Emergency room visits for toothaches and other dental concerns are on the rise nationally, according to recent analyses from the American Dental Association and The Pew Center on the States. This month, researchers at the Rutgers Center for State Health Policy report on the same trends in New Jersey.
Senior research analyst Kristen Lloyd and her team examined billing data for emergency departments across New Jersey. They counted up ER visits where patients showed up with a dental complaint not related to trauma or injury.
“There is no code that says this was an inappropriate use of the emergency department — that doesn’t exist, but it would be preferable and less costly for individuals to see a dentist,” Lloyd said.
The Rutgers report found that ER visits for dental trouble are especially frequent among young people age 19 to 34 — nearly twice the rate for any other age group examined.
“They are sort of in this gap, where they are falling off parents’ insurance or they are aging out of Family Care or Medicaid that provides them some dental coverage, and they can’t afford their own,” Lloyd said.
The number of ER visits for dental care was high in some low-income regions including Trenton, Atlantic City and Camden, but rates were lower than the state average in other low-income regions including Elizabeth, Jersey City and Union City.
“Their residents are not showing up in [emergency departments] as often for this,” Lloyd said.
New Jersey’s bigger teaching hospitals sometimes have a dental resident on-call, but most hospital emergency rooms don’t have a dentist on staff.
“They can provide you with an antibiotic and help with the pain but really you need to go to a dentist to get that taken care of ultimately,” Llyod said.
Many community-based dental offices are closed after 6 p.m. and on weekends, but the state’s federally qualified health centers (FQHC) have expanded hours.
“We are in every county, we have evening hours, we have Saturday hours and some of our FQHCs are even open on Sundays,” said Tonya Cook, the chief dental officer at the Jewish Renaissance Medical Center in Middlesex County.
FQHCs offer free or reduced-price care and the centers receive government dollars to serve low-income people.
“As long as they meet the requirements, the visit is covered — they have to pay a small co-pay — and then we can meet all their dental needs,” Cook said.
Cook is brainstorming with the Rutgers team to find ways to reduce emergency room visits. She said she wishes more hospital ERs would direct dental patients to a specific federally qualified health center.
“I think a lot of it is about having relationships with the hospitals and being able to refer patients back,” she said.
The Affordable Care Act does not require health plans to provide dental coverage to adults. While dental care is — technically — supposed to a be an “essential health benefit” for children — health-law watchers are sounding alarms and say the intent of that rule and the reality don’t match up.
Dental care is part of the Medicaid plan in New Jersey. When New Jersey expanded its Medicaid program this year, many of Cook’s uninsured patients recently gained dental coverage.
“I would like to see what happens in the next couple of months now that this population has insurance,” she said.
The emergency room is an expensive place to get any kind of care, and the Rutgers researchers are examining different parts of New Jersey’s health system looking for ways to move people to care locations that are less costly and most appropriate for the help they need.
The Nicholson Foundation funded the Rutgers study.