When people do not have access to preventive dental care for problems like gum disease and tooth decay, treatable dental issues will become a much bigger problem, often causing excruciating pain, leading them to seek care in an emergency room. According to the American Association of State and Territorial Dental Directors (ASTDD), approximately 2.4 million people use an emergency room to address non-traumatic dental conditions (NTDCs) such as tooth abscesses due to inadequate dental care. This is particularly true with individuals who may not have insurance or an established dentist where they can receive routine and preventive dental care.
As a former ER doctor, I encountered many situations where people did not realize that an ER can do little to help with a dental issue because physicians are typically not trained in dental care. In fact, it is illegal in most states for anyone other than a dentist to perform an emergency tooth extraction, emergency root canal, or other dental care. With limitations for treatment, emergency room physicians can only focus on managing symptoms and pain, not the root cause, which means a patient leaves with a costly medical bill from the ER and still needs to see a dentist for a long-term solution.
This presents a significant issue in terms of overcrowded ERs, potentially unnecessary pain prescriptions, and often a revolving door of patients returning since their dental issue was not resolved. We know intervention will help. That is why Sun Life’s dental benefits business, DentaQuest, mines our claims and other data in various markets nationwide to identify members with NTDCs who utilized an ER for care. Once identified, case managers in certain markets will reach out to educate them on how to access appropriate and cost-effective alternatives for dental issues. These include scheduling appointments with a patient-centered dental home to establish an ongoing relationship, as well as offering guidance on what to do during a dental emergency, how to get the appropriate care, and how to access the right care at the right time. Our case managers will also assist with needed services and transportation options for our highest-risk members who have health issues such as diabetes that make them more vulnerable to tooth decay and gum disease.
The healthcare system is fragmented, especially for people uninsured or underinsured, so it is imperative that all stakeholders including consumers, state governments, health insurance companies, and dental and medical providers, work together to create more access points for preventive dental care.