Nontraumatic Dental Emergency Department Visits and Follow Up Dental Care Among Wisconsin Medicaid Beneficiaries.

Abstract

Objectives: Emergency department (ED) visits for nontraumatic dental conditions (NTDCs) are a persistent concern for Medicaid beneficiaries. This study examined factors associated with NTDC-related ED utilization and dental follow up among Wisconsin Medicaid beneficiaries.

Methods: We conducted a retrospective claims-based cohort study using Wisconsin Medicaid claims from January 1, 2014, through December 31, 2019. The ED cohort (n = 553,669) outcome was at least one NTDC-related ED visit. The follow up cohort (n = 21,386 with an index NTDC-related ED visit) outcome was at least one nonemergency dental visit within 6 months. Multivariable logistic regression estimated adjusted associations. Supplementary analyses used a logistic prediction model and LightGBM under a balanced modeling framework.

Results: Adults had the highest NTDC-related ED visit rate (6.0%), exceeding children (1.5%) and older adults (1.5%). Rates were higher among White (4.4%) and Black (4.1%) beneficiaries than among Hispanic beneficiaries (2.7%). Only 8.8% of beneficiaries with an NTDC-related ED visit received dental follow up within 6 months. After adjustment, HMO enrollment, adult age group, and residence in non-Milwaukee urban or rural areas were associated with higher odds of NTDC-related ED visits. For follow up, the highest area level income quartile had greater odds of subsequent nonemergency dental care.

Conclusions: NTDC-related ED utilization and post ED dental follow up were associated with demographic, socioeconomic, geographic, and insurance related factors. The low follow up rate suggests a substantial gap between emergency care and subsequent nonemergency dental care, supporting care coordination, Medicaid dental access, and regional strategies for connecting ED patients to dental providers.