American Dental Association Comment on the New York Times story, ‘E.R. Doctors Face Dilemma on Painkillers’
Washington, D.C., May 1, 2012 – A story in today’s New York Times points up a new aspect of the unfortunate phenomenon of people seeking treatment for dental problems in hospital emergency rooms: patients claiming to be in agony from dental disease in order to procure prescription pain medication, and emergency room physicians trying to sort out which of them actually need those drugs.
The Times did not explore the underlying problem—there is virtually no consistent, substantive dental safety net for low-income adults. Medicaid dental programs, which vary state by state, generally focus only on covering children. The children’s programs range from pretty good to abysmal. There is less variation in states’ Medicaid adult programs, because there is no federal requirement for adult Medicaid coverage. It is virtually nonexistent.
Uninsured and indigent people cannot get routine dental care, small problems become big ones, and the pain becomes intolerable. As a result, they flock to emergency rooms with dental pain. That they have dental problems is apparent to ER physicians. But whether they actually need pain medication is a judgment call.
The one certain thing is that ERs, except in those rare cases where there are staff dentists, cannot actually treat dental problems. Patients are given antibiotics or pain medication and sent on their way, only to return with the same complaints, because ER physicians cannot address the disease, only the symptoms. The irony is that this revolving ER door costs Medicaid more than treatment by dentists would. States would actually save money by providing basic care, such as fillings and extractions, to these patients.
Ultimately, the ER/dental phenomenon points out the fundamental shortcomings in how this country provides and does not provide oral health care to those who can’t afford regular dental visits. Virtually all dental disease, especially the advanced cases that show up in emergency rooms, is preventable. When the nation shifts to a prevention rather than surgical model of public oral health and provides basic dental services to more people who otherwise cannot afford them, the ER physicians’ dilemma will be greatly diminished. Until then, we can expect more of the same.
In-depth ADA papers on breaking down the barriers that prevent too many Americans from achieving good oral health are available at: http://www.ada.org/breakingdownbarriers.aspx
About the American Dental Association
The not-for-profit ADA is the nation's largest dental association, representing more than 157,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit the Association's website at www.ada.org