Dental hygienists in emergency rooms

The Florida Public Health Institute recently published that there were 115,000 emergency room visits for preventable dental conditions in Florida in 2010, at a cost of $88 million.

by CHRISTINE NATHE, RDH, MS

Consider reading: Integration Of Oral Health Into Health-Care Systems
http://www.rdhmag.com/articles/print/volume-32/volume-12/columns/integration-of-oral-health-into-health-care-systems.html

Consider reading: Pediatrics and dental public health
http://www.rdhmag.com/articles/print/volume-32/issue-11/columns/value-are-the-cornerstone.html

Consider reading: Why faculty should be involved
http://www.rdhmag.com/articles/print/volume-32/issue-10/columns/why-faculty-should-be-involved.html

The Florida Public Health Institute recently published that there were 115,000 emergency room visits for preventable dental conditions in Florida in 2010, at a cost of $88 million. One third of those visits were charged to the state Medicaid program at a cost of almost $30 million, according to the report.1 This raises the question of whether the same amount could have been used to prevent the emergencies from occurring.

This phenomenon is not isolated to the state of Florida. In fact, I believe most dental hygienists know that Americans are using hospital emergency rooms at an alarming rate as a mechanism to receive emergency dental care. When people do not obtain consistent, preventive dental services and postpone care until they develop infections, they seek care in hospital emergency rooms. This consequence of failed prevention is costly to the health-care system, and more importantly, it rarely addresses the problem since few emergency rooms deliver comprehensive dental services. As a result, patients routinely receive temporary pain relief through medication, and in some acute cases, surgical care.

So once again, our challenge is to reach the people who do not consistently visit dental offices. One solution is to integrate dental hygiene into the existing health-care system. Just as school-based clinics provide access to underserved populations by using an existing setting, a hospital could replicate the same model. In order to provide care for underserved individuals, it is important to provide services wherever people go with their dental concerns.

As members of the health-care team, and in collaboration with dentists, dental hygienists can perform necessary procedures for total patient care. A dental hygienist working in an emergency room could be responsible for coordinating care by the dentists or physicians, while simultaneously educating, providing preventive care, and following up to ensure consistent and routine dental care for emergency room patients.

This solution addresses short- and long-term cost effectiveness principles. In the short term, patients can be triaged and followed up so that necessary dental care is provided to stop infection and pain. This decreases the costs associated with continued use of pain medicine and antibiotics, and on a larger scale, surgical intervention. In the long term, preventive education and services could decrease the need for restorative and urgent care.

This model creates a dental care coordination program and integrates oral health into existing health-care systems. The dental hygienist would improve and expand the quality of care, which would benefit the staff, administration, and most importantly, patients of an emergency room, while decreasing costs. This dental hygiene position, which would provide necessary preventive dental care, could become an integral part of existing interdisciplinary comprehensive services. RDH

References

(1) Gentry C. Lack of preventive dental coverage ends up costing state: report. Health News Florida (2012) Retrieved on November 7, 2012 from http://www.healthnewsflorida.org/hnf_stories/read/lack_of_preventive_dental_coverage_ends_up_costing_state_report.

CHRISTINE NATHE, RDH, MS, is a professor and graduate program director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of “Dental Public Health Research” (www.pearsonhighered.com/educator), which is in its third edition with Pearson. She can be reached at cnathe@salud.unm.edu or (505) 272-8147

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