to worsening of condition or repeat ED visits.

We believe dental emergencies are best managed by dental professionals in dental settings for the best oral health outcomes. Furthermore, patient education on what constitutes a dental emergency, when it is appropriate to seek dental-related treatment in the ED, and what community dental resources are available is essential. 

What dental emergencies are treated at the center?

Most dental “emergencies” and urgent treatment needs are related to acute pulpal and periodontal conditions, dental abscesses, and trauma. Our expanded services include dental extractions, intraoral incision and drainage of abscesses, limited pulp therapy and restorative procedures, palliative treatments and referral services to our specialty care when indicated.

How has COVID-19 impacted your care?

Currently, student patient care has been suspended until further notice.  Typically, all third-and-fourth-year dental students play an active role in providing care, which allows us to serve so many patients on a given day. Anywhere from four to six dental students on the Urgent Care clinical rotation are overseen by two faculty dentists, who are also involved with direct patient care.

Care is now provided by Affinia Healthcare dental providers working along with me. If a patient has questions or is concerned about their health, they are advised to call first. All patients have their temperature taken and are assessed for viral symptoms at the building entrance.  Somewhat counter-intuitively, we are seeing fewer patients than in previous weeks which we attribute to fear of coming for any kind of health care.  

We certainly look forward to resuming clinical training for our students and serving everyone coming for care.