Online Program

Causes of TOOTH fracture THAT result in emergency department visits

Monday, November 4, 2013

Romesh Nalliah, BDS, Office of Dental Education, Harvard School of Dental Medicine, Boston, MA
Min Kyeong Lee, DMD, Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA
John Da Silva, DMD, MPH, ScM, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA
Shankar Venugopalan, BDS, PhD, Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA
Veerasathpurush Allareddy, BDS, PhD, MBA, Cleft Craniofacial Fellow, Boston Childrens Hospital, Boston, MA
Objective: Identify the most frequently diagnosed causes of tooth fracture that result in hospital emergency department (ED) visits. Secondary goals include determination of characteristics of these visits including hospital charges, insurance status of the patients and outcomes after ED visit.

Methods: The Nationwide Emergency Department Sample (NEDS) from 2008 of the Healthcare Cost and Utilization Project was utilized for the current study. All hospital discharges related to a diagnosis of broken tooth from trauma (ICD-9-CM codes 873.63, 873.73) were evaluated and all estimates were projected to national levels.

Results: 193,123 ED visits were attributed to tooth fracture from trauma in 2008. Major payers were private insurance (32%), Medicaid (25%), and Medicare (6%); 32% were uninsured.

Fifty six died in the ED while 128 died subsequently after admitted into the hospital. About 1086 patients were discharged against medical advice. Total ED hospital charge was $195 million, and mean ED charge was $1,172. Total charge for ED and inpatient services was over $483 million with an average of $51,235 per inpatient stay. Admitted patients stayed for 5.3 days in the same hospital on average. The most common eitiology of trauma were falls (20%) and being struck (17%).

Conclusions: Falls and being struck are the most common cause of trauma that result in ED visits due to tooth fracture. Trauma that is with sufficient force to cause a tooth fracture could result in pulpal death and require endodontic therapy. The total cost of tooth trauma may be underestimated in this study.

Learning Areas:

Public health or related public policy
Public health or related research

Learning Objectives:
Identify the main causes of tooth trauma that result in utilization of hospital resources (rather than dental office resources). Describe those population groups more likely to take their dental complaint of tooth trauma to the hospital emergency room.

Keyword(s): Access to Health Care, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have published broadly using the Nationwide Emergency Department Sample (NEDS). I am a practicing dentist and am one of only a handful of people who have used the NEDS for studies on dental topics in the world.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.