June 24, 2018
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Patients going to Maine ERs with toothaches, other dental problems

By Jackie Farwell, BDN Staff

Two patients recently visited Dr. Wendy Alpaugh’s dental practice in Stonington after complaining to their doctors of painful facial swelling. Two expensive CAT scans later, both wound up in the dentist’s chair for a root canal.

“If they had realized how much less it would have cost them if they’d maintained the preventive care,” Alpaugh said, trailing off.

Toothaches and other avoidable dental problems were the primary culprit behind more than 830,000 emergency room visits nationwide in 2009, a 16 percent jump from 2006, according to a report released this week by the Pew Center on the States.

In Maine, dental disease was the top reason Medicaid recipients and uninsured people ages 15-24 visited ERs in 2006, Pew reported, citing a study by the Muskie School of Public Service at the University of Southern Maine. That year, tooth decay, abscesses and other dental problems were responsible for 3,400 emergency visits by Medicaid patients. The study highlighted poor access to preventive and acute dental care as major drivers.

Shortages of dentists in many areas and some dentists’ refusal to accept Medicaid patients contribute to the problem, the Pew study found. Modest investments in boosting access to preventive care could cut down on dental-related hospital visits and their associated costs, according to the study.

“We are seeing fewer people keeping up with their preventive care, preventive maintenance, and we’re seeing increasing numbers of people come in for crisis care,” said Alpaugh, who chairs the Maine Dental Access Coalition.

In 2009, Maine’s Medicaid program spent $6.6 million on avoidable dental emergency department visits and outpatient services that failed to treat the underlying disease, according to a February 2011 report by Department of Health and Human Services.

Maine has made some strides in the six years since the Muskie report, but access remains a major problem, according to Deb Dietrich, vice president of community health for MaineHealth, parent to Maine Medical Center in Portland.

“This [Pew] report will be a call to action to look in a very granular way what progress we’ve made since 2006,” she said.

Despite the barriers to access, Medicaid spending on dental care for kids has risen in Maine over the last decade, from $11 million in 2001 to about $30 million last year, according to data provided by DHHS. The number of children, which Medicaid defines as recipients under age 21, who were served jumped 50 percent to 72,625 over the same period.

Adults, on the other hand, aren’t covered for preventive care under Medicaid. Their benefits are limited to emergency procedures such as extractions.

At Eastern Maine Medical Center’s ER in Bangor, the cost to treat the most common dental problems averages $738, depending on each patient’s symptoms. That compares to around $100 for a typical cleaning at a dentist’s office.

Dental complaints at EMMC’s emergency room and walk-in care clinic are on the decline. From February of 2011 through the end of this January, visits for common dental diagnoses dropped to 403 from 556 the previous year.

Parent company Eastern Maine Healthcare Systems attributes the drop-off to its partnership with a dental clinic at nearby Penobscot Community Health Care.

About half of Maine’s 650 dentists don’t accept Medicaid patients. The average reimbursement rate of 40 cents on the dollar doesn’t even cover most dentists’ overhead costs, said John Bastey of the Maine Dental Association.

“The dentist, he or she eats 25 percent for any [Medicaid] patient they see,” he said.

On the private insurance side, many large employers continue to offer dental coverage despite the challenges of the recession. Small businesses, however, are struggling some, said Shannon Mills, vice president for professional relations and science at Northeast Delta Dental, which covers about 225,000 people in Maine.

“We are seeing a very slight trend at this point with small employers” dropping coverage, he said.

Maine’s three largest health systems are working to improve Mainers’ dental care from the very first tooth. Four years ago, EMHS, MaineHealth and MaineGeneral Health launched a privately funded initiative that teaches medical professionals how to apply a fluoride varnish to the teeth of children six months to three and a half years old.

To date, more than 100 medical practices statewide have participated, said Tom Violette, the program’s project director at EMHS.

“What studies have shown is oral health is probably the strongest predictor of future health status,” he said.

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