Pandemic dental office closures linked to increased burden on ERs from kids with dental issues

Dental office closures early in the COVID-19 pandemic were associated with a 62% increase in the share of emergency department visits from toothaches, abscesses, and other painful dental issues among children covered by Medicaid, according to a new study led by researchers at NYU College of Dentistry.

The findings, published in JACEP Open, suggest that families with young kids have difficulty accessing dental care during public health crises, which may further stress overburdened hospitals.

In March 2020, as COVID-19 cases grew exponentially in New York and around the country, public health measures to stop the virus’s spread prompted the closure of dental offices. While dentists could see patients for emergency appointments, all other routine dental care was postponed.

At the same time, hospitals were filling up with critically ill patients. NYU researchers wanted to understand whether patients with urgent dental issues were also ending up in emergency rooms.

“Emergency departments are not well equipped to treat dental conditions, as they are typically limited to relieving pain and referring patients to dentists to address the underlying issues,” said Shulamite Huang, a health economist and assistant professor of epidemiology and health promotion at NYU College of Dentistry.

“As a result, visiting an emergency department for tooth pain can be a waste of health care system resources—resources that are in short supply during times of crisis, including the peak of the COVID-19 pandemic.”

Huang and her colleagues examined Medicaid claims data for children under the age of 19 across New York State to determine if there were any differences in emergency department visits for dental concerns before the pandemic (in 2018 and 2019) versus 2020. They focused on issues including cavities, infections, and abscesses, and excluded injuries such as cracked or knocked-out teeth.

The researchers found that dental practice closures from March through May 2020 led to a 62% increase in the share of children’s emergency room visits from non-traumatic dental issues over 2019 levels (from 3.7% of ER visits focusing on dental issues in 2019 to 6% in 2020). This surge in visits was the most pronounced among young children up to age 9, who were seen in emergency departments for dental issues twice as often during this period compared to the previous year.

Notably, the increase in emergency department visits was sustained even after many dentists reopened their offices in May 2020, although to a lesser degree.

“The sizable changes in the emergency department dental care of very young children suggest that this population was likely to fall through holes in the dental safety net,” said Huang. “Although dentists were allowed to treat dental emergencies, Medicaid-insured children may have had difficulty accessing care during the initial phase of the COVID-19 pandemic.”

The authors cite several possible reasons for this, including parents having difficulty determining whether kids in pain are experiencing a true emergency. In addition, very young children covered by Medicaid may not have established care with a dentist before the pandemic, as finding a dentist that accepts Medicaid and treats young children can be a challenge.

In preparation for future pandemics or other crises that stress US hospitals, the researchers encourage health systems to consider options for emergency dental care that can divert patients from the emergency department, including offering limited hospital-based dental services or incorporating urgent dental care clinics within hospitals. In addition, ensuring that children covered by Medicaid have access to a dentist in their community may both prevent painful dental issues and provide them with emergency dental care when needed.

Additional study authors include Scarlett Wang of the NYU Wagner Graduate School of Public Service and Heather Gold of NYU Grossman School of Medicine.