Dental emergency visits tend to be evaluative in nature or are associated with prescriptions for pain or infection management, rather than providing definitive treatment, as more than 1 in 4 visits had no other procedure associated with them and, when there are other procedures, they tend to be for imaging and other non-definitive treatments. Dental emergency visits, however, are often a pathway to more definitive dental treatment, with 65% of those who return for dental treatment coming back within 30 days. This finding is in line with contemporary research during the COVID-19 pandemic in the UK, which found that 65% of urgent dental visits lead to definitive dental treatment and that emergency dental visits can effectively triage patients into needed clinical care (35).
Emergency dental visits, alone, are not enough for keeping people out of the ER for dental conditions, as about 2% of adults who have an emergency dental visit end up going to a hospital emergency room within 15 days. Rather, a full range of preventive and dental treatments are needed, as emergency dental visits are more often associated with ER visits than non-emergency visits and there can be a vicious cycle of emergency dental and ER visits for dental conditions. Among those enrolled in Medicaid, there is a great deal of stability over time in the rate of emergency dental visits with about 10% of dental encounters being on an emergency basis.
Efforts to stem the spread of SARS-CoV-2 and COVID-19 led to restricting the provision of dental care to dental emergencies. Recommendations to limit routine dental care by the WHO were adopted by many countries (5). While the response by regulatory and governing bodies has varied, much of the initial focus was on reducing viral spread, ensuring patient and provider safety and allowing time for updates to infection control policies and practice through limiting dental services (6-11).
In the United States of America, the response to COVID-19 from the Centers for Disease Control and Prevention (CDC), a national public health institute in the United States, along with the nation’s largest dental association, the American Dental Association (ADA) included initial guidance which encouraged limiting dental care to urgent or emergent treatment(12, 13). ADA interim guidance on returning to provide non-emergent care urged that treatment should be decided on patient or community risk of COVID-19, clinical risks associated with aerosol generating procedures, and the availability of personal protective equipment(14).
Dental professionals are at considerably high risk of exposure to pathogenic microorganisms that infect the oral cavity and respiratory tract due to the nature of the dental care setting and procedures, which involve a face-to-face proximity between patient and provider, handling of high-speed handpieces, and exposure to saliva, blood, and other body fluids. (1-4). The COVID-19 crisis and the resulting dental service restrictions presented providers, payers, and patients with an unprecedented challenge, and determining the full impact on overall oral health and long-term changes in demand for services will be difficult to predict. These reductions in dental services, even for a short period of time, will have significant impact on the oral health of Americans. Recent analysis has shown that ninety-two percent of families in poverty or low incomes have unmet dental needs.(16) These families rely on public insurance programs and access to low-cost or free dental services to address their needs. Given the great burden of dental disease in these populations, limitations on scope of service and dental office closures across the country have had a disproportionate impact on individuals experiencing poverty, the uninsured, and individuals who participate in United States government-sponsored programs such as Medicaid, which helps cover health care costs for low-income Americans, generally under the age of 65 (17).
There are several limitations to this study. While the dataset used is a large database with a population that is consistent with the Medicaid population as whole, it is not randomly generated sample of all Medicaid claims in the United States and so should not be assumed to be definitively generalizable. Additionally, while we focused on the Medicaid population to both the lack of information on this population and their unique vulnerability to untreated dental conditions, the Medicaid population is not like the population as a whole in the United States. Due to the consistency in trends over time, this study focuses on a single year of data for the bulk of the analysis and so cannot definitely state that the findings hold across all years of data nor that the patterns will hold across time. Regardless of the limitations, we believe that the findings reported here, including the stability of emergency dental visits over time, the nature of those visits as predominately evaluative in nature, and the outcomes of those visits for patients as often resulting in definitive treatment, but that they can lead to a cycle of emergency dental and hospital utilization for a small subset of patient provide useful information that can be built on by future work and used to make decisions in the current environment.