Predictors of survival of large non-occlusal non-incisal glass-ionomer restorations in older adults.

PURPOSE: This study aimed to investigate the predictors of survival of non-occlusal non-incisal glass-ionomer restorations as a surrogate for root surface restorations among older adults. METHODS: In a retrospective cohort analysis using the University of Iowa College of Dentistry electronic dental records, we included 721 patients aged 65+ who received 2+ surface non-occlusal non-incisal glass ionomer restorations placed from January 2005 - December 2011. Restorations were followed until September 2017 or until they were deemed to have failed. RESULTS: At baseline, participants' mean age was 77.6 ± 8.2 years, and 45.8% were females. Most patients were self-pay (65.2%). Most restorations were placed by residents and dental students (82.7%) and included only two surfaces (95.6%). About half (49.1%) failed during follow-up, with a median survival time of 3.7 years. The time ratio for lower incisors compared to other teeth was 0.6 (p = .006), for three-and-four-surface restorations compared to two was 0.7 (p = .007), for faculty as providers compared to residents and students was 1.4 (p = .039), and for the Geriatric & Special Needs Clinic compared to others was 0.8 (p = .013). Time ratios less than one indicate association with shorter durations for restorations, and time ratios greater than one indicate association with longer durations for restorations. CONCLUSION: Tooth type, number of restored surfaces, provider type, and clinic were all significant factors associated with survival of these restorations.

Orthodontics in the era of big data analytics.

The objective of this report was to provide an overview of the current landscape of big data analytics in the healthcare sector, introduce various approaches of machine learning and discuss potential implications in the field of orthodontics. With the increasing availability of data from various sources, the traditional analytical methods may not be conducive anymore for examining clinical outcomes. Machine-learning approaches, which are algorithms trained to identify patterns in large data sets, are ideally suited to facilitate data-driven decision making. The field of orthodontics is particularly ripe for embracing the big data analytics platform to improve decision making in clinical practice. The availability of omics data, state-of-the-art imaging and potential for establishing large clinical data repositories have favourably positioned the specialty of orthodontics to deliver personalized and precision orthodontic care. Specifically, we discuss about next-generation sequencing, radiomics in the context of CBCT imaging, and how centralized data repositories can enable real-time data pooling from multiple sources.

Should Pass/Fail Grading Be Used Instead of Traditional Letter Grades in Dental Education? Two Viewpoints: Viewpoint 1: Pass/Fail Grading Improves Learning Experiences for Students and Viewpoint 2: Traditional Letter Grading Provides Objective Evaluation for Dental Education.

Discussions about which grading system (letter grade or pass/fail) is more effective in dental education have been occurring for several decades. As more institutions continue to consider the change from the traditional five-tier letter grading system (A/B/C/D/F) to a two-tier grading system (pass/fail), this debate will likely continue. This point/counterpoint article examines arguments for and against each type of grading system, taking into consideration academic performance, learning outcomes, psychological well-being, learning environment, acceptance/performance in postgraduate educational programs, and student motivation. Viewpoint 1 supports the position that a pass/fail system improves learning experiences for dental students, whereas Viewpoint 2 argues that the traditional letter grading system provides for more objectivity and reliability in student evaluation.

Performance of 5 different displays in the detection of artificial incipient and recurrent caries-like lesions.

OBJECTIVES: The aim of this study was to assess whether auto-calibrating medical-grade monitors perform better than off-the-shelf monitors and tablet computers in detecting artificial incipient and recurrent caries-like lesions. STUDY DESIGN: Sixty extracted teeth (30 premolars and 30 molars) were selected. All molars received class II amalgam and composite restorations. A 7-mm2 area on the crowns of half of the teeth was demineralized. Phantoms consisting of 4 teeth were created. Three observers using a 5-point scale evaluated digital periapical radiographs for the presence of caries on 5 displays: 2 autocalibrating medical-grade monitors, 2 tablets, and 1 off-the-shelf monitor. Sensitivity, specificity, accuracy, and receiver operating curve data were calculated and verified through analysis of variance and Tukey tests. Observer agreements were assessed using Cohen's κ test. RESULTS: Intraobserver agreement ranged from 0.347 to 0.612 (molars) and 0.617 to 0.811 (premolars). Interobserver agreement ranged from 0.239 to 0.559 (molars) and 0.657 to 0.858 (premolars). The performances of tablets and the off-the-shelf monitor were similar to medical monitors when the same tooth groups were compared. Medical-grade monitors presented fewer statistically significant differences when different lesions where compared within the same display and restorative material. CONCLUSIONS: Evaluations of similar lesions were not significantly different among the 3 types of displays. However, the autocalibrating medical-grade monitors performed better when incipient and recurrent lesions were compared.

Impact of cone-beam computed tomography scan mode on the diagnostic yield of chemically simulated external root resorption.

