More Americans visit ER for costly and inefficient dental care

CBS/iStockphoto

(CBS/AP) Toothaches can be incredibly painful, but painful enough to send you to the emergency room?

For a growing number of Americans, the hospital is the first line of treatment for dental care, according to new research from the Pew Center. And these patients are probably paying 10 times as much and getting worse treatment than they'd get from a preventive visit to the dentist, experts warned.

"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.

For the report, Pew researchers analyzed hospital information from 24 states, data from the Federal Agency for Healthcare Research and Quality and studies on dental care. The researchers found ER visits nationwide for dental problems increased 16 percent from 2006 to 2009. 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.

Many ER dental visits involve the same patients seeking additional care. In Minnesota, nearly 20 percent of all dental-related ER visits are return trips, the report said. That's because emergency rooms generally are not staffed by dentists. Doctors might 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.

"It's the wrong service, in the wrong setting, at the wrong time," Gehshan said.

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Not all states collect data on ER visits for dental care, but those that do reveal the trend, Gehshan said.

The report found in 2009 alone:

• Fifty-six percent of Medicaid-enrolled children nationwide received no dental care.
• South Carolina ER visits for dental-related problems increased 60 percent from four years earlier.
• Tennessee hospitals had more than 55,000 dental-related ER visits - five times as many as for burns.

Using emergency rooms for dental treatment "is incredibly expensive and incredibly inefficient," said Dr. Frank Catalanotto, a professor at the University of Florida's College of Dentistry who reviewed the report.

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.

These infections can be dangerous, especially in young children, who may develop fevers and dehydration from preventable dental conditions. In Florida, for example, 200 children were hospitalized in 2006 for those types of infections, 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.

The recession has contributed to the trend, Catalanotto said. When a family member loses a job, dental care may take a back seat to food and other necessities.

Part of the problem is also low Medicaid fees for dentists. In Florida, only about 10 percent of dentists participate in the state Medicaid program, Catalanotto said.

The numbers also are rising in hospitals in Illinois, where dentists have complained about low Medicaid reimbursements. Pekin Hospital in Illinois t 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, 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.

Those two preventive moves are backed by the American Dental Association, according to a prepared statement it sent to HealthPop. The ADA also calls on 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.

Are there other cheap options for dental care? According to the National Institute of Dental and Craniofacial care, dental schools and dental hygiene schools can be a good source of reduced-cost treatment. Also, researchers recruiting for clinical studies will sometimes provide dental treatment for a particular condition they are studying.

The NIDCR has more resources for low-cost dental care.

[nottellin1]

Why is it that no one mentions the fact that many of the visits to the ER for dental care are made by, you guessed it, illegal aliens. These invaders have become so accusstomed to received 'free' care from ER's, why wouldn't they expect dental too. I hope everyone understands there is no dental care provision in Obamacare. Nothing will change even if there was since, supposedly, IAI's aren't covered. Obamacare will change very little in the amount of visits an ER receives.

[gjc1n1]

Unless you have an ongoing relationship with a dentist, most dentists will not treat your dental emergencies unless you can pay up front. Dental insurance is almost worthless with huge deductibles, co-pays and yearly maximums. Most dentists will not consider a payment plan. Dental emergencies start at $1,000. And that is just teh beginning. Any restoration service after the emergency is cleared up is beyond the reach of the average person. A dental implant for 1 tooth starts at $3,000. Who has that kind of money laying around.

[catwoman1952]

getting decent dental care at a reasonalbe rate has always been a problem. I have dental insurance, but it pays pitifully. In my case a dental infection caused a heart valve to fail, leading to half a million in cost to replace the valve. But if you don't have the money for dental care, you don't get it. I find it most puzzling that it costs so much and because it affects our overall health so much that the government should do something to help these people. People ar enot getting what they need to lic=ve a reasonable comfortable life. It is a constant struggle.

[stevador39]

American dentists do 'missionary' work in the third world. Gum disease is a known cause of heart conditions. Medicaid for poor children does not pay to fill teeth, only to pull teeth. Some dentists pull children's teeth just to make money.

[DavidPFiore]

Not having insurance would just be completely crazy. I am an accountant and in my local area "Penny_Health" is the best health insurance finder I ever had. Yes my insurance does cover dental and eye insurance which is a big help to my life.

[DanFreysinger]

When someone has to choose between feeding their children or buying them health insurance, guess which one takes priority?

[tjs7]

Emergency departments provide incredibly efficient care. The care in emergency departments, in total, represents only 2% of the health care dollar. There is no better resource to provide emergency and urgent care. The emergency department is uniquely able to evaluate and treat patients for emergency condition and intervene to provide care and prevent further deterioration. Many dental conditions that are not treated can lead to serious life threatening conditions. The emergency department 24/7 evaluates for these conditions and provides pain relief and treatment to prevent deterioration.

Due to failures of the rest of the health care system, including the dental system, the emergency department provides unscheduled care to those who cannot access care. This article does a great disservice by implying that the emergency departments are expensive and inefficient. The real problem is that the health care system does not provide timely access to preventative and health/dental maintenance care to millions of people. Those people then use the emergency department to meet their needs. The failure is the system's failure, not emergency departments' failures. In the case of dental care, it is a failure to provide routine preventative care at an affordable price to all Americans.

