Community Dental Program May Reduce Emergency Dental Admissions Interview with:
Jonathon P. Leider, PhD
Department of Health Policy and Management
Johns Hopkins University
Baltimore, MD What is the background for this study?

Response: The increasing utilization of Emergency Departments (ED) for the treatment of non-urgent and non-traumatic dental conditions among adults in the United States is an increasing policy issue. Research shows that seeking dental care in an ED is often more expensive and less effective when compared to a traditional dental office. Seeking care in the ED for non-traumatic dental conditions is more frequent among low income individuals and people in rural areas, who must often overcome insufficient dental coverage and access to receive office-based care.

Under the Affordable Care Act, there has been considerable expansion in state Medicaid dental coverage for adults. However, not all states are participating in the expansion or extension of dental benefits and dental professional shortage areas are fairly common– over 4,900 exist in the United States. Innovative programs are needed to effectively address the challenges low income individuals in rural areas encounter accessing care. Our study examined the expansion of a Community Dental Program (CDP) in rural Western Maryland and its impact on dental-related visits at a regional ED. What are the main findings?

Response: The CDP served approximately 1,600 unique clients across 2,700 visits during between 2011 and 2015. The population served by the CDP was largely low-income, childless adults from two rural Western Maryland counties. The model suggested that if the CDP had not provided services during that time period, about 670 more dental-related visits to the ED would have occurred, resulting in $215,000 more in charges.

This study shows that diversion programs and related urgent treatment programs within rural areas can be effective at reducing ED visits, which can result in substantial cost savings to taxpayers and more appropriate and cost-effective care for the patient. What should readers take away from your report?

Response: In rural communities that do not have a sliding fee scale clinic or Federally Qualified Health Center (FQHC) dental clinic, the CDP is a reasonable and accessible alternative for people to receive services from local dental providers. Arguably, this provides more definitive care to patients in urgent need compared to ED settings, where patients often needed follow-up dental care. Community dental access programs may be a viable way to patch the dental safety net in rural communities while holistic solutions are developed. recommendations do you have for future research as a result of this study?

Response: Future research should consider further investigating the role of ED-diversion programs in areas where financing and access issues are different (e.g., urban areas or those with alternative Medicaid benefit structures). Is there anything else you would like to add?

Response: This study describes one model of addressing oral health care needs in an underserved rural community, but it should not be considered a long-term solution to a significant gap in health care coverage. While the ACA has greatly increased access to medical care for millions of previously uninsured or underinsured people, dental coverage is not an included mandatory benefit for adults. In addition, Medicare does not routinely include a dental benefit. Many of the most vulnerable people in society find themselves with few options when they have dental pain, dental infections, or other urgent dental conditions. The inclusion of an oral health benefit as an integral part of health insurance coverage would ensure that more people will be able to seek dental care in a cost effective and appropriate setting, resulting in better health for the patient and potentially hundreds of millions in savings for the nation’s health care delivery systems as a whole.


Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 15, 2016 by Marie Benz MD FAAD