Dental Problems Showing Up as Emergencies

A study being released today by the Pew Foundation found that 83,000 emergency department visits in California in 2007 were due to preventable dental problems. That rate of dental emergencies is likely growing quickly, according to Shelly Gehshan, director of the national Pew Children’s Dental Campaign.

“It is the wrong service, in the wrong setting, at the wrong time,” Gehshan said.

“These are people who come in with dental pain, and they’re desperate. The emergency room can’t cure that, so they don’t really get the problem taken care of.”

The root problem, she said, is that there is too little financing for dental care in the health care system. “And when you lose adult dental coverage like California did in 2009, that creates an even bigger problem,” Gehshan said.

“We do have a safety net, and it’s not big enough,” she said.

In fact, she said, California’s dental care system can only handle about 70% of the need in the state, and that’s if the system were actually at full capacity.

Like most bad news, lately, it may be getting worse.

“We have national data that, between 2006 and 2009, the number of emergency visits grew by about 16%, and that’s a very conservative estimate,” Gehshan said. “Nationally, the trend is that ER visits are increasing. And given the loss of adult dental benefits [in California] in 2009, it’s very possible those statistics would be much higher now.”

Legislation recently passed by the state Senate — SB 694  by Alex Padilla (D-Pacoima) — would establish a state Office of Oral Health. That could go a long way toward improving the system, Gehshan said.

“California does not currently have anyone in charge of dental care, and you can’t solve a problem until you know the dimensions of that problem,” she said. “It also could take these issues out of politics and into evidence—based care, and that’s a big step.”

Training more dentists is likely not the full solution, she said. “Generally, dentists go out and practice in the same ways and places that dentists already practice,” Gehshan said. “Most of them don’t accept Medi-Cal, so in a way you’d just be adding more dentists to the current system.”

The first steps, she said, seem a little simpler. “First, we need to fluoridate the water.” There are a number of California cities, including Watsonville and Riverside, that don’t fluoridate their water, and that’s one of the most cost-effective ways to improve dental health, according to Gehshan. Also, she advocates for all children to get a tooth-sealant treatment.

“With this study, we wanted to focus some attention on just how bad this problem is,” Gehshan said. “In California, you’re looking at 333 areas where there is a federally designated shortage of dental care. You’re looking at a pool of about a million kids who may not have access to care, and that’s a huge problem.”

One-quarter of all kids in California have never been to a dentist, according to previous studies. So when those children and their parents end up in the emergency room, using time and resources that could be better spent on non-dental emergencies, that costs California cash, Gehshan said.

“We’re pouring money down a hole,” she said, “instead of putting it where it could do some good.”

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