Americans visiting the ER for dental problems ignoring preventive services: Report

By Dr. Ananya Mandal, MDFeb 29 2012

Latest figures show that more Americans are turning to the emergency room for routine dental problems. This choice often costs 10 times more than preventive care and offers far fewer treatment options than a dentist's office. This comes from an analysis of government data and dental research.

The number of ER visits nationwide for dental problems increased 16 percent from 2006 to 2009, and the report released Tuesday by the Pew Center on the States suggests the trend is continuing. In Florida, for example, there were more than 115,000 ER dental visits in 2010, resulting in more than $88 million in charges. That included more than 40,000 Medicaid patients, a 40 percent increase from 2008. In Minnesota, nearly 20 percent of all dental-related ER visits are return trips, the analysis said.

The report notes that most of the ER visits trouble such as toothaches that could have been avoided with regular checkups but went untreated, in many cases because of a shortage of dentists, particularly those willing to treat Medicaid patients, the analysis said.

The report adds that there are too many return trips to the ER because they are generally are not staffed by dentists. They can offer pain relief and medicine for infected gums but not much more for dental patients. And many patients are unable to find or afford follow-up treatment, so they end up back in the emergency room.

“Emergency rooms are really the canary in the coal mine. If people are showing up in the ER for dental care, then we've got big holes in the delivery of care,” said Shelly Gehshan, director of Pew's children's dental campaign. “It's just like pouring money down a hole. It's the wrong service, in the wrong setting, at the wrong time,” she said.

The center in Washington, D.C., is a division of the nonprofit Pew Charitable Trusts. Pew researchers analyzed hospital information from 24 states, data from the federal Agency for Healthcare Research and Quality and studies on dental care.

Gehshan said not all states collect data on ER visits for dental care. However in 2009 alone, 56% of Medicaid-enrolled children nationwide received no dental care. South Carolina ER visits for dental-related problems increased nearly 60 percent from four years earlier. Tennessee hospitals had more than 55,000 dental-related ER visits — five times as many as for burns.

Dr. Frank Catalanotto, a professor at the University of Florida's College of Dentistry who reviewed the report said, using emergency rooms for dental treatment “is incredibly expensive and incredibly inefficient.” Preventive dental care such as routine teeth cleaning can cost $50 to $100, versus $1,000 for emergency room treatment that may include painkillers for aching cavities and antibiotics from resulting infections, Catalanotto said.

The recession has contributed to the trend, Catalanotto added. When a family member loses a job, dental care may take a back seat to food and other necessities. Part of the problem is low Medicaid fees for dentists. In Florida, only about 10 percent of dentists participate in the state Medicaid program, he said.

Dr. Robert Glatter, emergency medicine physician at Lenox Hill Hospital in New York City, told HealthPop that his hospital has also experienced an influx of patients visiting the emergency department with toothaches and chronic dental problems. He said some of the patients have severe dental disease including abscesses and neck and facial infections which may require deep sedation. That ties of up additional emergency room resources. “In a broad sense, it may contribute to overcrowding in emergency departments, potentially causing delays for patients who may have more serious ailments,” Glatter said.

Shortages of dentists, especially in rural areas, have contributed to the problem, Gehshan said. She said the Pew center is working with states to develop training for dental hygienists and other non-dentists in treating cavities and other uncomplicated procedures. Other potential steps include increasing water fluoridation and use of dental sealants.

American Dental Association has called upon states to do more to address the oral health disparities, by increasing funding for Medicaid programs to attract more dentists. “Surely, all can agree that no one should have to seek dental treatment in a hospital emergency room,” the ADA said in a statement. “The inability to surmount the barriers to oral health care can result in delayed diagnosis, untreated oral diseases and conditions, compromised overall health status, and, occasionally, even death.”