Emergency department referrals

A growing number of people rely on hospital emergency departments (EDs) to provide care for dental pain and related issues. The habit of visiting the ED for dental care often keeps these individuals from choosing a dentist who can treat the complex, underlying problems causing their dental pain – a step that can prevent future dental emergencies.

Here are statistics that explain the scope of the issue:

• Emergency department visits for dental health care cost three times as much as a visit to the dentist, averaging $749 if the patient isn’t hospitalized, amounting to $1.6 billion annually (one-third of which is paid by Medicaid).
• In 2009, abscesses and dental caries – both largely preventable conditions – accounted for nearly 80 percent of dental-related emergency room visits, according to the Healthcare Cost and Utilization Project.
• In 2018, there were approximately 663,000 non-traumatic dental conditions (NTDCs) causing emergency department visits and approximately 7,500 inpatient admissions for non-dual-eligible adults ages 21-64.
• In 2018, emergency department use for non-traumatic dental conditions (NTDCs) among Medicaid-enrolled, non-dual-eligible adults ages 21-64 varied by state, but were generally higher for adults ages 21-34, with a national rate of 2,794 visits per 100,000 adult beneficiaries compared to 1,989 visits per 100,000 adult beneficiaries ages 35-64.
• Studies have shown that the uninsured and Medicaid patients seek dental care in emergency departments more frequently than those with insurance.
• Women aged 21 to 34 are the most frequent users of emergency departments for dental problems. As states cut adult dental Medicaid benefits in an attempt to reduce healthcare costs, these costs are simply shifted to the emergency department to provide palliative care for preventable dental conditions.
• Visits to the emergency department ER for dental pain can range from $400 to $1,500, as compared with $90 to $200 for a visit to the dentist. The most extreme cases of untreated dental infections have cost hundreds of thousands of dollars in hospitalization, and some have ended in tragic yet preventable deaths.

This ADA program focuses on three important opportunities:

• Connecting patients to ongoing care in their communities, including resources they may not know about
• Creating a stakeholder-based program that emphasizes the value of what dentists do and the importance of having a dental home
• A strong, supportive collaboration with local and national leaders from the American College of Emergency Physicians (ACEP)

Our program offers seven unique ED referral models, allowing customized design of public-private partnerships at the local level. These models range from an educational facility model that works from a community benefit perspective to a health-center-based specialty process to a patient volunteer model which allows community members to guide the process.

People suffering from dental pain need somewhere to turn for help. Though many assume that the emergency department is the only place they can seek dental care, it is possible to introduce them to other care options in their communities.

The ADA’s Action for Dental Health campaign supports seven ED referral models that can be implemented in your community. Here are fact sheets, reports and infographics that describe the various models and offer more background to help you get started.

ADA Emergency Department Referral Program development guide (PDF)

ADA Emergency Department referral models (PDF)

ADA Health Policy Institute infographic: ED referrals (PDF)

Analysis from the Centers for Medicare & Medicaid Services (CMS): Medicaid adult beneficiaries emergency department visits for non-traumatic dental conditions

Agency for Healthcare Research and Quality (AHRQ): Most frequent reasons for emergency department visits, 2018 

Here are webinars that can help you build an effective program in your area:

Emergency department referral model in action: addressing dental access, opioid prevention and pain management 

ACEP Online Learning Collaborative: Dental 101 for ED physicians

Michigan: Emergency department visits for dental pain decreased by 72%

In Calhoun County, a unique partnership between local dentists, community leaders and low-income residents transformed access to dental care. Patients who demonstrate financial need are referred to volunteer dentists from several sources, including hospital emergency departments. Volunteer dentists provide treatment to the patients in their own offices. As payment, patients provide community service to local nonprofit organizations.

Outcomes:

• Emergency department visits for dental pain decreased by 72% over 5 years and repeat visits have been nearly eliminated.
• One local hospital saved $6 million in 4.5 years.
• More than 43,000 hours of volunteer service were contributed to the community.
• More than 3,000 patients received free care.

Maine: Up to 70% reduction in emergency department visits for dental pain in some hospitals

In Maine, a simple model to use the dental workforce more efficiently got big results. Every patient who came to the emergency department with dental pain received one prescription for painkillers and antibiotics and a referral to a local clinic or oral surgeon. The goal: to eliminate visits to the emergency department for the same problem.

Program organizers report that emergency department visits for dental pain and infection at some participating hospitals dropped by as much as 70 percent, with the potential to save the state millions in Medicaid dollars.

The pilot program, which began with 11 hospitals, was expected to expand across the state.

Washington state: dentistry and medicine join forces to treat the uninsured

Swedish Medical Center in Seattle experienced an increase in emergency department visits for dental pain following severe cuts in adult dental Medicaid. Working with state and local dental societies, the hospital was able to reduce preventable visits to the emergency department by providing complex tooth extractions on-site to patients who were unable to receive care through the dental safety net. Volunteer dentists are recruited by the local dental society.

Outcomes:

• The program was recognized by the Health Resources and Services Administration as a best practice for referring dental patients from the ED.
• 380 patients were treated by more than 30 volunteer dentists in the first year.
• An estimated 1,000 patients were seen by 60 volunteer dentists in the second year.

Virginia: An in-hospital dental clinic significantly improves patient care

A pilot program to refer patients with dental pain from the emergency department to an urgent dental care clinic located in the hospital saw positive outcomes:

• Dental-related issues managed by the ED decreased by 52%.
• Dental patients with repeat visits to the ED dropped by 66%.