When Uninsured Have Dental Pain, They Often Head to the ER

Greater numbers of Americans , especially those who lack insurance coverage, are turning to the emergency room for routine dental care.  This choice frequently costs 10 times more than preventive care and offers far fewer treatment options than a dentist’s office.  The majority of these ER visits are to treat toothaches that could have been avoided with regular checkups but went untreated, often due to a shortage of dentists, particularly those who treat Medicaid patients.

The number of ER visits nationally for dental problems increased 16 percent from 2006 to 2009, and a report from the Pew Center on the States states that the trend is just getting started.

In Florida, more than 115,000 dental patients visited the ER in 2010, costing more than $88 million.  That included more than 40,000 Medicaid patients, a 40 percent increase when compared with 2008.  Many ER dental visits involve repeat patients seeking additional care.  In Minnesota, nearly 20 percent of all dental-related ER visits are return trips because emergency rooms generally are not staffed by dentists.  They are equipped to offer pain relief and medicine for infected gums but not much more.  Because many patients can’t find or afford follow-up treatment, they return to 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.”

For example, in 2009, 56 percent of children enrolled in Medicaid received no dental care.

Visiting ERs for dental treatment “is incredibly expensive and incredibly inefficient,” said Dr. Frank Catalanotto, a professor at the University of Florida’s College of Dentistry.  Preventive care such as regular teeth cleaning can cost $50 to $100, as opposed to $1,000 for emergency room treatment that may include painkillers for aching cavities and antibiotics from resulting infections, Catalanotto said.  Infections can be dangerous, particularly in young children, who often have fevers and suffer from dehydration from preventable dental conditions.  In Florida 200 children were hospitalized in 2006 for those types of infections.  The recession has only worsened the trend, according to Catalanotto.  When someone in the family is laid off, dental tends to take a back seat to food and other necessities.

The Wisconsin Hospital Association has estimated that 32,000 patients with dental problems visit hospital ERs every year. The fees paid to dentists by state health programs such as BadgerCare Plus are the fifth-lowest in the country, according to a report by the Pew Children’s Dental Campaign.  Raising the fees paid to dentists is not likely in the short term given the state’s budget, said Matt Crespin, associate director of the Children’s Health Alliance of Wisconsin, an affiliate of Children’s Hospital and Health System.  “That’s why some of those innovative models have to be looked at,” according to Crespin.

Pekin Hospital in central Illinois has seen a significant increase in ER patients with “very poor dental health,” said Cindy Justus, the hospital’s ER nursing director.  They include uninsured patients and drug abusers, and many are repeat patients.  “There’s just not a lot of options” for them, Justus said.  Shortages of dentists, most notably in rural areas, are part of the problem, Gehshan said.

In Illinois’ Cook County, — which includes Chicago — ER dental visits rose nearly 77,000 between 2008 and 2011.

The cause of the problem is too little financing for dental care in the healthcare system. “And when you lose adult dental coverage like California did in 2009, that creates an even bigger problem,” Gehshan said.  “We do have a safety net, and it’s not big enough,” she said.  In fact, she said, California’s dental care system can only handle about 70 percent of the need in the state, and that’s if the system were actually at full capacity.

Amazingly, 25 percent of all California children have never been to a dentist.  As a result, when those children and their parents end up in the emergency room, using time and resources that could be better spent on non-dental emergencies, that costs California’s taxpayers money, Gehshan said.

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