When a Toothache Becomes a Medical Emergency

Although rumblings have begun to include dental care under Medicare coverage, medical plans generally don’t cover your teeth. And for some people who forgo dental care because it’s not subsidized, a routine tooth problem can escalate into a serious medical issue.

Christopher Smith was one of those people. His story, as told by USAToday.com, started with a toothache and turned into a raging infection that ultimately landed him in intensive care on a ventilator and feeding tube.

Many people don’t have dental insurance, and most dental plans aren’t very good; unless you have chronic, expensive dental problems, most people don’t find these policies cost-effective. Smith, 41, didn’t have dental insurance and hadn’t seen a dentist in years.

The Affordable Care Act (ACA, or “Obamacare”) requires health plans to cover dental services for children, but not adults. Medicaid plans for adults vary according to what state you live in, and for Smith, a low-income resident of Kentucky, that coverage was limited.

Such limited insurance coverage brings many people to the ER when earlier intervention could have prevented such visits. More than 8 in 10 dental ER visits are by the uninsured or people with government insurance plans.

Analysis of federal data by the American Dental Association (ADA) showed that dental ER visits doubled in the 12 years between 2000 and 2012, from 1.1 million 2.2 million; that’s one visit every 15 seconds. Health-care reform has not shown any benefit in dental care.

Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville Hospital where Smith went, told USA Today, “[T]here is not a week that goes by that we don’t have someone hospitalized. … People still die from their teeth in the U.S.”

Tooth pain usually brings people to the ER, and by law, emergency departments have to see patients even if they can’t pay. Often, the treatment is only the provision of painkillers and antibiotics, and a referral to a dentist, but these visits cost more than three times as much as a routine dental visit. USA Today reported the average cost as $749 if the patient isn’t hospitalized, which amounts to a U.S. health-care system bill of about $1.6 billion a year.

Prevention, of course, is the key to these medical emergencies and their inflated cost. But many people just can’t afford preventive care. About 1 in 3 working-age adults and nearly 2 in 3 seniors lacked dental coverage in 2012. The 1 in 10 U.S. adults with Medicaid dental plans often can’t find dentists who take new patients. And some states, including Kentucky, also have a shortage of dentists.

Even some people who can afford it don’t get preventive dental care. About 4 in 10 U.S. adults did not go to the dentist in the last year; more than 1 in 4 working-age adults, and 1 in five seniors, have untreated cavities.

Dentists told USA Today that a lot of people just ignore dental problems until they can’t stand it anymore, and if that happens outside business hours, they go to the ER.

Which is where Smith, a singer and part-time security system installer, found out just how critical it is to maintain oral health.

When one of his molars fell out, he used a do-it-yourself kit for repair, but the temporary filling came out during a concert that night. He used an over-the-counter dental pain reliever, but the next day, as the pain worsened, his jaw swelled. He landed at the ER at 4 in the morning.

Doctors referred him to a dentist, who diagnosed a worsening infection and sent him back to the ER, where his tooth was removed. He went home, where the infection drained into his neck, making it difficult for him to breathe. As he waited in the hospital ER, on his third trip, the swelling increased and, he told USA Today, “I could feel my windpipe close.”

He was admitted, and doctors cut into his neck to drain the infection. He stayed in the hospital for a week.

Before you find yourself in a similar situation, research community health centers in your area, some of which offer low-cost care. Research local university dental school clinics, which often have treatment programs.

In Baltimore, according to USA Today, the University of Maryland School of Dentistry’s pre-doctoral clinic students provide a range of care under faculty supervision. There’s also a walk-in clinic for people with emergencies. “An ADA report last year,” the paper reported, “found that dental ER visits had fallen between 2012 and 2014 in Maryland amid state reforms such as increased Medicaid reimbursements for dentists and a larger provider network – inspired in part by the 2007 death of a 12-year-old boy from a brain infection that began as a toothache.”

To find a dental school program in your area, contact your state’s dental society at MouthHealthy.org.

To learn more about the connection between dental and heart health, link here.

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