In recent years, hospital emergency departments (EDs) have drawn millions of poor and underinsured patients coping with dental problems. Yet EDs remain tremendously expensive and ineffective sources of dental care, two new studies remind us.
Between 2008 and 2010, more than 4 million patients turned to hospital EDs for help with dental conditions at a cost of $2.7 billion. Research suggests that the vast majority did not receive dental procedures, but were instead treated with prescription medications. A total of 101 of the patients died in the emergency rooms, according to the study published in the April issue of the Journal of the American Dental Association.
The authors used data gleaned from the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality (AHRQ), to produce their paper. They found that uninsured patients made slightly more than 40 percent of all dental-condition related ED visits.
With routine professional and home care, most of the dental problems could have been addressed in less costly and more effective ways, or prevented altogether, the researchers noted. The lack of insurance or the means to pay for care, geographical isolation, poor diet and poor oral hygiene all contribute to the oral conditions that drive people to hospitals. Yet such patients seldom find actual dental care on the visits; only treatment with prescription medications, they pointed out.
“Health care providers, policymakers and hospital administrators should consider establishing oral health experts within hospital settings who can consult with treating clinicians regarding oral health emergencies or can directly manage the emergencies themselves,” concluded the research team, led by Veerasathpurush Allareddy, an associate professor at the College of Dentistry and Dental Clinics at The University of Iowa.
In a smaller study, researchers from the Rutgers Center for Health Care Policy and the Rutgers School of Dental Medicine focused upon emergency department visits for dental problems in poor regions of New Jersey between 2008 and 2010 and drew similar conclusions.
“Emergency departments are poorly equipped to deal definitively with dental and oral health needs,” noted lead author Kristen Lloyd. “Still, many people seek care in emergency departments for non-traumatic dental and dental-related conditions, possibly indicating inadequate access to dental care in the community.”
The Rutgers team found that young adults, particularly those lacking insurance or covered by Medicaid, were the biggest users. The researchers suggested that more dental providers in poor communities, higher Medicaid reimbursement rates for dental care and improved relationships between medical and dental providers could help address dental needs before patients end up seeking care in emergency rooms.
The two studies add to a growing body of research into the burgeoning problem.
Last year, a study by the American Dental Association found the number of dental emergency department visits had risen from 1.1 million in 2000 to 2.1 million in 2010. Over the same decade, dental emergency department visits also increased as a share of total emergency department visits. Dental visits increased from 1.06 percent of all emergency room visits in 2000 to 1.65 percent in 2010, the study found.
In 2009 alone, more than 900,000 emergency department visits and nearly 13,000 hospital inpatient stays were related to dental conditions, according to a statistical brief released last year by AHRQ.
Between 2006 and 2009, the incidence of emergency department visits for patients seeking dental treatment increased by 16 percent, rising from 874,000 to 936,432 visits, the report found.
The findings of the federal report echoed those contained in a 2012 study released by the Pew Center on the States. “A Costly Dental Destination: Hospital Care Means States Pay Dearly” found that financially stressed states have been required to bear the cost of expensive emergency treatment for decay, abscesses and other dental ailments.
The Pew study, which estimated that preventable dental conditions were the primary reason for 830,590 emergency department visits by Americans in 2009, concluded that states could reduce hospital visits, strengthen oral health, and reduce their costs by making modest investments to improve access to preventive care.