Impact of a Community Dental Access Program on Emergency Dental Admissions in Rural Maryland

Rowland, Sandi; Leider, Jonathon P.; Davidson, Clare; Brady, Joanne E.; Knudson, Alana

doi:10.2105/ajph.2016.303467

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…The proposed restoration of an adult dental care benefit for Maryland residents would allow Medicaid beneficiaries to seek dental care in more appropriate, and cost effective, settings ( 25 , 26 ). Promising community interventions to divert patients from the ED to dentists that can deliver acute dental care have been successfully used to reduce ED visits for dental conditions in rural Maryland ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland

Chalmers¹

2017

Front. Public Health

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ObjectivesHospital emergency departments (EDs) are a place where many Americans seek treatment of dental conditions. Racial and ethnic minorities consistently have higher rates of ED utilization than whites for dental conditions. The reasons for these disparities and significant public health concerns are investigated less often. In this paper, we measure trends in racial disparities in ED discharges for dental conditions in Maryland from 2010 to 2013. To understand these disparities, we also describe differences between racial groups in age, gender, income, location, payer, comorbidities, and the availability of dental care.Methods2010–2013 State Emergency Department Data for Maryland were used in the analysis. Rates per 100,000 of the population are calculated using information from census population estimates. Cost-to-charge ratios are used to estimate the costs of ED discharges. Dental/oral health-related conditions (DOHRC) are defined as discharge diagnoses of ICD-9-CM codes 520.0 through 529.9. Descriptive statistics and fixed effects logistic regression models with a rare event correction are used to analyze the data.ResultsBlacks, especially females aged 25–34, have larger proportions of total ED discharges due to DOHRC, and higher population rates of DOHRC, than any other racial or ethnic group. In 2013, Blacks represented 30% of Maryland’s population and accounted for 52% of ED costs for DOHRC. Hispanics and those of other races have much lower rates of DOHRC discharges. The regression results show that the high proportion of DOHRC discharges among Blacks may be explained by the concentration of Blacks in low-income central cities with less access to dental care.ConclusionThere are significant racial disparities in the ED utilization for DOHRC in Maryland. These disparities reflect the lack of access to dental care due to both cost and geographic limitations. This results in high healthcare costs and ineffective solutions for patients. Addressing oral health disparities will require policy solutions that are targeted to the populations most at need, and action plans that combine community and state level efforts.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland

Chalmers¹

2017

Front. Public Health

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“…This is especially true for providers willing to accept patients with MA. 20 , 21 In North Dakota, the Medicaid adult dental benefit covers exams, X-rays, cleaning, fillings, surgery, extractions, crowns, root canals, dentures (partial and full), and anesthesia. However, it will be important to find providers willing to accept MA patients.…”

Section: Discussionmentioning

confidence: 99%

“…ED providers contest this and indicated that opioids are not the recommended treatment for patients presenting with NTDC. Potential ED and dental team partnerships and referrals would not only improve quality and cost of care for patients, 21 but it would provide opportunity to educate dental providers on ED treatment and referral practices.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department and Dental Clinic Perceptions of Appropriate, and Preventable, Use of the ED for Non-Traumatic Dental Conditions in Hot-Spot Counties: A Mixed Methods Study

Schroeder,

Beck,

Medalen

et al. 2024

J Prim Care Community Health

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Objectives: Frequency of emergency department (ED) use for nontraumatic dental conditions (NTDC) is a well-researched community health concern. However, research predominately relies on ambulatory ED discharge records. This explanatory sequential mixed methods study reviewed NTDC ED use in hot-spot counties and assessed perceptions around preventable and appropriate use among EDs and dental clinics. Methods: Tooth pain data (2015-2021) were drawn from State Medicaid, and the Early Notification of Community-Based Epidemics (ESSENCE). NTDC data were compiled using International Classification of Disease, Ninth and Tenth Revisions. Employing extreme case sampling, providers in counties with the highest per-capita NTDC ED use were interviewed. Results: North Dakota experienced a decline in NTDC ED visits between 2017 and 2020, though the rate is now increasing. The greatest proportion of NTDC ED visits were among persons ages 20 to 34 and 35 to 44. ED and dental care staff have misconceptions around each other’s roles in reducing NTDC ED visits, but unanimously suggest community-level prevention as a solution. Conclusions: NTDC ED use was perceived as “appropriate” care. However, there is consensus that improved access to, and utilization of, affordable and quality preventative dental care would reduce NTDC ED visits and improve overall community health, especially among populations experiencing greater inequities.

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“…In the past, several programs promoting these types of services have successfully reduced ER use for NTDCs [ 35 ]. Despite these measures, ER visits for NTDCs continue to be a substantial strain on the health care system, with emergency services provided in the ER being the only dental coverage available to many patients in WV and surrounding regions [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Understanding Emergency Room Visits for Nontraumatic Oral Health Conditions in a Hospital Serving Rural Appalachia: Dental Informatics Study

Khanna¹,

Cecchetti²,

Bhardwaj³

et al. 2022

JMIR Form Res

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Background In the Appalachian region, a variety of factors will impact the ability of patients to maintain good oral health, which is essential for overall health and well-being. Oral health issues have led to high costs within the Appalachian hospital system. Dental informatics examines preventable dental conditions to understand the problem and suggest cost containment. Objective We aimed to demonstrate the value of dental informatics in dental health care in rural Appalachia by presenting a research study that measured emergency room (ER) use for nontraumatic dental conditions (NTDCs) and the associated economic impact in a hospital system that primarily serves rural Appalachia. Methods The Appalachian Clinical and Translational Science Institute’s oral health data mart with relevant data on patients (n=8372) with ER encounters for NTDC between 2010 and 2018 was created using Appalachian Clinical and Translational Science Institute’s research data warehouse. Exploratory analysis was then performed by developing an interactive Tableau dashboard. Dental Informatics provided the platform whereby the overall burden of these encounters, along with disparities in burden by age groups, gender, and primary payer, was assessed. Results Dental informatics was essential in understanding the overall problem and provided an interactive and easily comprehensible visualization of the situation. We found that ER visits for NTDCs declined by 40% from 2010 to 2018, but a higher percentage of visits required inpatient care and surgical intervention. Conclusions Dental informatics can provide the necessary tools and support to health care systems and state health departments across Appalachia to address serious dental problems. In this case, informatics helped identify that although inappropriate ER use for NTDCs diminished due to ER diversion efforts, they remain a significant burden. Through its visualization and data extraction techniques, dental informatics can help produce policy changes by promoting models that improve access to preventive care.

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Impact of a Community Dental Access Program on Emergency Dental Admissions in Rural Maryland

Abstract: Community dental access programs may be a viable way to patch the dental safety net in rural communities while holistic solutions are developed.

Cited by 8 publications

References 15 publications

Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland

Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland

Emergency Department and Dental Clinic Perceptions of Appropriate, and Preventable, Use of the ED for Non-Traumatic Dental Conditions in Hot-Spot Counties: A Mixed Methods Study

Understanding Emergency Room Visits for Nontraumatic Oral Health Conditions in a Hospital Serving Rural Appalachia: Dental Informatics Study

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