Emergency department dental care

Background

As Canada reviews publicly financed dental care, concerns are being aired over emergency department (ED) visits for dental problems. Policy stakeholders characterize ED visits for dental care as inefficient and costly to the healthcare system. Problems with ED dental visits include (1) EDs are not usually prepared to handle dental problems, (2) treatment is usually with antibiotics or analgesics and does not resolve the actual problem, and (3) such visits further burden an overextended ambulatory care system. To further define the problem, administrative data were analyzed to determine the exact nature of ED visits for nontraumatic dental problems in Ontario.

Methods

Hospital-based ambulatory care centers contribute to the Canadian Institute for Health Information's National Ambulatory Care Reporting System. The data include demographic, diagnostic, procedural, and administrative information. Specifics were culled from fiscal years 2003/2004 and 2005/2006, covering ED visits involving diseases of the oral cavity, salivary glands, and jaws (nontraumatic cases). Patient and visit characteristics were noted.

Results

The total number of ED visits for dental problems was 141,365, or approximately 1.2 visits per person per year. Overall 2003 ED volume was depressed because of the effect of the severe acute respiratory syndrome (SARS) outbreak. Most visits were made by persons aged 20 to 44 years and 78% were triaged as less urgent to nonurgent. Discharge to home was the outcome in 92.7% of cases. Periapical abscesses and toothaches accounted for most visits, with a significant number classified as “other.” Most of the patients with common dental problems received no intervention or the intervention was not coded. Some patients received pharmacotherapy or other services (Table 3 ). Of the coded interventions, the top four codes used were “therapeutic intervention on the whole body,” “diagnostic intervention on the body system,” “therapeutic intervention on the vein,” and “diagnostic intervention on the oropharynx.” Most of the visits occurred on weekends, with peaks at 10 am and 7 pm for children and adults and at 10 am only for senior adults. The number of visits for nontraumatic dental problems was similar to the number for pneumonia and greater than the number for diabetes and hypertensive disease complications.

Table 3.

The Number of Emergency Department Visits for Dental Problems in Ontario, Canada, by Main Problem and Type of Intervention, 2003/04–2005/06

Main problem	Type of intervention	Visits	%
Periapical abscess without sinus	No intervention/not entered	36,215	85.2
	Pharmacotherapy/implantation of internal device	2974	7.0
	Assessment	1317	3.1
	X-ray/CT scan	606	1.4
	Drainage	410	1.0
	Extraction/excision, total/partial	138	0.3
	Electrocardiogram	105	0.2
	Other measurement	99	0.2
	Prescription	62	0.2
	Specimen collection	52	0.1
Toothache not otherwise specified	No intervention/not entered	33,756	92.4
	Assessment	1236	3.4
	Pharmacotherapy/implantation of internal device	796	2.2
	X-ray/CT scan	131	0.4
	Electrocardiogram	88	0.2
	Other measurement	71	0.2
	Anaesthetisation	69	0.2
	Prescription	57	0.2
Dental caries unspecified	No intervention/not entered	6993	89.9
	Assessment	379	4.9
	Pharmacotherapy/implantation of internal device	119	1.5

(Courtesy of Quiñonez C, Gibson D, Jokovic A, et al: Emergency department visits for dental care of nontraumatic origin. Community Dent Oral Epidemiol 37:366-371, 2009.)

Discussion

The number of ED visits for nontraumatic dental problems in Ontario was significant when compared to the number of visits for other major health problems. The pattern of visits suggests that they are related to a lack of access to dental care, with peaks indicating the patients are employed and the children were being brought after work or school. The visits are made to manage common dental problems, not urgent situations. The ED responses generally involve no treatment or no definitive resolution to the problem. The conclusion is that there is a need for dental services in Ontario for those who are not covered under private or government-subsidized insurance programs and ED visits are not the best means to meet the need.

Clinical Significance.

Data from US sources confirm the findings of this study with respect to US ED dental visits for nontraumatic care. When insurance does not cover the situation, we are left with ambulatory services offered at the local hospital. Further study is needed to determine what the best answers are to the problem, but a change in policy is needed to provide appropriate and viable alternatives to nontraumatic ED dental care.