Report: A Costly Dental Destination
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.
Oral health problems can also lead to poor nutrition, inability to concentrate in school, social withdrawal and difficulty securing employment.<a name="continued"></a>
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.
Related coverage: Kansas' Oral Health Care Provider Shortage
→ Bill considered that would allow dentists to have more practice locations (2/18/14)
→ Statehouse push made for mid-level dental practitioners (2/12/14)
→ Americans for Prosperity joins effort to license mid-level dental providers (1/8/14)
→ Kansas Medicaid program still lags nation in oral health care for kids (11/12/13)
→ Kansas dental program for children on hold because of KanCare MCO (11/11/13)
→ Dental mediation effort ends without compromise (11/4/13)
→ Disputing parties enter formal mediation over mid-level dental providers (10/3/13)
→ Pew report cites need for mid-level dental providers (6/25/13)
→ Dentist groups announce scholarships for dentists going to rural areas (2/7/13)
→ Advocates for mid-level dental providers meet with legislators (2/6/13)
→ Bill to license mid-level dental providers introduced (1/29/13)
→ Regents will hear proposal to train mid-level dental practitioners (10/17/12)
→ Dentist shortage proposal not funded in Regents' recommended budget (9/20/12)
→ Report questions economic viability of mid-level dental providers (7/26/12)
→ Task force recommends building state's first dental school (6/21/12)
→ Dentists shouldn't fear mid-level dental care, expert says (4/20/12)
→ No consensus on how to end ‘dental deserts’ (4/9/12)
→ Worldwide review says mid-level dental providers give good care (4/10/12)
→ Bill to increase dental care access given initial approval in Senate (3/15/12)
→ New caucus told of oral health success in southeast Kansas (3/8/12)
→ More Kansans head to ER for dental care (2/29/12)
→ Dental association says new program will increase access in rural areas (2/2/12)
→ ‘Turf battle’ continues over dental practitioner bill (1/30/12)
→ Summit to focus on training plan for mid-level dental practitioners (11/29/11)
→ Between a hygienist and a dentist, a hard sell (10/26/11)
→ Political fight continues over mid-level dental practitioners (10/11/11)
→ Better prevention would help solve dentist shortage, advocate says (7/22/11)
→ Dentists: Practitioner bill flawed (3/9/11)
→ Videos detail shortage of Kansas dental providers (12/8/10)
→ Slow going in efforts to solve state’s dentist shortage (8/30/10)
→ Safety-net clinics filling gap in dental services to low-income Kansans (8/30/10)
→ Replacing town’s only dentist ‘hardest’ project ever (8/30/10)
→ Progress made on oral health, but problems remain (1/14/09)
→ Funding bill contains seed money for 'dental hubs' (5/4/07)
→ Increasing access aim of oral health coalition (12/21/06)
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