Repeated Use of Emergency Departments for Nontraumatic Dental Conditions: Factors Associated With Being a Superutilizer

Abstract

Background

Due to inadequate access to regular, affordable dental care, many patients turn to emergency departments (EDs) for the treatment of nontraumatic dental conditions (NTDCs). NTDC ED visits are a large burden on the U.S. healthcare system, with over 1.3 million visits each year and over $1 billion in associated charges. This study examines the characteristics of ED visitors and superutilizers (4+ ED visits in a calendar year) for non-dental (general) and dental reasons; investigates the cost of care for ED visitors and superutilizers; and estimates associations between patient characteristics and the likelihood of superutilization.

Methods

Data obtained from the State Emergency Department Databases was used to summarise trends in visits by general and dental ED visitors and superutilizers, including visit rates and costs, across 14 states and 5 years. Logistic regression models were developed to estimate the likelihood of being dental superutilizers and superutilizers (for dental and non-dental visits) based on the characteristics of their first ED visit (age, gender, race/ethnicity, income quartile, insurance type, presence of comorbidities and state in which ED visit occurred).

Results

Of the total number of ED visitors (N = 25 905 031), the majority (92.4%) were general (non-dental) visitors; 6.4% were general superutilizers; 1.2% were dental visitors; and less than 1% (n = 2617) were dental superutilizers; dental superutilizers made up 0.2% of all superutilizers. Individuals who sought ED care for dental or non-dental reasons four or more times in a year were more likely to be white, be in the second or third quartile in terms of income, and have insurance coverage through Medicaid, other dental insurance, or to be uninsured. Finally, mean and median treatment costs for general and dental superutilizers were considerably higher than for both general and dental visitors to the ED.

Discussion

Individuals seeking ED care for NTDCs four or more times in a year are more likely to be white, have insurance coverage through Medicaid, Medicare or to be uninsured, and have one or more medical comorbidities. Cost of care for superutilizers is also considerably higher than for other ED visitors. Expansion of dental services for adults, particularly those on Medicaid, is needed to ensure they can access timely preventative and restorative services and avoid the burden of dental crisis requiring a visit to the ED.