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Experts say Iowa's dental care is ahead of other states

BY CHASTITY DILLARD | MARCH 06, 2012 6:30 AM

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An apple a day may keep the dentist away, but staying away from the dentist might be a bad move. In fact, it cost the state as much as $5 million each year.

A recent Pew Center report showed more Americans are gambling against routine dental visits. Instead of visiting the dentist for checkups or to get treatment for minor issues, more Americans are ignoring their oral problems.

But when those problems worsen, many of those people are ending up in the emergency room.

In 2007, 10,000 emergency-room visits in Iowa were for oral health reasons — costing the state $5 million. In 2009, there were 14,274 dental visits, with 75 percent adults ages 18 to 44.

Michael Kanellis, the associate dean for patient care at the University of Iowa College of Dentistry, said Iowa doesn't have it as bad as many states in which large urban areas suffer the most, but it's still an issue here.

"With more people out of work, the first thing they will stop spending on is dental care, and so they can end up in the hospital, which isn't good because they will end up with palliative care," said Kanellis, who is also a pediatric dentist.

The UI Hospitals and Clinics' emergency and specialty dental clinics see roughly 150,000 patients each year. That offsets the number of dental injuries seen in the emergency room.

But Kanellis said emergency-room treatments are only able to temporarily alleviate a patient's pain or swelling. Most doctors recommend following up with a visit to the dentist, and those who don't usually end up back at the emergency room.

And emergency rooms aren't equipped to handle dental problems.

"It's a problem because, number one, it's high cost care in a setting that is inappropriate," said Peter Damiano, the director of the UI Public Policy Center. "Most ER's are not set up for treating dental problems and [patients] shouldn't be seen there in the first place."

Dan Caplan, the head of the UI Preventive and Community Dentistry Program, said most dental emergencies can be avoided.

"Prevention in dental disease tends to be cheaper in the long run than the treatment of it," he said. "We have a lot of preventative strategies in preventing cavities and a lot of toothaches."

Avoiding cavities solves many problems, Caplan said, something dentists often stress to patients.
Astha Singhal, a UI Ph.D. student in dental research, conducts research that compares different states' data of emergency room care for dental issues.

"The emergency room is not an answer," she said. "It's making our health-care expenditures go up. It's highlighting the fact that even though [patients] go to the [emergency room] and get care, it's not a solution."

But Shelly Gehshan, director of the Pew Children Dental Campaign, said how a state addresses dental health serves as a good indicator on the system's effectiveness.

"It's the canary in the coal mine," she said. "Because if your rate of people going to the emergency room for dental problems is above zero, it basically means that some people can't get service."

Gehshan said there are low-cost programs states can use to help tackle the problems.

"If water is fluoridated, you have to make sure that they continue to fluoridate," she said. "All states should do a better job on getting more sealants on low-income kids' teeth. It's really a low cost."

Another problem is Medicaid reimbursement rates — 50 to 60 percent nationwide — which push dentists to not accept these patients.

But more than 70 percent of Iowa dentists accept Medicaid, Kanellis said.

Damiano said the problem is people think of dental health issues as optional.

"We are learning more and more that it isn't separate," he said. "An infection in your body is in an infection in your body."


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