Local ERs note influx of patients with dental problems

Local hospitals are seeing more patients coming to the emergency room with dental problems.Local hospitals are seeing more patients coming to the emergency room with dental problems.The number of Valley residents turning to emergency rooms for everyday dental problems is on the rise, and the price tag the state is paying is many times higher than if the patients were treated at a dentist’s office, local physicians and dentists say.

Many of these trips to the ER are for toothaches or other problems that could have been prevented with regular dental visits, but with an ever-shrinking number of dentists willing to treat Medi-Cal patients, the result has been an increase in poor dental hygiene among those who do not have the funds to pay for periodic checkups.

“We’ve seen it increase fivefold over last year,” said Dr. David Smith, director of business development for the emergency room at Madera Community Hospital. “The norm was one to two patients a day who had dental problems, but now it’s five to seven — for a patient that formerly would have been treated as an outpatient in a dentist’s office.”

Those who use the ER for dental care often return again and again because the problem cannot be treated properly with the limited options that are available there.

“I can give them antibiotics and pain medication,” Smith said. “A dentist would take care of the problem definitively.”

The current recession has contributed to the problem as well. Those living on shoestring budgets will place rent, food and other necessities before a trip to the dentist.

Adam Marks, a physician’s assistant in Orosi, says that many of the residents in that area cannot afford to see a dentist. Most Denti-Cal coverage for those ages 21 and over was eliminated in 2009, resulting in adverse effects for those without another form of dental insurance.  

“Adults in Orosi and Cutler too often have poor dental hygiene because they do not have the coverage to pay for it,” Marks said.

Smith said that dental health left neglected could lead to chronic infections and other problems, including heart disease.

Dr. David Engstrom has been a dentist in Selma since the 1980s. He said that dentists who accepted Denti-Cal are reluctant to take Medi-Cal due to recurring foul-ups with billing issues by those in Sacramento. Medi-Cal’s payment rates are notoriously low, too.

“A lot of dentists don’t take Medi-Cal because of the reimbursement rates,” Engstrom said.

Those who live in the Fresno area have an alternative, however. Community Regional Medical Center has a contract with the county of Fresno to provide health care for those who cannot pay. The Medically Indigent Services Program includes the services of an outpatient dental clinic, the Surabian Dental Center.

“It’s a safety net for people who don’t have dental insurance,” said Mary Lisa Russell, senior communications specialist at CRMC. Recent statistics from CRMC’s ambulatory care figures show that more than 4,700 patients received services in the dental clinic over a period of one year.

The services of CRMC’s dental clinic appear to have taken the load off of other local hospitals. A representative of Saint Agnes Hospital in North Fresno said that dental patients at their ER were rare.

“That’s not something we’ve actually seen here,” she said.

Other counties aren’t as fortunate. Dan Allain, FNP, director of critical care at Kaweah Delta Hospital in Visalia, said that patients with dental problems routinely visit the hospital’s emergency room as well as the urgent care clinic a mile away.

“Actually, we’ve been seeing a trend toward this for the last two years,” Allain said. “We see them for general tooth pain, dental abscesses, fractured teeth and other problems, most of which are the result of dental decay.”

Allain said that patients with these problems are asked a simple question.

“Do you see a dentist?” he said. Most do not.

Smith said the state is extremely shortsighted on this issue, and they can’t seem to figure out a better method. A dentist charges around $80 for a visit, but in the emergency room, the charge is “north of $300.”

The whole thing is not cost efficient, Smith said. The more patients he sees, the more money the state will have to pay both him and the hospital. And the patient has no incentive to economize since they don’t have to pay for any of it.

“The state is bankrupting itself because no one is watching the speedometer on this,” Smith said. “It’s massively inefficient, because we don’t have dentists in the ER.”