Kids winding up in ER for dental care

By Lee Bowman
Scripps Howard News Service
Posted4/23/2012 6:02 AM

Way too many Americans -- particularly children -- are winding up in emergency rooms and operating rooms with rotten teeth.

School-system surveys done in 10 states within the past three years show the percentage of third-graders with untreated tooth decay running as high as 40 percent in Arizona, to just under 15 percent in Washington State, according to tallies compiled by the federal Centers for Disease Control and Prevention.

A national CDC survey in 2007 found that 44 percent of 5-year-olds have had cavities.

A February study by The Pew Center for the States found that preventable dental conditions were the primary reason for more than 830,000 emergency room visits in the U.S. in 2009, up 16 percent from just three years before.

Experts say emergency room care is 10 times more expensive than routine dental services. ER care for preventable dental problems -- not from trauma -- often runs $1,000 or more per episode, while a preventive exam and cleaning in a dental office is $60 to $100.

The Pew study noted, for instance, that there were more than 115,000 dental-related ER cases in Florida in 2010, at a cost of more than $88 million. Nationwide, in 2009, the study noted, 56 percent of children enrolled in Medicaid did not receive any dental care, even a routine exam.

"The fact that so many Americans go to hospitals for dental care shows the delivery system is failing,'' said Shelly Gehshan, director of the Pew Children's Dental Campaign in a statement. "The care provided in an ER is much more expensive and it generally doesn't solve dental problems."

Most hospital emergency departments don't have dentists on staff, and are likely to treat patients for pain, give them an antibiotic for an infected tooth, but are unable to address underlying problems.

In many cases, full-scale surgery under general anesthesia becomes necessary. Officials at Children's Hospital Colorado in Aurora said they performed more than 3,000 operations for pediatric dentistry last year, with the average cost of treatment around $3,000.

"There is an inextricable link between oral health and general health, and it is crucial that we find better ways of taking care of the oral health of our most vulnerable populations," said Dr. Scott Tomar, a public health dentist and epidemiologist at the University of Florida College of Dentistry.

There are many reasons behind desperation dentistry. More than 1 in 6 Americans lack health insurance, and dental coverage is even less common.

Many dentists (fewer than half in 25 states) don't accept patients on Medicaid or state child health programs because of low reimbursement rates, a problem highlighted in a report last year from the Institute of Medicine on improving access to oral care. And 47 million Americans live in areas that lack a sufficient number of dentists.

But there are also problems with getting parents to appreciate the need for dental care starting with the first teeth. Too many still have the false impression that "baby teeth" somehow don't count, that they're going to eventually fall out anyway.

In fact, infections and decay in primary teeth can be life-threatening if unchecked, and may cause permanent teeth to be misaligned or not come in at all, among other problems. And by the time the permanent teeth do come in, bad habits have been established. More than 1 in 5 children ages 6 to 11 have decay in their permanent teeth.

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry both recommend that parents start taking their infant to a dentist by age 1, and work with professionals to teach kids to brush and floss as early as they can and avoid too many sweets and juices.

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