A 2-year retrospective study of pediatric dental emergency visits at a hospital emergency center in Taiwan

Emergency Department and Dental Clinic Perceptions of Appropriate, and Preventable, Use of the ED for Non-Traumatic Dental Conditions in Hot-Spot Counties: A Mixed Methods Study

OBJECTIVES

Frequency of emergency department (ED) use for nontraumatic dental conditions (NTDC) is a well-researched community health concern. However, research predominately relies on ambulatory ED discharge records. This explanatory sequential mixed methods study reviewed NTDC ED use in hot-spot counties and assessed perceptions around preventable and appropriate use among EDs and dental clinics.

METHODS

Tooth pain data (2015-2021) were drawn from State Medicaid, and the Early Notification of Community-Based Epidemics (ESSENCE). NTDC data were compiled using International Classification of Disease, Ninth and Tenth Revisions. Employing extreme case sampling, providers in counties with the highest per-capita NTDC ED use were interviewed.

RESULTS

North Dakota experienced a decline in NTDC ED visits between 2017 and 2020, though the rate is now increasing. The greatest proportion of NTDC ED visits were among persons ages 20 to 34 and 35 to 44. ED and dental care staff have misconceptions around each other's roles in reducing NTDC ED visits, but unanimously suggest community-level prevention as a solution.

CONCLUSIONS

NTDC ED use was perceived as "appropriate" care. However, there is consensus that improved access to, and utilization of, affordable and quality preventative dental care would reduce NTDC ED visits and improve overall community health, especially among populations experiencing greater inequities.

Hospital emergency department visits made by developmentally disabled adolescents with oral complications

Purpose

We used Andersen's Behavioral Model in a cross-sectional study to determine the factors associated with utilization of the emergency department (ED), controlling for whether an adolescent has a developmental disability (DD) and one or more oral complications (toothaches, decayed teeth, bleeding gums, eating or swallowing problems).

Methods

Data from the 2016–2019 National Survey of Children's Health (NSCH) was used for this secondary data analysis study. We used frequencies and percentages to describe the sample characteristics. Chi-square tests were used for bivariate analyses. Multivariable logistic regression modeling was conducted to predict ED visits by adolescents aged 10–17 controlling for predisposing, enabling, and need variables.

Results

The sample consisted of 68,942 adolescents who were primarily male, non-Hispanic White, and born in the U.S. Parents reported that 69% of the adolescents had neither a DD nor an oral complication; 10% had no DD but experienced one or more oral complication; 16% had a DD but no oral complication; and 5% had both DDs and one or more oral complication. Adolescents with both a DD and an oral complication reported the highest level of ED visits at 33%, compared to 14% of adolescents with neither DD nor oral complication. Regression analysis showed that adolescents with a DD and oral complication (OR: 2.0, 95% CI: 1.64–2.54, p < 0.0001), and those with DDs but no oral complications (OR: 1.45, 95% CI: 1.25–1.68, p < 0.0001) were at higher odds of having an ED visit compared to those with neither a DD nor an oral complication. Not having a Medical Home increased the likelihood of ED visits by 14% (p = 0.02). Those with private insurance (OR: 0.63, 95% CI: 0.53–0.75, p < 0.0001) and those from a family where the highest level of education was some college and above (OR: 0.85, 95% CI: 0.73–0.98, p = 0.03) were less likely than their counterparts to have had an ED visit.

Conclusion

Adolescents with DDs and oral complications utilize ED visits more frequently than those with neither DDs nor oral complications. Integrating the dental and medical health systems and incorporating concepts of a Patient-Centered Medical Home could improve overall health care and reduce ED visits for adolescents.

Analysis of adult dental emergencies at a medical center in southern Taiwan

Background/purpose

Materials and methods

Results

Conclusion

The impact of the COVID-19 epidemic on the utilization of dental services and attitudes of dental residents at the emergency department of a medical center in Taiwan

Background/purpose

Dental visits are a high risk activity during the COVID-19 pandemic. This study investigated the utilization of emergency dental services and clinical practical attitudes of dental residents in this period.

Materials and methods

Retrospective chart data from 13th November 2019 to 31st March 2020 in Kaohsiung Medical University Hospital, Taiwan were used. We obtained electronic medical records to review data from 515 patients who visited the emergency department with dental complaints and we contacted the 26 residents assigned to act as primary care providers to participate in this study.

