Management of Emergency in Dental clinic

As comprehensive oral care becomes more difficult for young adults to afford, more and more of them are turning to emergency rooms for dental treatments, a new study shows.

The total number of dental emergency department visits in the United States nearly doubled from 2000 to 2010, according to a study by Thomas Wall, MA, MBA, and Kamyar Nasseh, PhD, from the American Dental Association (ADA), published online in May on the ADA Web site.

The rate of increase in dental emergency room visits outstripped the increase in overall emergency room visits during this period, the researchers found. "This has nothing to do with the recession," Marko Vujicic, PhD, managing vice president of the ADA’s Health Policy Resources Center, told.

To tally dental emergency room visits, the researchers used the National Hospital Ambulatory Medical Care Survey.

To put these visits in the context of overall numbers of dental visits, they used annual dental use data from the Medical Expenditure Panel Survey of the Agency for Healthcare Research and Quality. They found that dental visits as a percentage of total emergency room visits increased from 1.06% in 2000 to 1.65% in 2010, a statistically significant change.

By far the greatest increase came among young adults. As a percentage of all dental visits, emergency room visits by people aged 21 to 34 years increased from 1.5% to 3.0%. The increase among people 35 to 49 years old was from 0.5% to 0.9%. For other age groups, the trend lines were nearly flat.

Young adults may be turning to emergency rooms for dental care because they cannot pay for comprehensive oral care, said Dr. Vujicic, citing previous research.

"The largest percentage that indicate they have financial barriers is the 21- to 34-year-old group," he said.

States, Employers Cutting Benefits

Many states have pared back their adult dental Medicaid benefits; some cover emergency rooms only.

At the same time, many employers are cutting dental benefits, said Dr. Vujicic.

Previous research has shown that a large proportion of dental emergency room visits are for caries and that many of the patients going to emergency rooms for care could be better served in dental offices, the researchers note.

The Affordable Care Act is unlikely to help, the researchers report, because it does not require anyone to purchase dental benefits or make money available for them: It only requires plans in the small-group and individual markets to offer these benefits to children.

The findings in the study echo an earlier report by the Pew Center that also found dental emergency room visits increasing.

"In general, ADA agrees with Pew that [emergency department] visits are increasing and that that’s a problem," Shelly Gehshan, MPP, director of the center’s Children’s Dental Campaign. "There is a big issue with the affordability of dental care."

Gehshan, who was not involved in the ADA study, said 3 policy changes could help with the problem: "I think we need more financing, we need more dental providers, and we need more innovation in the system."

Pew supports a provision of the Affordable Care Act that would have funded demonstration projects using alternative dental providers such as dental therapists in an effort to offer more basic dental care at a lower cost. Congress later blocked funding for the program.

Citing previous research Dr. Vujicic disputed the need for more dental providers: Four of 10 dentists say they could see more patients, he said.

"Dental-Related Emergency Department Visits on the Increase in the United States." ADA Health Policy Resources Center. Published online May 2013.