Americans who turn up in the emergency room to get dental care aren’t lost, they’re probably just running out of options.
According to a new report from the Pew Center on the States, more than 800,000 visits to the ER in 2009 were for toothaches and other avoidable dental ailments.
“People showing up at emergency rooms for dental is really your sign that your system is breaking down,” Shelly Gehshan, director for the Pew Center’s Children’s Dental Campaign says. “It’s just not serving enough people. This is your symptom of a system in crisis.”
During times of economic crisis, state Medicaid programs often target dental benefits as their first budgetary cut, pushing low-income patients from the dentist office to the emergency room. But the shift from Medicaid reimbursements to hospitals is still costly to states. Dental groups have long since said that ERs only provide temporary relief for dental emergencies and lead to reoccurring hospital visits, which burden taxpayers. “We’re spending in the worst possible way,” Gehshan says.
For example the report shows that in 2002 Maryland had a 12 percent increase in the rate of ER dental visits once the state stopped Medicaid reimbursements for private practice dentists treating adult emergencies. Florida reported more than 115,000 dental-related ER visits in 2010, and in Oregon a 31 percent hike of ER cases among Medicaid enrollees over a three-year-period.
Access to dental care is also creating the surge in ER visits. Safety-net facilities like community health centers are losing federal dollars and are unable to provide comprehensive dental care. The report suggests several steps to alleviate this problem. “States committed to serving more low-income people should ensure their Medicaid reimbursement rates are high enough to cover the cost of care,” the report notes. Gehshan says that 90 percent of dental care in the U.S. is done by private practitioners and the majority of them don’t accept Medicaid.
Another strategy includes implementing ‘dental therapists’ or providers that are similar to nurse practitioners in the medical field. According to the report, dental therapists would be supervised by dentists and “could perform some services offered by dentists, including both preventive and restorative (e.g., filling cavities) care.” Minnesota and some Native American Alaskan tribes are already using these professionals.
But the American Dental Association, which released a statement on Tuesday agreeing with much of Pew’s report, opposes the idea of expanding dental therapists in the U.S. The dental association challenges Pew’s projections of a decreasing supply of trained dentists and notes that relegating patients to “so-called ‘midlevel dental providers’ is wrongheaded.” The ADA cites the Journal of Dental Education’s 2009 report that “both the ratio of dentists to population and the net number of dentists will increase, not decrease, contrary to what the Pew report states.”
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Glad to see this issue getting more and more attention.
Midlevel’s will fill voids in dentistry which are constant and never ending; nursing homes, prisons, mental institutions, community health care centers, Indian reservations and rural dental needs across our nation. Corporate ADA and its affiliated state dental associations continue to muscle out competitors which have been trained and educated to provide oral health care services. These competitors include trained and educated denturists who have been closed down and jailed for providing denture care using non-invasive and reversible dental procedures, yet the American Dental Association and state dental boards continue to allow oral piercing to go on knowing the outcome of the procedures used which are invasive and irreversible. The battle between ADA’s policies and denturists, have been on going for decades. My case in Wyoming is a good example of the many men and women across our nation who have fought to do what they’ve been trained and educated in and that’s providing denture care directly to the public. Denturists are regulated in six states and the fight goes on in the other 44. I’m not giving up my profession. Gary W. Vollan L.D.
Hi Mr Vollan,
I am amoral surgeon and I agree with you that this repression of the development of an ancillary dental manpower workforce is simply the ADA keeping out competition on all fronts, i.e. denturists, dental hygienists, et.c The medical profession has all kinds of ancillary professionals extending the medical services of physicians, i.e. nurse practioners, physician assistants, etc,. Why doesn’t the dental profession help to develop its ancillary workforce. As you so well point out there is so much unmet dental need in our country. ( I did work as a public health dentist in Arizona in the “80s on the Navajo-Hopi Indian reservations). It would greatly benefit society as a whole to be able to extend basic dental care services to those areas and populations of greatest need and highest risk. There are not enough dentists in the areas where the need is greatest. L Bryant, DDS