Rhode Island Children's Hospital Emergency Department visits for oral health conditions, 2006 - 2010.

Hospital emergency departments (eds) pRoVIde cRItIcal and highly-demanded services to communities, including treatment for emergency oral/dental problems. EDs also serve as dental safety net points of access for a significant number of low income and uninsured Rhode Island children and adults who have limited access to oral health care due to lack of dental insurance, immigration status, or a number of other reasons. However, reliance on the ED for less severe, or non-emergent oral/dental conditions results in significant health care spending and increased pressure on the already crowded and overburdened EDs throughout the State. Despite the fact that most children’s dental problems are preventable with age-appropriate and effective disease management through regular dental visits, significant numbers of children experience dental decay. According to the National Health and Nutrition Examination Survey, more than a quarter of US young children age two to five years, more than half of the children age six to eight years, and 60% of adolescents 12 to 19 years had dental caries in the period of 1999–2004. Similarly, the 2010-11 Rhode Island Third Grade Oral Health Survey found about half of Rhode Island third graders have experienced dental decay. Evidence suggests that regular preventive dental care visits beginning in early childhood can reduce the need for restorative and emergent care, particularly for children at high risk of developing dental caries. However, regular preventive dental care is not equally accessible for all children. Parents may bring their children to the ED for non-urgent or traumatic dental/oral health concerns. For children and families without a dental home and/or an affordable source of dental care, EDs are the last resort to obtain dental care. However, most non-traumatic and non-urgent dental care needs are more adequately addressed and treated in primary outpatient dental offices or clinics. The objectives of this report are to (a) document the extent of Rhode Island children’s hospital ED visits for oral/dental conditions that are mostly preventable and treatable in primary care settings; (b) assess ED visits by children’s age, insurance status, and primary diagnosis; and (c) discuss how to assure optimal and regular dental care for all Rhode Island children and decrease unnecessary hospital ED visits. MetHods The data used for this analysis were obtained from the Rhode Island Hospital Discharge Database (HDD). Since 1989, Rhode Island hospitals are required to submit financial and statistical data using the statewide uniform reporting system to the Rhode Island Department of Health pursuant to their licensure authority. Data on hospital inpatient and ED encounters are submitted by all 14 Rhode Island non-federal acute-care and specialty hospitals. HDD provides information on patient demographic characteristics, insurance, hospital admission and discharge related details including admitting diagnoses and clinical procedures rendered. Data extracted and summarized for this report were all ED visits between January 1, 2006 and December 31, 2010 for children (20 years old and younger) with primary admitting diagnoses related to oral/dental conditions (i.e., ICD-9-CM codes of 520.0–529.9) that did not result in hospital admission. Children under 21 years of age were included to align with the age eligibility covered by Rhode Island Medicaid, which provides dental benefits for eligible children through the Early Periodic Screening, Diagnosis, and Treatment (EPSDT). Using SAS v9.3, descriptive statistics of the ED visits were generated by children’s age, insurance type (or expected source of payment identified in hospital’s initial admission records), and primary diagnosis.