Results

After the COVID-19 outbreak, 17% fewer patients had dental emergency utilization at a hospital emergency center relative to the previous period. A survey of residents also showed a decline in the number of patients. There were no significant differences of patients' problems and diagnoses between the two periods. After the COVID-19 outbreak, 61.5% of the residents were afraid of being infected by a patient's disease and the proportions of dentists wearing waterproof gowns, face shields, and surgical hair caps were 76.9%, 88.5%, and 76.3%, respectively. These variables increased significantly after the outbreak of COVID-19.

Conclusion

Despite the trend of a decreased number of patients, their utilization of dental emergency services seems to be similar before and after the COVID-19 outbreak, possibly related to strict hospital infection control policies and the relatively low number of COVID-19 confirmed patients internationally at that time.

Quality assessment of clinical practice guidelines for the management of paediatric dental emergencies applicable to the COVID-19 pandemic, using the AGREE II instrument. A systematic review

OBJECTIVE

To assess the quality of Clinical Practice Guidelines (CPG) related to the management of paediatric dental emergencies applicable to the COVID-19 pandemic, through the use of the measuring instrument AGREE II (Appraisal of Guidelines for Research and Evaluation in Europe).

SOURCES AND DATA COLLECTION

A rigurous online search of CPG was accomplished among the main CPG compilers: National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse, Agency for Healthcare, Research and Quality (AHRQ), Andalusian Health Technology Assessment Department (AETSA), American Academy of Family Physicians, Tripdatabase. Furthermore, because of the need to identify CPG that meet the inclusion criteria, a manual search, among the main national and international dental organizations as well as recognized web sites, was also accomplished.

SELECTION OF RESEARCH STUDIES

All of the guides focused on paediatric dental emergencies, available in the database and "gray" literature, and published between 2000 and 2020 (applicable to COVID-19 pandemic) were included without any language restrictions. The CPG that did not contain the full paper or were addressed to adults or children with special needs, were excluded from the selection. The evaluation of the CPG, independently included, were achieved by four (04) experts by using AGREE II.

RESULTS

Five (05) out of twenty-three (23) selected CPG, were classified as "acceptable" according to AGREE II. These five guides were evaluated to determine their "Recommendation degree". Only one (01) CPG "Guía Clínica AUGE de Urgencias Odontológicas Ambulatorias-Chile, 2011" reached a score of 75%, the highest among the other guides (5 domains with a score ≥ 60%, including the domain III "Rigour of Development") to be considered as a "highly recommended" CPG.

CONCLUSIONS

According to the quality assessment and recommendation degrees criteria from AGREE II, high, middle and low quality CPG were identified. Only one CPG reached a score of 75%, to be classified as "highly recommended". Therefore, it is suggested that the existing CPG updates and future CPG use the available tools and methodologies during their elaboration, in order to guarantee their quality.

CLINICAL SIGNIFICANCE

High quality CPG for the management of dental emergencies are designed to support dental health professionals in decision-making to adopt specific dental procedures in the current COVID-19 pandemic. As a matter of fact, these CPG might contribute to reduce the risk of transmission, in case of fresh outbreak of the illness. Likewise, they might help to determine which cases warrant medical attention in centres with special facilities for COVID-19.

[Children's consultations for dental emergency. Retrospective study in Île-de-France]

BACKGROUND

In France, the children oral health status has improved but the use of care remains insufficient. The complexity of the acts, the access to care difficulties and the programs of prevention and care for children lack of knowledge contribute to late care and often, in emergency. This study aims to describe the young patients' characteristics consulting in dental emergency and analyse the modalities of recourse.

METHODS

A retrospective study was conducted on medical records. An extraction of data was carried out concerning all children under the age of 16, admitted to the Dental Emergency Functional Unit of the Pitié-Salpêtrière Hospital Group in 2015. Several variables of interest were analysed: socio-demographic characteristics, the time of the visit and the diagnostic category (tooth pathologies, facial trauma, infections, periodontal diseases and other emergencies). Descriptive and bivariate analyses were conducted.

