Oral Health Funders Collaborative Releases Study of Oregon Emergency Department Dental Visits

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A new study of emergency department visits in Oregon, released today, finds that dental problems drive 77 patients every day to emergency departments across the state.

Our study demonstrates that ED dental visits are very common in Oregon, and concentrated among the most economically disadvantaged young adults

A new study of emergency department (ED) visits in Oregon, released today, finds that dental problems drive 77 patients every day to emergency departments across the state. Read the full report here.

Dental problems represent the second most common ED discharge diagnosis in adults (ages 20-39 years) after abdominal pain. Medicaid beneficiaries and the uninsured are at particularly high risk for ED dental visits. The visits are associated with a 25% repeat visit rate for the same problem, and account for $8 million in statewide hospital costs annually.

“Our study demonstrates that ED dental visits are very common in Oregon, and concentrated among the most economically disadvantaged young adults,” said Dr. Benjamin Sun, MD, MPP, Associate Professor, Department of Emergency Medicine at Oregon Health & Science University. Dr. Sun and Dr. Donald Chi, DDS, PhD, with the University of Washington’s Department of Oral Health Services produced the study in collaboration with researchers from both universities, as well as staff from the Slocum Research & Education Foundation, Metro and the Oregon Office of Rural Health.

Dr. Sun observed that, “It will be critical to identify more effective and less expensive approaches to this common problem. Controlling ED dental costs will be especially important for Oregon’s Medicaid beneficiaries, as the state combines medical and dental benefits into the same budgets.”

The Oral Health Funders Collaborative, made up of 10 leading philanthropic organizations representing Oregon and Southwest Washington, commissioned the research. The Collaborative has come together to raise awareness of oral disease, with a goal of identifying and implementing the most potent and cost-effective strategies to improve oral health for all residents of Oregon and SW Washington. They are also focused on reducing disparities in access and quality.

For this ED study, investigators reviewed data from a sample of Oregon hospitals and the All Payer All Claims Database, in addition to analyzing interviews with patients, administrators, and health care providers. Their goals were to understand the frequency of dental visits to Emergency Departments in Oregon, the costs associated with the visits, and the reasons people go to the ED for dental pain, which include:

  •     Community-level factors such as lack of urgent care clinics, insufficient information about available dental care, and no water fluoridation;
  •     Provider-level factors such as the reluctance of dentists to accept Medicaid insurance, dental office policies that may not permit after-hours emergencies, and referrals to EDs by dentists;
  •     Patient-level factors such as dental fears, emphasis on symptom-driven care rather than preventive oral health, and lack of a regular dentist.

The study found that over 500 Oregonians require hospital admission for dental problems and their complications every year. While these costly admissions might be avoided with prompt access to dental care in the community, the research highlights the need to preserve access to EDs for dental care when no other options are available – to avoid putting patients with dental problems at risk of developing complications such as spread of dental infections to the face, neck or heart valves, or of dental infections worsening chronic diseases such as diabetes.

“Too many people in Oregon are suffering from dental pain caused by bacteria in the mouth. These people seek medical attention in the Emergency Department, a place that is ill-equipped to address the problem. Generally, ED physicians can only prescribe antibiotics or painkillers to treat the infection even though the problem might be solved if a dentist extracted the tooth. This research underscores the need for more education and prevention services early on in a person’s life, to reduce the chance of infection in their young adulthood – as well as the frequency and cost of ED visits for dental pain,” said Melissa Freeman, Director of Strategic Projects at The Oregon Community Foundation.

By commissioning this research, the Oral Health Funders Collaborative sought to highlight system changes needed to improve access to affordable, timely and quality dental care for people who are uninsured, under-insured or on Medicaid. “As a collaborative, we are focused on raising awareness of dental disease and investing in infrastructure to improve the system for all,” said Freeman.
The study team identified several potential solutions, such as: improving preventive dental care for adolescents; strengthening the oral health surveillance system; incorporating oral health in public schools; and improving patient and provider education about dental benefit changes in the state Medicaid program.

The Collaborative has also been working on a strategic plan for improving oral health in Oregon, in partnership with the Oregon Oral Health Coalition and the Oregon Health Authority.

About the Oral Health Funders Collaborative

The Oral Health Funders Collaborative was formed in 2011 to address one of Oregon’s most pressing public health problems: dental disease. Ten of our region’s top charitable foundations have pooled resources and coordinated efforts to raise awareness of oral disease and invest in research and infrastructure needed to improve oral health for residents of Oregon and Southwest Washington. Members include The Ford Family Foundation, The Dental Foundation of Oregon, Grantmakers of Oregon and Southwest Washington, Kaiser Permanente, Northwest Health Foundation, The Oregon Community Foundation, Providence Health & Services, Ronald McDonald House Charities® of Oregon and Southwest Washington, Samaritan Health Services, and Cambia Health Foundation. PacificSource Foundation for Health Improvement contributed resources to the study as well.

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Brandi Buckman