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Dental care in the ER: wrong place, wrong time

Dr. John Sattenspiel
Sattenspiel says that in a better coordinated system, patient-centered teams could steer patients toward timely preventive care, including dental checkups.

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 checkups.