Dental complaints in emergency departments: A national perspective

Abstract

Study objective: Using nationally representative data, we sought to describe the incidence of emergency department (ED) visits for dental-related complaints for children and adults in the United States. We hypothesized that dental-related ED visits were more likely than other ED visits to have Medicaid or no insurance as the payer. Methods: We used data from the 1997 to 2000 National Hospital Ambulatory Medical Care Survey, a national probability sample survey of hospital ED visits that is conducted by the National Center for Health Statistics. From these data, all ED visits in which one of the reasons for the visit was toothache or tooth injury were compiled and used to determine national estimates of counts and rates of ED visits for dental-related complaints. Logistic regression analysis on the outcome variable, presentation to the ED with a dental complaint (versus other problem), was performed to determine the association with payer and other covariates. Results: During the 4-year period from 1997 to 2000, there were an estimated 2.95 million ED visits in the United States for complaints of tooth pain or tooth injury, for an average of 738,000 visits annually. Population-based rates and proportion of all ED visits for dental complaints were highest in the 19- to 35-year-old group, accounting for 1.3% of all ED visits and 5.6 ED visits per 1,000 people in this age category. “Dental problem, not otherwise specified” was the most commonly assigned International Classification of Diseases, Ninth Revision , Clinical Modification diagnosis. Multivariate logistic regression results indicated that the adjusted odds of presentation to the ED for a dental complaint compared with other problems were significantly elevated for visits in which Medicaid or self-pay was listed as the payer relative to those with private insurance. Conclusion: EDs are an important point of care for dental-related complaints, particularly for individuals who lack private insurance. ED providers should be equipped to triage, diagnose, provide basic treatment, and ensure appropriate follow-up care for dental problems, which may require enhancement of dental training for emergency medicine providers and improved dental care during and after ED visits. [Ann Emerg Med. 2003;42:93-99.]

Introduction

Medicine and dentistry have largely existed as independent entities, with distinct training, care systems, and settings where care is provided. However, patients may seek dental care from medical providers because they are unaware of this distinction, because the dental problem exists in the context of an injury or other medical problem, or because they lack access to traditional dental care. Emergency departments (EDs) are a well-known point of entry into the health care system, particularly for persons with difficulty accessing routine, preventive services; 44% of Americans lack dental insurance and, therefore, may experience these difficulties in accessing nonemergency dental services.¹ However, to date, knowledge of the nature of dental concerns among patients presenting to EDs has been limited to information obtained from single institutions.2, 3, 4, 5, 6, 7, 8, 9, 10, 11 To our knowledge, no previous study has addressed the nature of ED use for dental complaints from a national perspective. Using nationally representative data, we sought to describe the incidence of dental-related complaints most commonly reported among children and adults visiting EDs. In addition, we hypothesized that dental-related ED visits were more likely than other ED visits to have Medicaid or no insurance as the payer.