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Luo H, Moss ME, Webb MD, Winterbauer NL, Tucker-McLaughlin M, Yockey RA, Smith AW, Wright WG. The most common types of nontraumatic dental conditions among emergency department visits in North Carolina before and during the COVID-19 pandemic. J Am Dent Assoc 2024; 155:149-157. [PMID: 38069961 PMCID: PMC11044986 DOI: 10.1016/j.adaj.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina. METHODS The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. RESULTS By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. CONCLUSIONS The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. PRACTICAL IMPLICATIONS More efforts are needed to reduce ED visits for NTDCs.
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Schroeder S, Beck J, Medalen N, Stepanov A. 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. J Prim Care Community Health 2024; 15:21501319231222396. [PMID: 38185859 PMCID: PMC10773277 DOI: 10.1177/21501319231222396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
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.
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Affiliation(s)
| | - Judy Beck
- North Dakota Department of Health and Human Services, Bismarck, ND, USA
| | - Nikki Medalen
- Quality Health Associates of North Dakota, Minot, ND, USA
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Simon L, Cardenas V, Davila-Parrilla L, Marsh RH, Samuels-Kalow M. Challenges connecting emergency department patients with oral health care: A qualitative analysis of patients, emergency department clinicians, and dentists. J Am Dent Assoc 2023; 154:1087-1096.e4. [PMID: 38008526 PMCID: PMC10823431 DOI: 10.1016/j.adaj.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/25/2023] [Accepted: 09/05/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Unmet dental need shares many risk factors with unmet health-related social needs (HRSN) such as housing and food security and are a common cause for seeking treatment at the emergency department (ED). METHODS The authors recruited a purposive sample of English-speaking and Spanish-speaking patients, ED clinicians at 3 urban EDs, and dentists from nearby communities to participate in qualitative interviews to explore barriers to and facilitators of screening for HRSN and unmet dental needs in the ED. Themes were identified from transcripts using a modified grounded theory approach. RESULTS Interviews were conducted with 25 ED patients, 19 ED clinicians, and 4 dentists. Four themes were identified: (1) a preference for formalized resources, which more frequently exist for HRSN than for oral health; (2) frequent use of ad hoc resources that are less reliable or structured, particularly for dental referral information; (3) limited knowledge of oral health care resources in the community; and (4) desire for more assistance with identifying and addressing resource needs for both HRSN and oral health. Patients were amenable to screening through a variety of modalities and felt it would be helpful, but clinicians emphasized the need for easier referral processes because of frequent failure to connect patients to oral health care. CONCLUSIONS More robust infrastructure and clinician support are needed to ensure successful referral and screening without undue provider burden for both medical and dental clinicians. PRACTICAL IMPLICATIONS Patients are amenable to screening for unmet oral health needs and HRSN in the ED, which may improve access to care.
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Giannouchos TV, Reynolds J, Damiano P, Wright B. Association of Medicaid expansion with dental emergency department visits overall and by states' Medicaid dental benefits provision. BMC Health Serv Res 2023; 23:625. [PMID: 37312114 DOI: 10.1186/s12913-023-09488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/02/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Evidence on the association of Medicaid expansion with dental emergency department (ED) utilization is limited, while even less is known on policy-related changes in dental ED visits by Medicaid programs' dental benefits generosity. The objective of this study was to estimate the association of Medicaid expansion with changes in dental ED visits overall and by states' benefits generosity. METHODS We used the Healthcare Cost and Utilization Project's Fast Stats Database from 2010 to 2015 for non-elderly adults (19 to 64 years of age) across 23 States, 11 of which expanded Medicaid in January 2014 while 12 did not. Difference-in-differences regression models were used to estimate changes in dental-related ED visits overall and further stratified by states' dental benefit coverage in Medicaid between expansion and non-expansion States. RESULTS After 2014, dental ED visits declined by 10.9 [95% confidence intervals (CI): -18.5 to -3.4] visits per 100,000 population quarterly in states that expanded Medicaid compared to non-expansion states. However, the overall decline was concentrated in Medicaid expansion states with dental benefits. In particular, among expansion states, dental ED visits per 100,000 population declined by 11.4 visits (95% CI: -17.9 to -4.9) quarterly in states with dental benefits in Medicaid compared to states with emergency-only or no dental benefits. Significant differences between non-expansion states by Medicaid's dental benefits generosity were not observed [6.3 visits (95% CI: -22.3 to 34.9)]. CONCLUSIONS Our findings suggest the need to strengthen public health insurance programs with more generous dental benefits to curtail costly dental ED visits.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, 29208, Columbia, SC, USA.
| | - Julie Reynolds
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Peter Damiano
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Brad Wright
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, 29208, Columbia, SC, USA
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Oluwatosin A, Trop B, Kreuser K, Topalli X, Sadilek T, Wilk K, Sapp T, Peterson T, Ouellette L, Jones JS. Antibiotic and opioid prescribing for simple toothache in the emergency department. Am J Emerg Med 2022; 60:220-222. [PMID: 35835658 DOI: 10.1016/j.ajem.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ayotunde Oluwatosin
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Brandon Trop
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - Kaitlin Kreuser
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - Xhesika Topalli
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - Tyler Sadilek
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - Katie Wilk
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - Thomas Sapp
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Thomas Peterson
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Lindsey Ouellette
- Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
| | - Jeffrey S Jones
- Spectrum Health, Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America.
