Practice protocol tips for dealing with abscess infections

By Sabrina Hinkle, EFDA

On August 31, 2011, Kyle Willis died as a result of infection from an abscessed molar. As I read Kyle’s story I couldn’t help but notice that it was the perfect storm — nothing fell into place for this young man. In a public statement, Kyle’s family asked that we learn from this and never let it happen again. I didn’t know Kyle or his pharmacist, nor do I even know who his dentist was. But his family is right — let’s do our best as dental professionals to make sure this doesn’t happen again on our watch.

More than 108 million Americans have no dental insurance. A recent survey by the Kaiser Family Foundation found that one in three people skip dental care or checkups because they feel they can’t afford them. Ultimately, the dentist will make decisions for any practice and patient, especially when a prescription is involved.

At your next office meeting, consider setting forth an office policy with guidelines when dealing with abscess infections. Everyone in your office needs to clearly understand the dangers that infection presents, and everyone must do their part to ensure no one slips through the cracks of care like Kyle.

• Consider writing the prescription to instruct that the patient cannot fill the pain medication prescription without filling the antibiotic prescription first or at the same time.

• Make sure that the patient understands the pain is stemming from the infection, and when the infection is controlled the pain will subside. With most antibiotics, there will be substantial relief within 24 hours.

• Pharmacists will partially fill any prescription, especially pain meds. Make sure your patients know this. If finances are tight for a patient, have the person pick up the full antibiotic (as your doctor prescribed and dosed in writing) and then the patient can pick up 24 hours of pain medication. The patient can go back every day for more pain medication. For those with extremely tight budgets, it can be easier to come up with $1 a day for 10 days rather than $10 up front.

• Make it perfectly clear that you share RX costs with your patients. No, this is not required by law, but it is excellent patient care. Be compassionate. Sadly, Kyle died in Ohio. The super-sized chain store Meijer has 196 locations in Michigan, Illinois, Indiana, Ohio, and Kentucky. Meijer stores offer free antibiotics to anyone. Was Kyle aware of this? Likewise, Walmart offers many antibiotics for $5. Kyle’s aunt, Patti Collins, stated, “'The (doctor) gave Kyle antibiotics and pain medication. He couldn't afford to pay for the antibiotic, so he chose the pain meds, which were not what he needed.” Know your neighborhood, shop around, and make some calls. Let patients know who has the best prices for the most common drugs you prescribe.

• Every patient that presents to your office with an abscess needs to have their temperature taken and documented. Most ER doctors agree that when infection is present, a fever of 101 or greater is a signal that the patient’s health is in jeopardy. Those patients presenting with a fever at or over 101 should be strongly encouraged to go to ER immediately, or you should be proactive and call the ambulance yourself. This is no longer just about the patient, but your standard of care. What is your liability if you take no action? In every city and every state there is a hospital that will accept patients no matter what their ability to pay. Documenting that an ambulance was called and the patient refused treatment protects your office if this patient does not follow your instructions and does not take his or her infection seriously.

• Most patients will share their financial concerns with us more than with their family. In 2007, 12-year-old Deamonte Driver died when bacteria from his tooth abscess spread to his brain. His mother, Alyce, couldn't find a dentist who accepted Medicaid in their city.

It was reported that Kyle told his dentist he couldn’t afford an extraction. But one can only guess that Kyle didn’t tell his family he couldn’t afford his prescription. No matter what they felt about his finances, I’m sure someone in that family would have paid for an antibiotic or offered to go the local Meijer and pick up a free antibiotic.

Some people have trouble asking loved ones for help. When a patient tells you finances are a concern, have a policy in place whether or not you will donate the initial dose of antibiotics from your in-office supply. Nearly every office I know of has prophylactic antibiotics on hand. We all know the wholesale cost we pay for antibiotics is very affordable, so any office could consider writing this off.

• What will be your policy for free dental work? If Kyle or Deamonte were to come to your office, would you barter care with them? Would you consider a free extraction if you knew a life was on the line? Naturally, we didn’t go into dentistry to give away our services, and we certainly don’t want to become the office where every patient with a bad tooth thinks a free extraction is the policy with an “I can’t afford it” excuse. It is my experience that people who are genuine in their needs have no problem helping you if you help them. Examples: “Mr. X, we’re having a community service day at the park in two weeks. If I take this tooth out for you today, I would like for you to pass out balloons to the kids that day. Can I count on you?” “Mrs. Y, I don’t accept Medicaid, but I really hate to see Jr. suffering. I know that you knit. If I give you the yarn would you consider making a scarf for my mother’s birthday?”

I have actually found this empowers patients and makes them feel like contributors. They take ownership in their treatment and are not charity cases. Offices with a reputation of community involvement have high rankings in compassion, which leads to referrals from all levels of income. People are prideful when they help each other. You are not belittling patients to ask them for kind acts in return. The people who were expecting something for nothing might act insulted or not show up for an event, but the people who really need you will take care of you in return. Isn’t that what inspired us to go into health care to begin with?

Cases such as Kyle’s and Deamonte’s are rare, but this is 2011, and that makes it totally unacceptable to suffer a loss of life because of dental infection. What will be your office policy?

Sabrina Hinkle began dental assisting in 1983. She completed the Indiana University Expanded Functions Program in 1986 and loves every aspect of dentistry. Experienced in management and chairside assisting, she has worked with solo practitioners, group practices, and associateships, as well as in large multilocation practices with commissioned dentists. She is a published author, speaker, and practice management consultant focusing on dental industry issues. Excited about CAD/CAM dentistry, Sabrina is currently a CEREC trainer with Patterson Dental.