Going upstream from the ER (Part 1)

By the CDHP team

Dr. Anu TateWe’re all rightly dismayed by the health costs and human suffering that drive people to seek dental care in emergency rooms. Young adults (ages 19-34) are the biggest users of ER dental, according to analysis from the ADA Health Policy Institute. From 2006-2012 that analysis found little change in ER dental visits for children, but the percentage of visits paid for by Medicaid shot up 19%. Since children’s cavities are the strongest predictor of poor tooth decay in adulthood, consider that a bellwether of costs to come.

Except: What if oral health care went upstream? What if systems supported early prevention and disease management before problems become acute?

Dr. Anupama Tate (right) is driven by that opportunity. A board certified pediatric dentist at the Children’s National Medical Center in Washington, D.C., Dr. Tate recently canceled dental surgery for a pain-wracked 5-year-old because she didn’t have information about the kindergartner’s chronic heart condition – which can be worsened by oral bacteria. Dr. Tate wanted to work with the family three years ago, when the girl, age 2, showed signs of early tooth decay. But the mother feared the procedures and never returned to the dental clinic. The girl’s tooth decay went unmanaged.  

Dr. Tate says she -- and this mother -- needed backup.

“Parents are always aware that their child has dental problems, but they don’t know the severity of the problem or their options,” she told me. “Countless providers have seen this girl but no one said, ‘What’s going on with those teeth?’ The pediatrician and cardiologist don’t see our dental records and I don’t see their medical records. That is a huge problem.

“If all members of the pediatric health care team members deliver clear, consistent and repeated messages about the importance of oral health to overall health, we can capitalize on opportunities to modify diet and behavior, and create a call to action,” said added.

Dr. Tate noted that prevention and coordinated disease management require system changes: a reframing of professional education and training, a commitment inside private practices and institutions, and supportive design and administration of public benefits.

Read the blog post that is Part II to this topic.

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children ages 6-12 suffered a toothache in the previous six months.
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