[Best4patients]

As an emergency physician for over 30 years lets look at the facts. Emergency physicians are trained to care for dental emergencies. As dentists are less available to provide care and often refuse to provide care patients with dental emergencies- usually pain, infections or trauma, come to where help and caring service is available, the ER. ERs serve society by being always available and will see anyone. At only 2% of health care costs, this is a real bargain for the US. Fix the dental system and the EDs will not need to provide great care to those with dental problems. My dentist will only take emergencies if you are a paying patient and only during week day business hours. She also collects money from all care in almost 100% of her patients. The average ER, although providing care to all, only collects about 40- 50 % of all patient's bills. Yet we will always be there to provide care 24 hours every day. What a service to those in need and for what is offered, it is relatively inexpensive.

[winemaster2]

Absolutely right! It is an insult to injury. ER today are staffed by doctors from some out side agency that is not part of the hospital or the doctors even having privileges at attending. More then half these doctors, in particular rural areas hacks, who in the AMA CV do not even state as to what medical school they attended. There are no dentists in 99% of ER nor do these doctors have any training in the field. Average ER fee before anything is close to $300. That is for registering for acute care. The actual doctor visit is 7.5 minutes. All that is done is writing of a pain killer prescription. In case of Medicare . Medicade that costs less than $5.00 Even the pain killers prescribed is some odd that is ineffective.
Tooth aches are on account of infections and these yahoos in the ER will not prescribe an antibiotic. All ER does is provide a five to 10 year old list of dentists in the area.

The worst is acute care tooth ache costing medicare $300 or more is covered for ER visit, where there are no dentists, but not to a dentist directly that may provide acute care. This is what this US Congress wrote into the law.

I happen to have the exact same experience. Far worst in this nation is no doctor ever talks to the patient on the telephone and on every prescription etc in case of any sort of problem the written instructions are to call your doctor.

[EMDoc]

As a current emergency medicine doctor I have great concerns with some of the above statements.

First - 90% of physicians (this includes emergency medicine, surgery, radiology, whatever) are not employed by a hospital, but by independent groups that contracts with the hospital. This does not make us hacks. This is actually done to prevent the hospital from directly dictating medical decision making to physicians. It is actually a checks and balance. It is a great thing.

Second - As a current EM physician in training, we are trained in evaluating and determining if a toothache is life-threatening. It is true I am unable to pull a tooth or do a root canal. But I am able to start some of the treatments and determine if hospitalization is required.

Third - not all toothaches are secondary to infections and to just to start a prescribing antibiotics to everyone would be a great disservice to the individual (serious adverse reactions can occur with antibiotics) and to society (bacterial resistance to antibiotics is already a problem).

Fourth - you may feel like you only saw the doctor for 7.5 minutes, however trust me that generally they are doing a lot more on your behalf then you realize. Following up labs and studies if needed. Maybe even calling the dentist and getting you follow up.

I understand your frustration and share it that I would applaud if we were able to get the patients that just had a simple toothache to their dentist in a timely manner. However, dentists, like many other business have 8-5 hours. When you are concerned or in serious pain, emergency departments were designed to evaluate and if needed, stabilize. We will see anyone, anytime, regardless of your ability to pay. We will do our best to guide you through the system (by the way that is going above and beyond what we are paid to do, even if it is a 10 year old list - which at my shop it is not - but shouldn't the a patient take some responsibility in finding dentists in the area?)

Overall, it seems that your frustrations stem from your local hospital system, and I would urge you to contact them rather than attempt to make a wrong general statement about the delivery of emergency care.

[Caerlt]

I pay $1900 a month to maintain COBRA insurance from DH's last job. A little over $100 of that is dental coverage. I have a $25 fee for routine cleaning. Most other procedures, I pay 50%. Many are not covered at all. We have a $1500 yearly cap on what our dental will pay for--that doesn't cover even one major dental issue, such as a cavity. We are a family of 4. This year we have 1 dental surgery, 4 cleanings, and 3 other prodedures, barring cavities or accidents between now and December 31. COBRA or no COBRA, either way I pay out of pocket. We're lucky we have even this. THAT'S why ER's are packed with dental emergencies.

[jmailbox]

It's a sad state when you acutally look at the numbers.

Almost anything at a Dentist's office for filing in cavities is covered by insurance. But anything else like a Bridge, Crown, Cap, Dental Surgery are all uncovered expenses because it's considered "Cosmetic".

Most peopole, myself included, who have to get Crown because a tooth has gotten so bad, there's nothing left to patch on it, need to have a crown. But to insurance companies, it's considered cosmetic surgery because they think no one should care if you have a gap in your mouth.

Anything else insurance does cover for dental work is only reimbursed for 1/3 of the cost, that's just ridiculous.

I bet you anything those stupid cosmetic teeth whitening services are covered, but not the medically nesscary stuff. What a shame, insurance companies are so greedy

[LautenBK]

People go to ER for dental treatment because most dental insurance policies ONLY cover preventative care at 2 visits per year. Emergencies or accidents are NOT COVERED. Where would you go?