New Jersey residents are using hospital emergency departments for oral-health problems that could be addressed more effectively by dentists in their communities, according to a new report by the Rutgers Center for State Health Policy. However, with limited dental services in some communities, many people turn to hospitals when they have a toothache or other dental issues.
Statewide, there were 533 emergency room visits for non-traumatic oral care per 100,000 residents from 2008 to 2010. The problem is most acute for uninsured adult patients whose incomes are high enough that they don’t qualify for Medicaid. The Affordable Care Act requires that children’s dental care be covered by insurance plans, while New Jersey requires that Medicaid cover adult dental care as well.
While there is no shortage of dentists statewide, the report said there was evidence of a shortage of dental services in low-income areas, particularly off-hours. The state’s 21 federally qualified health centers provide dental care in many of the low-income areas covered by the report.
The report found that the most frequent users of emergency departments for non-traumatic oral care were young adults and residents of low-income areas.
However, there was wide variation in how much residents of different low-income areas used hospitals to treat dental problems, indicating that high-use areas could lower the use of expensive emergency services by increasing the level of community dental care.
Dental care experts cited the report in calling for several policy changes, including providing funding for new dental clinics or for off-hours dental care at existing clinics, such as the federally qualified health centers that serve low-income areas and requiring hospitals to have dentists in their emergency departments.
The report’s lead author, Kristen Lloyd, a senior analyst at the center, noted that emergency rooms usually can only provide temporary treatment for oral health problems, and rarely provide definitive treatment of the underlying problem.
The report used hospital charge data to study 13 areas with large low-income populations and compare the results to statewide emergency department dental-care use.
Residents aged 19 to 34 made 1,381 visits to hospitals for non-traumatic dental issues per 100,000 residents, more than twice as many as the overall population. ) New Jerseyans in this age group who lived in low-income areas visited emergency departments at an even higher rate, 1,686 visits per 100,000 residents.
Residents of Camden were nearly nine times more likely to use emergency departments for dental care as people in Union City. The report suggests that this is due to a relative lack of community-based dentists in Camden and other areas with a high number of emergency-department dental visits, including Atlantic City, Trenton and Asbury Park.
“There’s room for improvement in the low-performing areas,” Lloyd said yesterday in a webinar announcing the results.
Dr. Barbara Rich, past president of the New Jersey Dental Association, noted that many dentists offer comprehensive care to uninsured patients and schoolchildren for continuing-education credits.
Rich said the state could strengthen its dental-care system by requiring dental exams before children attend school; requiring dental chairs in hospitals; funding sealants for children; establishing more pediatric residency programs; and require that tap water be fluoridated.
Dr. Cecile Feldman, Rutgers School of Dental Medicine dean, emphasized that the issue is important in terms of patients’ health and financial impact. . When patients can’t afford to pay, these costs are incurred by hospitals and government. State and federally funded charity care partially offsets the cost of care to patients who cannot afford to pay.
The annual cost to hospitals to provide these services was an estimated $4,888 in Atlantic City and $4,783 in Camden, per 1,000 residents.
Feldman added that it’s “fascinating” that dentistry is an optional part of private health insurance plans, considering the pain and health conditions that dental problems can cause.
Feldman said she would be interested in learning more about the pattern of dental care that patients receive before and after hospital visits. She noted that concerns about transportation, a lack of knowledge about oral health, and fear of visiting the dentist contribute to the emergency visits.