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Americans are spending more on ineffective dental care than ever before

Aug. 30, 2022
Public health-care dollars are stretched thin, and emergency department care for nontraumatic dental conditions is gobbling up more and more of them. Read more about this study from JADA.

A study published in the September issue of JADA found that spending on emergency dental care increased 216% from 1996 to 2016. This increase was primarily driven by adults ages 20-44 and paid for by public funds.1

Emergency department care drove growth in spending

The growth of emergency department care also outpaced other dental expenditures during this period. The increase was primarily driven by (1) price and intensity, which is the variety and complexity of care provided, and (2) more frequent service use. Population growth played a minimal role in this increase.

Problems with ED visits

There are numerous problems with treating nontraumatic dental conditions (NTDCs) in hospital emergency departments. The authors wrote that “ED visits due to NTDCs tend to be evaluative and associate with prescription drugs for pain control (primarily opioids) and infection... approximately 74% of patients who have been in EDs for NTDCs in the United States (1997-2007) received at least 1 analgesic prescription and 56% at least 1 antibiotic prescription." (emphasis added)

Unnecessary opioid prescriptions contribute significantly to the risk of abuse, and antibiotic resistance is also a growing concern.

More: The malpractice implications of prescribing opioids for dental pain

The study authors also described the “vicious cycle” of emergency visits that do not resolve the disease causing the pain and infection.

Medicaid spending rose

While public spending (likely funded by Medicaid) on NTDC rose significantly during the study period, out of pocket spending declined.

“Our results showed that the reductions in OP spending coincided with the start of the ACA in 2010 and the expansion of benefits that followed,” wrote the authors. “This is plausible because ED use for NTDCs is common in uninsured patients, the segment of the population who benefitted from the ACA."

The study cites access to care issues as the main reason individuals seek care for dental conditions in emergency departments. In the United States, hospitals are required to provide a minimum level of care, regardless of the patient's ability to pay.

Dental coverage under Medicaid is dependent on the state government, and reimbursement rates for participating dentists are significantly lower than commercial dental insurance, according to the ADA.2 Such rates limit the feasibility of participation for many dental practices.

“Expenditures on EDC due to NTDCs are not effective and represent a growing source of public health expenditure that is not justified,” concluded the authors.

More: Dental therapists are not the enemy

References

  1. Hugo FN, da Cunha AR, Dieleman JL, Kassebaum NJ, Lamster IB. Spending on emergency care due to nontraumatic dental conditions in the United States, 1996 through 2016. J Am Dent Assoc. 2022;153(9):859-867. doi:10.1016/j.adaj.2022.05.003
  2. Nasseh K, Vujicic M, Yarbrough C. A Ten-Year, State-by-State, Analysis of Medicaid Fee-for-Service Reimbursement Rates for Dental Care Services. American Dental Association Health Policy Institute. October 2014. https://www.aapd.org/assets/1/7/PolicyCenter-TenYearAnalysisOct2014.pdf