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Departments
President's Message
Help! It Hurts!
Untreated dental emergencies are a growing problem even for established patients
Scott D. Lingle, D.D.S.
Emergency dental care is something we provide every day. Sometimes it is just a little rough spot on a tooth or restoration or a small denture sore. Sometimes you will hear the familiar phrase that they have never had a pain like this before.
ñYou canÍt even imagine what IÍm going through!î
They need and want help, and that is what we are here for. We help them. We feel good. They feel good. But are we always there for them?
When Robert Anderton was president of the American Dental Association, he wrote a comment in the Journal of the American Dental Association about a growing problem of untreated dental emergencies. And he wasnÍt talking about the people who donÍt have dentists or who go to the dentist only when they have a problem. He was talking about the established patient in dental practice. To make it more fun, as a dentist/lawyer, he looked at the legal side of the problem. If your patient has a true emergency and you are not available, did you abandon that patient?
Come on now! We have lives too! We canÍt be available all the time. We need to have family time and vacations. And most dentists donÍt leave town for two weeks without making some arrangements. Besides, dental emergencies are not life-threatening.
Well, Dr. Anderton was sympathetic to all these reasons or excuses, but he had concerns about whether they would hold up in court. What is our ethical responsibility to our patients? What unwritten contract do we have with them to provide emergency care? Like so many things, it will vary from state to state and with whatever the current mindset of the courts is. And how many lawyers there are.
Then there is the growing problem of the people with an emergency who do not have regular dentists or who are on public programs and cannot find a dentist to take them.
As the workforce shortage increases with the rising tide of retirements, this problem will continue to exacerbate. Currently many of these patients end up in hospital emergency rooms. Ask any ER physician, and he or she will tell you it is one of their biggest headaches. The most they can do is give those patients antibiotics and pain killers and wish them luck finding help tomorrow. (I was surprised that some of them are quite adept at giving a Marcain block injection.) Then they send an ER visit bill to the patientÍs insurance carrier or to Medicaid. All that time and expense, and no definitive care. My neighbor, the ER doc, has already inquired about my teaching him to do extractions.
So what are some solutions?
First of all, be responsive to your patients. Many dentists already carry pagers or cell phones and provide the contact that our technology-age clients expect. If you donÍt, consider it. You would be surprised how seldom patients abuse it, and how much they appreciate it when they do have to use it. ItÍs not bad marketing as well.
Second, consider a more formal arrangement with some colleagues for day-to-day coverage rather than just vacations. I have been involved in a ñbeeper groupî for more than 20 years. For awhile, we had up to nine doctors involved, and we rotated the beeper every week. Now there are just four practices involved, and it works better than ever. We rotate the beeper every two weeks. Each dentist is on call 24 hours a day, seven days a week for a two-week period. Holidays are planned out a year in advance. It sounds brutal, but the reality is most periods go by without a single call. When they do happen, most emergencies are well handled over the phone. But when someone falls off a bike or takes a softball in the mouth, boy, are they impressed!
Finally, what about the many who donÍt have dentists? This past year the MDA introduced legislation to establish an after-hours dental emergency center. If you were able to eliminate what the state and the medical insurance companies are spending on hospital ER care, there would be a substantial amount of money to fund the dental ER that does provide true definitive care. I am not talking about volunteer dentists. The staff would be paid professionals, as they are in the hospitals. In fact, the dental center should be at the hospital or very close by should a medical referral be needed.
The legislature decided to put this off to study it for a year and come back with recommendations. During this time, we need to clarify our position. Where is the need in the Metro area and the rural area? How far can we expect someone to travel to get to a center? How are we going to find dentists to staff these ERs or Urgent Care clinics? If we donÍt solve this problem, someone else eventually will.
Dr. Lingle is the president of the Minnesota Dental Association. He is a general dentist in private practice in Saint Paul, Minnesota.
Copyright 2003. Minnesota Dental Association
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