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Dental Concerns Unrelated to Trauma in the Pediatric Emergency Department
Barriers to Care
David H. Dorfman, MD;
Beth Kastner, MPH;
Robert J. Vinci, MD
Arch Pediatr Adolesc Med. 2001;155:699-703.
Objectives To describe patients with nontraumatic dental problems treated in our
pediatric emergency department (PED) and to determine if barriers to access
prompted seeking care in the PED rather than from a dentist or dental clinic.
Design Questionnaire administered to a convenience sample of patients with
nontraumatic dental complaints.
Setting An urban PED.
Main Outcome Measures Insurance status, primary medical and dental care, duration of symptoms,
diagnosis, and reason for seeking care in the PED.
Results Two hundred patients were enrolled. Median age was 17 years (range,
1-22 years). Forty-five percent were African American. Forty-nine percent
had Medicaid. Fifty percent identified a regular dentist, whereas 71% had
a primary care physician. Thirty-four percent of patients 4 years and older
had not seen a dentist in more than a year. Children younger than 13 years
were more likely than teenagers to identify a regular dentist (odds ratio
[OR] = 2.8; 95% confidence interval [CI], 1.3-6.1). Those with a regular medical
provider were more likely to have a regular dentist (OR = 7.7; 95% CI, 3.4-18).
The most common reasons for not going to a dentist were as follows: dentist
closed, 34%; lack of dental insurance or money, 17%; and lack of a dentist,
16%. Patients with symptoms for more than 72 hours were more likely to cite
lack of a dentist as their reason for coming to the PED (OR = 7.4; 95% CI,
1.9-33).
Conclusions Many pediatric patients do not have regular dental care, and this is
associated with a lack of primary medical care. Access barriers to acute dental
care include lack of insurance or funds, lack of a dentist, and limited hours
of dental care sites. Improved insurance reimbursement, active enrollment
of adolescents into preventive dental care, and expansion of provider hours
may limit PED dental visits and improve the health of patients.
From the Department of Pediatrics, Boston Medical Center, Boston University
School of Medicine, Boston, Mass.
Reprints: David H. Dorfman, MD, Boston Medical Center/Department
of Pediatrics, 91 E Concord St, Sixth Floor, Boston, MA 02118 (e-mail: david.dorfman{at}bmc.org).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Increasing prevalence of emergency department visits for pediatric dental care, 1997-2001
Ladrillo et al.
Journal of the American Dental Association 2006;137:379-385.
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