Emergency department visits for nontraumatic dental conditions: a systematic literature review

Abstract

Objective: To summarize the literature on factors associated with emergency department (ED) use for nontraumatic dental conditions (NTDCs). Methods: Following a database search, empirical studies were included if they examined factors associated with ED visits for NTDCs. The factors identified in these studies were further categorized using the Andersen Behavioral Model. Where appropriate, odds ratios (ORs) predicting the likelihood of NTDC ED visits were extracted to obtain summary estimates using random effects models. Results: Sixty-three articles were included. Nontraumatic dental ED visits made up about 2.2 percent of all ED visits. Having public health insurance coverage such as Medicaid [OR = 2.17, 95 percent confidence interval (CI) = 1.79-2.64], and being uninsured (OR = 2.80, 95 percent CI = 2.39-3.39) were predictive of ED visits for NTDCs. Adults were more likely to use the ED for NTDCs compared to children and older adults. Rural adults had increased odds of ED use for NTDCs compared to urban adults (OR = 1.31, 95 percent CI = 1.12-1.52). Among younger children, regular dental care without sealant placement was associated with increased ED use for NTDCs. In the United States, both expansion and restriction of Medicaid dental coverage for adults were associated with increased ED visits for NTDCs. Conclusions: Policy makers and health care providers should address modifiable factors such as accessible dental care for the uninsured, and comprehensive dental coverage for those with public dental benefits. Targeted interventions should focus on young adults, children with special needs, and subpopulations with low socioeconomic status and chronic health conditions.

A state‐wide study of dental comorbidities in psychiatric disorders resulting in avoidable emergency department presentations

“…This is probably because toothache and dental abscesses are generally a complication of caries. As in other work, we found that people from Indigenous, poorer or rural backgrounds were generally at greater risk of all types of avoidable dental conditions 16–18 . There were similar findings for people with mental illness although this did not apply to all forms, the associations being non‐significant for periodontal disease and stomatitis.…”

“…As in other work, we found that people from Indigenous, poorer or rural backgrounds were generally at greater risk of all types of avoidable dental conditions. [16][17][18] There were similar findings for people with mental illness although this did not apply to all forms, the associations being nonsignificant for periodontal disease and stomatitis. This excess of presentations in psychiatric patients is consistent with findings of inequitable access to guideline-appropriate care for physical ill-health in general.…”

“…[23][24][25] In addition, a recent systematic review of studies in all age groups found no differences between Caucasian and African-Americans and a reduced odds of presentation in Hispanic Americans. 17 Explanations for an increased risk of an ED presentation for toothache, dental abscesses and caries in people with a psychiatric history are similar to those responsible for the excess of non-traumatic ED presentations in other socially disadvantaged or marginalised groups. These include limited financial resources and factors such as smoking, alcohol or substance use.…”

“…29 This is illustrated by findings from the United States where people without health insurance are more likely to present to ED with dental conditions, and this is especially relevant for those with mental illness who may encounter difficulties in obtaining cover. 17,30,31 Dental treatment is also often largely excluded from universal healthcare systems in countries such as Canada, Australia and the United Kingdom. 5,16 Dental hospitals and community clinics offer subsidised care but are concentrated in metropolitan areas and often operate on an appointment model, potentially delaying care for acute conditions, or on a first-come, first-served basis so that patients have to arrive early in the day.…”

Addressing Oral Health of Low-Income Populations—A Call to Action

“…In fact, uninsured adults are 3 times more likely to visit the emergency department for dental emergencies than privately insured adults. 5 Medicaid adult dental coverage varies significantly across states. According to a report from the Center for Health Care Strategies, 3 states have no adult dental coverage, 11 have emergency dental services only, 15 have limited dental benefit, and 20 states and Washington, DC, have extensive coverage under Medicaid.…”