title: Emergency department visits for nontraumatic dental problems: a mixed-methods study.
abstract: OBJECTIVE
  We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits.
  
  
  METHODS
  We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon's All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities.
  
  
  RESULTS
  Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education.
  
  
  CONCLUSIONS
  Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits.
authors: Benjamin C. Sun, Annick Yagapen, Susan Malveau, and Ben Chan are with Department of Emergency Medicine, Oregon Health and Science University (OHSU), Portland. Robert A. Lowe is with the Department of Medical Informatics and Clinical Epidemiology, OHSU. Donald L. Chi and Peter Milgrom are with Department of Oral Health Sciences, University of Washington, Seattle. Eli Schwarz is with School of Dentistry, OHSU. Zunqui Chen is with Department of Public Health and Preventive Medicine, OHSU. Sankirtana Danner is with Oregon Rural Practice-Based Research Network, OHSU. Erin Owen is with Slocum Research and Education Foundation, Eugene, OR. Vickie Morton is with Financial Services, OHSU.
authors: Benjamin C
authors: BC
authors: Sun
authors: Donald L
authors: DL
authors: Chi
authors: Eli
authors: E
authors: Schwarz
authors: Peter
authors: P
authors: Milgrom
authors: Annick
authors: A
authors: Yagapen
authors: Susan
authors: S
authors: Malveau
authors: Zunqui
authors: Z
authors: Chen
authors: Ben
authors: B
authors: Chan
authors: Sankirtana
authors: S
authors: Danner
authors: Erin
authors: E
authors: Owen
authors: Vickie
authors: V
authors: Morton
authors: Robert A
authors: RA
authors: Lowe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003729:Dental Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009922:Oregon; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000900:Anti-Bacterial Agents