EDs Providing More Non-traumatic Dental Care for Uninsured Patients

October 6th, 2016

SACRAMENTO, CA – From 2001 to 2008, emergency department visits for routine dental conditions – such as cavities, tooth pain and gingivitis – increased by 41% in the United States, while ED visits for all conditions rose by only 13% during the same time period, according to a new study.

In fact, more than 2% percent of all ED visits now are related to non-traumatic dental conditions, according to a study published recently in the journal Health Affairs. Even though Medicaid dental insurance is more readily available than in the past because of the Affordable Care Act, those numbers might not decline much because of access issues, according to California researchers and colleagues.

Many states don't provide dental coverage for adults under their Medicaid programs. In addition, rural communities often have too few dental providers, while many urban dentists are unwilling to take on new Medicaid patients, according to the study.

"Past research has shown that many dentists do not accept Medicaid," study co-author Kathryn Fingar, a researcher at Truven Health Analytics in Sacramento, said in a Stanford University press release. "Therefore people with Medicaid may find it difficult to get dental care in an office-based setting, even if they have dental insurance and even if there is an adequate supply of dentists in their community. In these instances, patients may need to use emergency rooms for dental problems, which generally can do little for patients seeking dental care except prescribe pain medications and antibiotics."

For the study, researchers examined county-level rates of ED visits for non-traumatic dental conditions in 29 states in 2010. An adequate supply of dental providers was associated with lower rates of ED visits for dental care by patients with Medicaid in rural counties, the study found. That was not the case in urban counties, however, where about 90% of the visits occurred.

The authors suggest several possibilities to reduce the number of ED visits for dental problems, including:

• Establish on-site dental clinics in emergency rooms.
• Expand dental coverage using less-expensive telehealth and mid-level dental providers who are not dentists, but trained to perform preventive and restorative care, such as fillings and minor extractions.
• Incentivize payers or providers to offer or refer patients to preventive dental care, similar to colon and cervical cancer screenings routinely offered today.

"The large number of visits to emergency rooms for dental conditions that could be treated in outpatient settings is indicative of the fact that our health-care system treats dental care differently than other preventive care,” said senior author Maria Raven, MD, MPH, associate professor of emergency medicine at the University of California San Francisco, “when, in fact, dental care should be considered part of a person's overall health and well-being,"