Toothaches Create New World Of Pain For EDs

Can you say, “Open wide?” Patients increasingly are showing up at the ED with dental problems. Those visits rose 16% from 2006 to 2009, according to a new report. Here’s information on how expensive ED-provided dental care can be and what can be done about it.

Your ED probably doesn’t have a dentist on staff. Few do. But that doesn’t mean you won’t be called on to provide dental care.

In Florida, 315 patients a day seek treatment for dental problems in the state’s EDs. One emergency physician in Louisiana says he sees at least 1 dental patient every 12-hour shift. According to a recent report from the Pew Center on the States, more than 830,000 ED visits in 2009 were for preventable dental conditions.

The costs add up. In Minnesota, 7 urban hospitals spent more than $4.7 million on 10,000 ED visits for dental issues. Treating 115,000 dental ED visits in Florida in 2010 generated charges exceeding $88 million. For routine dental care, such as toothaches, a visit to the ED costs 10 times more than a visit to a dentist’s office.

A growing number of patients, though, lack access to dentists—but can still get to a hospital. Approximately 47 million people live in areas designated as having a shortage of dentists. Even when a dentist is available, many people cannot afford to see one, either because they lack insurance or dentists do not accept the insurance they have. In half of the states, less than 50% of dentists accept Medicaid. Current economic challenges have led more states to reduce reimbursement rates for dental care through Medicaid and cut funding for other dental programs, so

Because EDs typically cannot address the underlying causes of dental problems such as abscesses and toothaches, 80% of patients treated for oral health issues need subsequent care from a dentist—and most are unlikely to get it. As a result, 20% of dental-visits to EDs are made by patients who have previously been treated there.

To reduce the burden of dental care on your ED, consider creating a referral list for local dental clinics or having a dentist on call.

Longer-term solutions suggested by the Pew Center include encouraging community and state investments that provide incentives for pediatricians to provide basic dental care, expanding the types of practitioners who can work under a dentist’s supervision to provide care for children, and raising Medicaid rates for dentists.

View other topics in this week's edition of Pertinent Practice Pearls (free for everyone):

• For Many Women, No ‘Elephant Sitting on Their Chest’ with MI
• Find Out When to Trust Rapid Flu Tests
• Opioid Prescriptions from ED Less Likely to Result in Fatalities

View related topics in EB Medicine's publications:

• Fixing Faces Painlessly: Facial Anesthesia In Emergency Medicine (free for subscribers)
• Acute Dental Emergencies In Emergency Medicine (free for everyone)