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Feb. 29, 2012
TOPEKA Toothaches and other dental problems accounted for at least 17,500 emergency room visits in Kansas in 2010, according to a national report released this week by the Pew Center on the States.
And there likely were more than that given that of the 142 hospitals in Kansas at the time of the study, 30 did not report data on dental-related ER visits.
Most of the visits involved low-income or uninsured patients who did not have other access to dental care they could afford.
“Nearly all dental emergencies can be prevented through routine, preventive care that is not available to many Kansas families,” Cathy Harding, executive director of the Kansas Association for the Medically Underserved, said in a prepared statement that accompanied the report.
It’s unclear how much the visits cost Kansas hospitals or the state’s Medicaid program. A 2010 study of dental-related ER visits found that treating about 330,000 cases cost nearly $110 million, or more than $300 per visit on average.
Tanya Dorf Brunner — executive director of Oral Health Kansas — said ERs are not the appropriate place for people with dental problems, because only symptoms can be treated there, not the underlying problem.
"The only services that can be provided in the emergency room are prescriptions for antibiotics and/or pain medication," she said. "The patient usually ends up back in the ER with the same problem, because he or she is not able to get the underlying dental problem fixed."
The cost for the individual and for the community when oral health problems go unchecked can be many more times expensive than the cost of prevention, advocates have said.
Once oral health has deteriorated to the point that the pain forces someone to a dentist or the emergency room, the cost for corrective procedures — such as root canals — is steep.
Access to care
In Kansas, children in low- and modest-income families are eligible for Medicaid-funded dental care; adults are not.
But fewer than 25 percent of the state’s dentists accept Medicaid patients. Twenty-eight of the 105 counties in Kansas do not have a dentist who takes Medicaid.
Medicaid patients in Ellsworth County do have access to dental care. That's probably why the hospital there has not seen many ER patients seeking dental care, said Ellsworth County Medical Center Chief Executive Roger Masse.
"We are fortunate in Ellsworth that there are two dentists in the community and they make themselves available. Some with Medicaid coverage can be seen by those dentists," Masse said.
To increase access to preventive dental care in the state, Oral Health Kansas, the Kansas Health Foundation and other groups have supported the licensing of mid-level dental practitioners in Kansas. The Kansas Health Foundation is a major funder of the Kansas Health Institute.
Under proposed legislation, the practitioners would be able to provide a prescribed list of routine dental services under the supervision of a dentist, but the dentist would not necessarily have to be present during the procedures.
Dentists opposed to the bill have said they think it would be unsafe to let the practitioners do things such as drill and fill teeth without a dentist at hand.
'Recipe for disaster'
Ellsworth dentist Mark Herzog said he has accepted Medicaid patients for 26 years — even though these days he loses money on them — because "it's a moral obligation to me."
He said the proposed midlevel practitioner idea was a bad one because it would let technicians with too little training perform tasks best done by dentists.
"It think it's an accident waiting to happen," he said. "I think it's a recipe for disaster."
Herzog said only dentists should be allowed to perform procedures that aren't reversible, including drilling and extracting adult teeth.
Herzog said he supported other approaches to increasing oral health care access, including the recently announced KIND program, sponsored by Delta Dental of Kansas Foundation and the Kansas Dental Association. The program aims to place three recently graduated dentists in underserved areas this year using loan repayment incentives.
The American Dental Association responded to the Pew report saying:
The report validates what the ADA has been saying for years: Too many Americans face barriers that impede their ability to get dental care...We believe that part of the solution involves a fundamental shift away from surgery and toward prevention.
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