June 3, 2016
by Dr. Bruce Pynn
As I return from the hospital emergency room (ER) after seeing yet another patient in dental pain (my fifth this week while on-call and that’s not counting the infections and fractures!), I wonder how we can do better as a dental community by these patients while easing the burden on the emergency department at the hospital.
The reasons patients find their way to the ER is often out of desperation and or frustration. They have nowhere else to turn. Many patients who don’t have a dentist, dental coverage or coverage through one of the government funded programs (GFP) (in Ontario, the GFP for adults are Ontario Works and Ontario Disability Support Program) – which can be inadequate.
While these GFPs cover some of the basics (i.e. extractions), the reimbursement rates are well below private dental insurance and below the actual cost of the treatment leading some dentists to limit the number of social assistance patients they can accept to some not taking these patients at all. It’s a significant problem and affecting access to dental care for these patients.
In 2014, approximately 60,000 dental patients showed up at the Ontario hospital emergency rooms at a cost of $30 million dollars.* The cost of an ER dental visit is more than $500 and the patient doesn’t receive any definitive dental care – often just a consult by the ER doctor, an brief intra-oral exam , perhaps an x-ray, some pain medications and or some antibiotics. This cost does not include those who require hospitalization or surgical intervention. In addition, more than 200,000 visited their primary medical provider for dental pain at the cost $8 million and again no treatment.
It is imperative that strategies are developed at a local, regional, and provincial levels to decrease the heavy burden that is being placed on Ontario’s emergency rooms, while at the same time enabling patients to get the care they deserve.
Many of the dental concerns I see in my hospital’s ER can – and should – be managed in the community. In my home of Thunder Bay, community dentists work with the ER to triage and re-direct patients into dental offices. It doesn’t always work, but it’s a good start. The Ontario Dental Association is working with government to seek out opportunities to streamline the dental care system, improve funding and provide all Ontarians with access to high quality, timely dental care in their own communities. This work benefits the dental community, government and most importantly, our patients.OH
*Statistics, Association of Ontario Health Centres
**A personal note, perhaps a selfish reason, I would like to try and help fix this problem because when I have the ‘Big One’, as Redd Foxx would say on ‘Sanford and Sons‘, I don’t want the ER department to be busy with non-traumatic dental issues and/or ER doctor distracted by a patient with a toothache. And I am sure no one else does either!
Dr. Bruce Pynn is Oral Health’s editorial board member for oral and maxillofacial surgery. He maintains a private practice in Thunder Bay, ON. He is an Associate Professor, North Ontario School of Medicine, Lakehead University, and Chief of Dentistry, Thunder Bay Regional Health Sciences Center.