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ER Visits Due to Dental Problems on the Rise, Research Paper Says

By Jane Norman, CQ HealthBeat Associate Editor

May 15, 2013 -- The number of emergency room visits due to dental problems nearly doubled in the United States in a 10-year period, according to a research paper recently released by the American Dental Association.

The dental group said that the number of visits related to problems with teeth grew from 1.1 million in 2000 to 2.1 million in 2010. As a share of all ER visits, dental-related visits grew from 1.06 percent to 1.65 percent during that time period, according to statistics derived from the National Hospital Ambulatory Medical Care Survey.

Young adults ages 21 to 34 are accounting for the increase in visits, likely because many don't have dental insurance, the paper said.

The findings again highlighted national problems with low-income people's access to dental care. Some 130 million Americans lack dental insurance, and Medicaid provides limited or no adult dental coverage. The health care law (PL 111-148, PL 111-152) did not provide for oral health care for adults either, even though dentists say it's just as important as care for the rest of the body.

But there are divisions between dentists and other types of providers over how to proceed. A separate report issued by the nonprofit consumer group Community Catalyst made the case for using mid-level dental workers to help alleviate the problem of access. Also known as dental therapists, the mid-level providers—similar to nurse practitioners or physician assistants in the medical field—are not yet widely authorized by states and their expansion is opposed by dentists.

The Community Catalyst report said that in Minnesota and Alaska, the two states where therapists practice, a third of services provided were preventive, most commonly sealants and fluoride varnishes for teeth. The therapists' clients are made up mostly of publicly insured children, low-income adults, Native Americans and others who don't have access to dental services, the report said.

Robert A. Faiella, president of the American Dental Association, said in an interview that dentists are launching a three-pronged national campaign to battle the problem of access: treat those in need of dental care who most need it right away, prevent disease before it starts through community fluoridation and tooth sealants and educate patients about how oral health fits into their overall health condition.

Tight budgets for Medicaid make it unlikely that states will expand their coverage for the poor, Faiella acknowledged. Dentists want to participate in Medicaid but in many states it's very difficult just to enroll, he said, with months needed to become credentialed. One model for changing that is in Oklahoma, where there are just two pages needed for Medicaid enrollment and Faiella said that "absolutely" makes a difference.

"Understanding where state budgets are, we are still advocating for improvements in the system," he added.

There are also a number of programs where local dentists are working with hospitals to divert patients away from ERs there and provide care instead in private offices with a sliding scale for fees, he said. A Michigan program asks that patients provide community services in exchange for their dental work.

Faiella said dentists are opposed to training more dental therapists because the need is not for more providers but rather a better way to get dental care to poor people. "We just need inroads into the susceptible populations to have them receive access into the system that already exists," he said. For example, the safety net could be expanded if private dentists were to contract with federally qualified health centers and community health centers, he said.

Nonetheless, the Community Catalyst report said that legislation is pending in eight states to expand the use of dental therapists and several other states are studying the model to see if mid-level providers might be useful.

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