When patients visit the emergency department (ED) for nontraumatic dental conditions, they are typically referred to dentists for treatment. In order to address pain and fear of infection during the referral process, avoidable antibiotic and opioid prescriptions are sometimes dispensed.
The investigators of a new study, published in the Journal of the American Dental Association,
found that more than half of patients filled a prescription for an antibiotic within 7 days of a dental-related ED visit. Of these, around 40% filled a prescription for an opioid.
The study team conducted a retrospective analysis using the IBM MarketScan Research Databases in Treatment Pathways from 2012 through 2014. Patients with Medicaid or commercial insurance were included, and stratified in the analysis on this basis.
Diagnoses were assessed according to the International Classification of Diseases, 9th
revision, Clinical Modification.
The investigators discovered that fewer commercially insured people (1.3%) visited the ED for dental related reasons during the study period when compared with individuals insured through Medicaid (4.9%).
“Treatment of dental conditions in the ED often indicates a lack of access to preventive or acute oral health care,” the study authors explained.
Common diagnoses were similar between the 2 insurance groups, with 44.3% of commercial-insurance individuals and 54.2% of Medicaid-insured individuals diagnosed with an unspecified disorder of the teeth and supporting structures.
Periapical abscess without sinus was diagnosed in 16% of Medicaid patients and 19.1% of commercial patients. A diagnosis of unspecified caries applied to 9% of commercial patients and 27.1% of Medicaid patients seen in the ED.
Within 7 days of an ED visit, 55% of commercially insured and 54.9% of Medicaid patients filled an antibiotic prescription. More than 30% of patients with a dental-related ED visit were given both an opioid and an antibiotic.
This discovery reveals that there may be stewardship benefits to expanding access to preventative dental care.
“ED visits for conditions that could be avoided with adequate preventive or acute oral health care or treated by a dentist in an outpatient setting are an additional costly burden to the health care system,” the study authors wrote.
While not all of these prescriptions are unnecessary, they represent a substantial target for stewardship efforts. Additionally, even necessary prescriptions may be avoidable if access to care were expanded prior to infection.
However, even when patients do have access to dentistry there are stewardship barriers to overcome as well. A study in JAMA Network Open
found that more than 80% of antibiotics prescribed for infection prophylaxis before dental visits are unnecessary.
Additionally, stewardship efforts need to address antibiotic prescribing prior to dental treatment in patients who have undergone certain orthopedic procedures
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