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Editorial: A trip to ER for teeth shows decay of system

Dental visits don’t rate high in popularity, but their value soars when you consider the alternatives.

Increasingly, Americans are showing up at emergency rooms when their dental issues reach unbearable proportions, according to a Pew Center on the States report. About all emergency rooms can offer is pain relief.

Most of these problems could be solved at a fraction of the cost with regular preventive care, but more people are losing access to routine maintenance because of cuts to Medicaid. Plus, government payments to dentists are not keeping pace with costs, so more dentists are choosing not to accept Medicaid patients.

It’s a sure sign of a broken health care system when people in dire dental pain are showing up at facilities that don’t staff dentists.

Tracking national trends, Spokane County is experiencing the same surge in ER visits, an 18 percent increase per year between 2005 and 2009, according to a 2010 Spokane Regional Health District report. The costs have also escalated, jumping from $1.6 million in 2005 to $4.1 million in 2009.

Those trends have almost certainly gotten worse, says Melissa Rehling, dental director for Community Health Association of Spokane, because the state has since eliminated regular dental coverage for Medicaid-enrolled adults. With local programs like Access to Baby and Child Dentistry, options remain for children (although 56 percent of Medicaid-covered kids nationwide received no dental care in 2009). Adults, meanwhile, often endure terrible pain. Some head to an emergency room or urgent care before trying to get help at CHAS, because they can’t even afford the nominal fee the community clinics must charge patients to keep themselves afloat.

A 2010 analysis by the Washington State Hospital Association highlights a significant difference between ER patients covered by Medicaid and those covered by employer plans. Dental issues don’t register in the top 25 reasons private-coverage patients use an ER. They rank sixth among Medicaid patients. This points to the difficulty of accessing preventive care for Medicaid patients.

Beyond the pain, the oral diseases contracted can lead to other serious health problems, such as diabetes and heart conditions. Eighty-six percent of Spokane County dental ER visits were for gingivitis or other infections that pose a much graver threat than broken teeth. Forty-five percent of ER visitors showed up multiple times for the same dental issues.

As Shelly Gehshan of Pew Charitable Trusts says, “It’s the wrong service, in the wrong setting, at the wrong time.”

What’s happening with dental care is the same thing that’s happening with all health care services when governments cut back. Budgets are balanced by shifting the costs elsewhere, but the underlying problem remains.

And in this case, the cuts are literally painful.

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Editorial: Washington state lawmakers scramble to keep public in the dark

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