Dental care in the ER: wrong place, wrong time
says that in a better coordinated system, patient-centered teams
could steer patients toward timely preventive care, including dental
May 17, 2011 - When someone shows up in a
hospital emergency room with a toothache, it's not just the patient
who hurts. Dental treatment in the ER — inefficient, costly
and untimely — is a sign of missed opportunity for preventive health
and a failure for coordinated care.
Unfortunately, it happens a lot.
For example, 2,085 patients of a leading Lane County medical
group went to hospital emergency rooms for dental problems last
year. That accounts for more than 4 percent of the group's ER
visits. The most common diagnosis was tooth decay — the most
preventable of chronic diseases in adults and children.
"ERs are not the place to go for dental care," says Dr. John
Sattenspiel, chief medical officer of Lane Individual Practice
Association (LIPA), a Eugene-based doctors group that contracts with
the state to take care of Oregon Health Plan clients. "All they can
do is something temporizing," such as prescribe antibiotics for a
presumed infection or narcotics for pain.
Meanwhile, the underlying problem, a lack of preventive oral
health, goes untreated.
"It's not the kind of system that anybody who actually wanted to
take care of the issue would set up," Sattenspiel says.
Several factors combine to bring dental patients to the ER, the
most expensive and least effective place for treatment. Many
Oregonians have no source of routine dental care, either because
they lack insurance or can't find a dentist to see them. When
coverage of preventive dental care is limited or people have a hard
time making appointments, they tend to wait until dental problems
turn into emergencies such as infection, inflammation or pain. Wait
times for dental appointments are long. Few clinics have walk-in
hours, and those that do often cannot see patients right away.
In a better-coordinated system, as in Oregon's proposed health
transformation, patient-centered teams would help steer patients
toward timely preventive care, including dental