Emergency department use for nontraumatic dental conditions among children and adolescents: NEDS 2014‐2015

Abstract

Objectives: Despite great efforts to improve paediatric dental care access in the last two decades, the use of emergency departments (ED) for dental conditions among children that are more appropriately addressed in dental offices remains a public health concern in the United States. We examined factors associated with ED visits for nontraumatic dental conditions or NTDCs and ED visits for any other reason among children and adolescents.Methods: A retrospective secondary data analysis of ED visits was conducted using the 2014-2015 Nationwide Emergency Department Sample (NEDS) data. NTDCs were further categorized as diseases of hard tissue (eg dental caries), pulp/periapical (eg root canal infections), gingival/periodontal (eg conditions that affect the supporting tissues) and other. We included patient/socioeconomic characteristics, disposition, time of visit, and the Grouped Charlson Comorbidity Index (GRPCI) in our analysis. Bivariate associations were tested using chi-squared test (α = 0.05).Results: There were 70 616 194 ED visits in 2014-15, with 465 353 (0.7%) visits for NTDCs. Statistically significant differences were observed for all patient characteristics tested, except for gender when comparing children visiting the ED for NTDCs and children visiting for any other reason. Medicaid was the expected payer for nearly 60% of all ED visits, and the uninsured shared a larger proportion of NTDC visits (19.4%) than other visits (8.8%). Late adolescents (aged 18-21) accounted for over 50% of NTDC visits but only one-fifth of all other types of ED visits. Late adolescents (18-21 years old) who were uninsured had a significantly higher proportion of NTDC visits. Of all NTDC visits, 19.1% were related to hard tissue disease, 25.3% pulp/periapical, 7.9% periodontal disease, and the remaining were grouped as other dental diseases. Conclusions:The ED use for NTDCs is more common among late adolescents, Medicaid and uninsured groups. Examining and implementing new approaches that improve access to routine dental care for these groups may help in reducing inefficient ED use related to NTDCs.

Caries-related hospital morbidity in the Brazilian Unified Health System from 2008 to 2022

“…dental caries) in different countries and health systems. [12][13][14][15] The intersection between DC as a Public Health issue and its treatment in inpatient settings raises the question: how does the Brazilian Unified Health System (SUS) fit into this scenario?…”

Non‐traumatic emergency department dental visits among patients 0–25 years of age: A systematic review and meta‐analysis

“…These guidelines consider the diagnosis and management of fractures, luxations and avulsions of both the primary and permanent dentition. Nontraumatic dental conditions (NTDC) are therefore any diagnosis that is not traumatic in nature and commonly includes dental caries, periapical abscesses, facial cellulitis, periodontal disease and acute presentations of oral pathology 6 . Given the vast range of possible diagnoses, there is no classification of NTDC.…”

“…Worldwide NTDC place a significant strain on emergency departments (EDs) of tertiary hospitals 6 . One study from the United States of America (USA) demonstrated an increase in dental presentations in EDs over the past 10–20 years 8 .…”

“…Nontraumatic dental conditions (NTDC) are therefore any diagnosis that is not traumatic in nature and commonly includes dental caries, periapical abscesses, facial cellulitis, periodontal disease and acute presentations of oral pathology. 6 Given the vast range of possible diagnoses, there is no classification of NTDC. NTDC, however, are covered by specific codes within the International Classification of Disease, an epidemiological diagnostic tool maintained by the World Health Organization.…”

“…7 Worldwide NTDC place a significant strain on emergency departments (EDs) of tertiary hospitals. 6 One study from the United States of America (USA) demonstrated an increase in dental presentations in EDs over the past 10-20 years. 8 Many factors influence the prevalence of NTDC, including patient distance from the hospital, socioeconomic status of the population surrounding the hospital, limited oral health awareness and irregular access to dental services.…”