Barrier to Care: Emergency Department Utilization for Non-traumatic Dental Conditions in California

ABSTRACTIntroduction Every year in the United States, emergency departments (EDs) receive approximately 2.4 million non-traumatic dental condition (NTDC) visits. The American Association of State and Territorial Dental Directors (ASTDD) developed a surveillance guideline to understand which specific conditions dental infrastructure can address before patients succumb to the ED for care.Methods Descriptive epidemiology data of ED encounters from the California Department of Health Care Access and Information were analyzed. Primary diagnostic NTDCs in California EDs between 2016 and 2019 were reviewed using ASTDD surveillance protocol. Ophthalmic condition surveillance, with guidance from California Health and Human Services data, was used as a comparison due to similar national ED utilization rates.Results In California, 82 unique codes were used for primary NTDC diagnoses for the approximate 54,000 NTDC visits annually. The most common NTDC code was “Other Specified Disorders of Teeth and Supporting Structures,” accounting for 74–80% of all NTDC diagnoses. Ophthalmic condition codes had greater specificity with 12% as their most frequent code for “laceration without a foreign body of the left eyelid.”Conclusion Relatively few dental-related ED visits are associated with highly informative NTDC codes, limiting surveillance efforts to track the prevalence of underlying conditions. There is an opportunity to guide patients to proper dental care by 1) forming dental partners with EDs and 2) establishing referral protocol through case managers. If an ED had a standardized workflow to guide patients to dental care, a significant barrier could be addressed for both patients and providers