Epidemiology of Utilization of Emergency Departments for Non-Traumatic Dental Conditions in Minnesota: 2007 to 2012

Background:

Utilization of Emergency Departments (ED) for non-traumatic (NT) dental conditions is an emerging public health concern. EDs are an expensive dental destination and often do not provide definitive care. Resulting in repeat visits, increasing costs and worsening of treatable conditions. Lack of access to oral health care is a significant reason for such visits.

Methods:

Statewide ED visits from 2007-2012 were identified from Minnesota’s hospital discharge data. ICD-9-CM diagnostic codes for oral diseases were categorized into preventable/non-preventable and low/high severity conditions. Hospital-specific cost-to-charge conversion ratios were obtained from CMS. Adjusted general linear models were used for cost analysis and adjusted logistic regression models were used to characterize determinants of ED use.

Results:

Of all oral ED visits 91.6% were for NT conditions. A disproportionate burden for preventable and low severity conditions was observed. While oral ED visits did not increase significantly from 2007-2012 overall, visits for preventable and low-severity conditions were significantly higher in subsequent years compared to 2007. Total costs were $92,494,115 with mean and median cost/visit being $517 and $146 respectively. Mean cost/visit for Preventable & Low-severity; Preventable & High-severity; Non-preventable & Low-severity; and Non-preventable & High-severity conditions were estimated.

Conclusions:

Categorizing conditions by preventability and severity helps unearth hidden trends in ED use for oral conditions. Using costs instead of charges helps better evaluate economic aspects of the issue. Utilization of EDs maybe an indicator of oral health disparities, and useful to evaluate impact of systems and policy changes to improve access to oral health care.