Going upstream from the ER (Part 2)

By the CDHP team

Dr. Jeff ChaffinOur last post described opportunities in coordinated disease management for young children. When such opportunities are missed, national data reveal that the dental caries process continues into the teen years and young adulthood.

If we hope to reduce emergency dental visits, we must better understand those barriers and how to address them.

The consequences may be well illustrated in the oral health of U.S. military recruits, a cohort of young adults who typically grow up in households where money is tight, a proxy for heightened risk for cavities. Department of Defense (DoD) studies find that recruits have higher levels of untreated dental disease than their peers, notes Dr. Jeff Chaffin (right), the dental director for Delta Dental of Iowa, but who earlier led dental services for TRICARE, the DoD’s health care program. 

In a 2008 study of more than 5,000 new recruits, “over half (52.4 percent) of recruits had an urgent dental condition that needed to be addressed before they were considered deployable. The bulk of the dental care was extractions and fillings,” Dr. Chaffin said. “An alarming finding was that among those who needed fillings, 20 percent needed seven or more fillings.”

Alarming indeed. The percentage of recruits needing extensive restoration may suggest that civilian ER numbers would be even higher if these young people didn’t enter the military.

Why weren’t they getting care before entering service? Most recruits cited cost, but many were likely eligible for publicly supported preventive dental services while they were growing up.

Here, the messages from Dr. Tate and Dr. Chaffin converge: for prevention and disease management to succeed, at-risk families need coordinated support from medical and dental professionals. For instance, Dr. Chaffin found that the children of military officers were 2.5 times more likely to have a dental visit than children of enlisted personnel, even though both groups voluntarily enrolled in the dental insurance and examinations and preventive procedures were covered at 100% with a network dentist. “Typically, officers have higher education levels than enlisted members, so military rank was viewed as a surrogate for socioeconomic status,” he said. “This suggested that even when cost and access are the same, there appear to be other barriers for low-income families in accessing dental care.”

If we hope to reduce emergency dental visits, we must better understand those barriers and how to address them. People in acute pain need immediate relief, but preventing that pain in the first place will require a new paradigm of coordinated care.

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Did you know?

44% }
of U.S. children will have at least one cavity by kindergarten.
More on the state of dental health ›