Emergency Department Use for Potentially Avoidable Dental Reasons by Vulnerable Populations in South Carolina

Background: Oral health is a significant unmet need for many Americans. Access to and use of dental services continue to contribute to oral health disparities. We examined the degree to which certain vulnerable populations use emergency departments (ED) for ambulatory care sensitive conditions (ACSC), particularly dental. Methods: Our cross-sectional design used 2008 and 2009 ED ACSC discharge data to examine geographic, racial, and insurance status differences in dental-related ED (D-RED) utilization. The dependent variable was D-RED visits. The independent variables were race, payor status, rurality, dental physician shortage area (DHPSA). Results: D-RED visits made up 12.36% of the total ED ACSC visits. Blacks (41.45%) and Hispanics (1.60%) were less likely (p<.05) than whites (55.58%) to have D-RED visits. Selfpay (58.61%) and Medicaid (13.32%) were more likely (p <.05) to have D-RED visits than the privately insured (21.54%). Rural populations (28.31%) had 1.1 (p<.05) times the odds of a D-RED visit than urban. Whole county DHPSA (38.13%) had 1.1 (p<.05) times the odds of D-RED visits than those without a designation. Conclusion: Vulnerable, underserved populations are more likely to use ED care for potentially avoidable dental reasons. While some might argue expanding public insurance dental benefits would alleviate this disparity, the etiology of the disparity is more complex than this simple solution. Addressing generational misconceptions and perceived value of dental care and personal oral health behaviors is essential. Lessening bureaucratic obstacles for provider participation in Medicaid and investing in dental capacity, especially in rural, must be a part of the solution.