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Kisely S, Lalloo R. A state-wide study of dental comorbidities in psychiatric disorders resulting in avoidable emergency department presentations. Aust Dent J 2021; 66:423-429. [PMID: 34325489 DOI: 10.1111/adj.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Attendances at emergency departments (EDs) for dental conditions are unnecessary and come at a significant cost to health services. METHODS A population-based record-linkage analysis of a retrospective cohort over 2 years across state-based facilities in Queensland. This was to determine if people with mental illness were more likely than the general population to attend EDs for a range of non-traumatic or avoidable dental conditions. RESULTS There were 1 381 428 individuals in the linked database, of whom 177 157 (13%) had a psychiatric history and 22 046 (1.5%) had one or more avoidable dental presentations. These were toothache (n = 9619), dental abscesses (n = 8449), caries (n = 1826), stomatitis (n = 1213) and gum disease (n = 939). After adjusting for confounders, psychiatric patients were significantly more likely to present with toothache, dental abscesses and caries but not stomatitis or gum disease. Depending on the dental outcome, other risk factors were male sex, lower income, rurality and Indigenous status. CONCLUSIONS Given these findings, possible interventions should include an increased emphasis on assessing oral health in mental health or primary care, especially in non-metropolitan areas, as well as early dental referral. Service planning for this population should including easier navigation of dental services, availability outside normal office hours and free outreach dental clinics.
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Affiliation(s)
- S Kisely
- School of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia.,Addiction and Mental Health Services, Metro South Health, Woolloongabba, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - R Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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Cothron A, Diep VK, Shah S, Brow A, Thakkar-Samtani M, Okunseri C, Tranby EP, Frantsve-Hawley J. A systematic review of dental-related emergency department among Medicaid beneficiaries. J Public Health Dent 2021; 81:280-289. [PMID: 34075587 DOI: 10.1111/jphd.12458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/11/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dental-related emergency department (ED) visits are a growing public health concern. Dental insurance coverage is a strong predictor of dental service access. The objective of this study was to conduct a systematic review to assess the incidence of dental-related ED visits for Medicaid dental enrollees compared to those with other insurances. METHODS PubMed, EMBASE, and Google Scholar were searched for surveillance and observational data published in English from January 1999 to April 2020 to address the following PECOT question: Do patients with nontraumatic dental conditions (NTDC) (P1), or patients with any dental condition (P2) who have Medicaid (E) compared to other insurance status (private insurance, Medicare, no insurance) (C) have a differential incidence of single dental-related ED visits (O) in the literature search results from 1999 to April 2020 (T)? A critical appraisal was performed using a combination of the AXIS tool (for cross-sectional studies with observational data and MetaQAT (for public health evidence). RESULTS This systematic review included 32 studies. Overall, risk of bias was low. Due to significant statistical heterogeneity, a synthesis without meta-analysis was conducted. NTDC ED visits ranged from 16.0 percent to 79.8 percent for Medicaid patients and 0.9 percent to 57.2 percent for uninsured patients. The range for any dental visit to the ED was 2.2-63.8 percent for Medicaid patients and 2.9-40.8 percent for uninsured patients. CONCLUSIONS The results of this study support expanding insurance coverage in Medicaid programs to reduce ED use for NTDC visits in the United States.
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Affiliation(s)
| | - Vuong K Diep
- CareQuest Institute for Oral Health, Boston, MA, USA
| | | | - Avery Brow
- Chase Brexton Health Care, Baltimore, MD, USA
| | | | | | - Eric P Tranby
- CareQuest Institute for Oral Health, Boston, MA, USA
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Kisely S, Ogilvie J, Lalloo R. Avoidable emergency department presentations for dental comorbidities of psychiatric disorders: A population-based record-linkage analysis. J Psychosom Res 2021; 143:110387. [PMID: 33611073 DOI: 10.1016/j.jpsychores.2021.110387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Indigenous peoples and those from non-Caucasian, poorer or rural backgrounds are at greater risk of emergency department (ED) presentations for non-traumatic or avoidable dental conditions. There is no information on people with mental illness. OBJECTIVE To compare avoidable dental ED admissions in psychiatric patients with those of the general population over 2 years. METHODS A population-based record-linkage analysis across state-based facilities in Queensland, Australia. Avoidable dental ED presentations were defined using ICD10 codes K02.9, K04.7, K05.0, K08.8 and K12. RESULTS There were 1,381,428 individuals in the linked database, of whom 657,933 (47.6%) were male. Of the sample, 177,157 (13%) had a history of contact for mental health problems and 22,046 (1.5%) had at least one avoidable dental presentation. The most two common were unspecified disorders of teeth or supportive structures (n = 10,184) and periapical abscesses (n = 7970). After adjusting for confounders, those who had ever needed psychiatric treatment were 72% more likely to experience an avoidable dental presentation (95% = 1.65-1.79; p < 0.0001). Other significant independent risk factors were lower income, rurality and Indigenous status. Within the inpatient psychiatric group, those with substance use or personality disorders had the highest risk of avoidable presentations. CONCLUSIONS In common with other marginalised groups, psychiatric patients have increased avoidable presentations. Possible clinical interventions could include an increased emphasis on oral health assessment in primary health care and early dental referral. Dental education and service planning should consider this population's needs including easier navigation of services, availability outside normal office hours, and free outreach dental clinics.
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Affiliation(s)
- Steve Kisely
- School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; Addiction and Mental Health Services, Metro South Health, Woolloongabba, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada.
| | - James Ogilvie
- Griffith Criminology Institute, Griffith University, QLD, Australia
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Herston, QLD, Australia
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