RESULTS

On the 62,500 dental emergency consultations in 2015, 5359 were for patients under 16 years of age (8%). Data were available for 5044 children. Among these, children aged 6 to 11 accounted most of consultations (43.9%). There were more boys (57.2%). The most frequent emergency diagnoses were related to a tooth pathology (42.9%) and traumatic event (38.4%). Consultations were more held on the evening schedule on weekdays and the day on weekends. Patients aged 0 to 5 years consulted more at night (P<10^-3) and were, proportionally, the most affected by traumatic events (39.2%). Children aged 6 to 11 and 12 to 16 years consulted more often during the day (P<10^-3), for emergencies related to a carious event (43.9% and 43.6%). Patients residing in Seine-Saint-Denis accounted for 22.6% of total visits and those living in Paris accounted for 20.8%.

CONCLUSION

A large proportion of children presenting for dental emergencies, have most of the time, only the need for usual care. An offer of dental care, adapted to the territory needs, is necessary for the children dental health management. Preventive measures from an early age and early recourse would be favourable.

Trends, demographics, and conditions of emergency dental visits in Taiwan 1997-2013: A nationwide population-based retrospective study

BACKGROUND/PURPOSE

The disparate or irregular dental care was associated with acute clinical problems that may lead to care seeking for emergency visits. The aim of this study was to determine the time trends, demographics, and conditions of emergency dental (ED) visits in Taiwan.

METHODS

This cross-sectional study was conducted to analyze the insurance reimbursement of dental care services in National Health Insurance Research Database. The demographic characteristics and age-period effects of ED visits were estimated by multivariate Poisson regression. In addition, the top causes of ED visits were evaluated and stratified by traumatic and non-traumatic conditions.

RESULTS

The prevalence of ED visits were 3.18, 5.44, and 4.83 (per 10,000 persons) in 1997, 2002, and 2013, respectively. The primary diagnosis code for ED visits was 522 'pulp and periapical tissues'. Pulpitis (522.0), cellulitis (528.3), acute periodontitis (523.3), and caries (521.0) were the top 4 non-traumatic reasons for seeking ED visits. The top 3 traumatic conditions were open wound of internal structures of mouth without mention of complication (873.6), open wound of face without mention of complication (873.4), and loss of teeth due to trauma (525.1). The higher prevalence of ED visits were found in male (aRR = 1.50, 95% CI: 1.49-1.51), 6 y/o group (aRR = 1.56, 95% CI: 1.53-1.59), east region (aRR = 1.27, 95% CI: 1.25-1.29), and dependent coverage group (aRR = 1.16, 95% CI: 1.14-1.19).

CONCLUSION

Taken together, these demographic data could serve as a reference for the authorities concerned to improve the current situation of ED in Taiwan.

Paediatric dental emergencies: a retrospective study and a proposal for definition and guidelines including pain management

AIM

This was primarily to perform a retrospective analysis of 1000 emergency dental visits in order to characterize the nature of the dental emergency and the treatment provided and secondly to define a guideline for dental emergency treatment in children including pain management.

MATERIALS AND METHODS

A retrospective review was conducted of 1000 patients (aged 0-16 years) who visited the dental emergency service of the paediatric dental clinic at the Ghent University Hospital, Belgium over a period of 3 years. Data regarding age, gender, reason for visit, year of visit, consequent appointments and treatment provided were collected. Statistical analysis was carried out using descriptive statistics (frequency distribution) and Chi-square test, with significance level set as P < 0.05.

RESULTS

The number of patients visiting with a dental emergency increased annually. Approximately half (50.2%) of all paediatric dental emergency consultations were based on pain due to caries and its consequences. More than a quartile (26.7%) of emergency patients suffered from dental trauma of either primar or permanent teeth. The majority (96.7%) of the patients reported pain, 16.3% of the patients did not necessarily need immediate attention.

CONCLUSION

Dental emergencies in a university hospital based setting were predominantly related to caries and trauma. A precise definition of dental emergencies is recommended in order to prevent abuse of paediatric emergency services.

On the road to epigenetic therapy

In this issue of the Biomedical Journal, we examine how far the explosion of epigenetic studies in recent years has translated to benefits for patients in the clinic, and we highlight an original study suggesting that increased vegetable intake protects against osteoporotic fractures. We also hear several opinions on the use, or perhaps misuse, of Impact Factor and what the future should hold for this publication metric.