INTRODUCTION: The aim of this in-vitro study was to evaluate the influence of cone-beam computed tomography scans on the diagnosis of chemically simulated external root resorption. METHODS: One hundred extracted anterior teeth were selected. Subsurface demineralization was induced on a limited area of the apical third of the root of 49 teeth. Each tooth was placed in an empty socket of a partially edentulous dry mandible. Cone-beam computed tomography images were obtained according to 3 protocols: (1) half scan, 0.40-mm voxel size; (2) full scan, 0.40-mm voxel size; and (3) full scan, 0.125-mm voxel size. Three observers evaluated the images. Sensitivity, specificity, accuracy, and area under the curve were compared with the Cochran Q and Mann-Whitney U tests. RESULTS: Protocol 3 had the highest sensitivity (81.63%), accuracy (80.67%), and area under the curve (0.807). There were statistically significant differences between protocol 3 and the other 2 protocols (P <0.001). The specificity of protocol 1 (84.97%) was greater than that of protocols 2 (69.93%) and 3 (79.74%); however, a statistically significant difference was found only between protocols 1 and 2 (P = 0.005). CONCLUSIONS: A more dedicated, high-resolution scan should be acquired when one intends to investigate the early stage of external root resorption during orthodontic treatment. However, this does not imply that all orthodontic patients should be subjected to high-dose cone-beam computed tomography scans.

Candidate gene analyses of 3-dimensional dentoalveolar phenotypes in subjects with malocclusion.

INTRODUCTION: Genetic studies of malocclusion etiology have identified 4 deleterious mutations in genes DUSP6,ARHGAP21, FGF23, and ADAMTS1 in familial Class III cases. Although these variants may have large impacts on Class III phenotypic expression, their low frequency (<1%) makes them unlikely to explain most malocclusions. Thus, much of the genetic variation underlying the dentofacial phenotypic variation associated with malocclusion remains unknown. In this study, we evaluated associations between common genetic variations in craniofacial candidate genes and 3-dimensional dentoalveolar phenotypes in patients with malocclusion. METHODS: Pretreatment dental casts or cone-beam computed tomographic images from 300 healthy subjects were digitized with 48 landmarks. The 3-dimensional coordinate data were submitted to a geometric morphometric approach along with principal component analysis to generate continuous phenotypes including symmetric and asymmetric components of dentoalveolar shape variation, fluctuating asymmetry, and size. The subjects were genotyped for 222 single-nucleotide polymorphisms in 82 genes/loci, and phenotpye-genotype associations were tested via multivariate linear regression. RESULTS: Principal component analysis of symmetric variation identified 4 components that explained 68% of the total variance and depicted anteroposterior, vertical, and transverse dentoalveolar discrepancies. Suggestive associations (P < 0.05) were identified with PITX2, SNAI3, 11q22.2-q22.3, 4p16.1, ISL1, and FGF8. Principal component analysis for asymmetric variations identified 4 components that explained 51% of the total variations and captured left-to-right discrepancies resulting in midline deviations, unilateral crossbites, and ectopic eruptions. Suggestive associations were found with TBX1AJUBA, SNAI3SATB2, TP63, and 1p22.1. Fluctuating asymmetry was associated with BMP3 and LATS1. Associations for SATB2 and BMP3 with asymmetric variations remained significant after the Bonferroni correction (P <0.00022). Suggestive associations were found for centroid size, a proxy for dentoalveolar size variation with 4p16.1 and SNAI1. CONCLUSIONS: Specific genetic pathways associated with 3-dimensional dentoalveolar phenotypic variation in malocclusions were identified.

Cross-Sectional Analysis of National Dental Residency Match Data.

The Dental Residency Match (DRM) program provides an ethical and unbiased selection process for applicants to postdoctoral dental programs, based on mutual interests of applicants and programs. The aims of this study were to conduct a descriptive analysis of DRM metrics for the years 2008 to 2015 and to test the hypothesis that there was a difference in number of ranks submitted between programs that filled all their offered positions and those that did not. DRM metrics data from years 2008 to 2015 were obtained from the National Matching Service. Trend analyses and panel data assessments were made. Six types of postdoctoral dental programs (GPR, AEGD, oral and maxillofacial surgery, pediatric dentistry, orthodontics, and dental anesthesiology) participate in the DRM program. The results showed that the number of programs participating and number of residency positions offered increased over the study period. The programs that filled all their positions ranked more applicants than the programs that did not fill their positions (p<0.05). The number of acceptable applicants increased over the study period for all programs except those in dental anesthesiology. These results suggest that participation in DRM is increasing, most programs are able to fill their positions with acceptable applicants, and programs seeking to fill all their positions need to submit a large number of ranks.

Global Dental Research Productivity and Its Association With Human Development, Gross National Income, and Political Stability.

OBJECTIVE: The objective of this study is to examine the associations between country level factors (such as human development, economic productivity, and political stability) and their dental research productivity. METHODS: This study is a cross-sectional analysis of bibliometric data from Scopus search engine. Human Development Index (HDI), Gross National Income per capita (GNI), and Failed State Index measures were the independent variables. Outcomes were "Total number of publications (articles or articles in press) in the field of dentistry" and "Total number of publications in the field of dentistry per million population." Non-parametric tests were used to examine the association between the independent and outcome variables. RESULTS: During the year 2013, a total of 11,952 dental research articles were published across the world. The top 5 publishing countries were United States, Brazil, India, Japan, and United Kingdom. "Very High" HDI countries had significantly higher number of total dental research articles and dental research articles per million population when compared to the "High HDI," "Medium HDI," and "Low HDI" countries (p < 0.0001). There was a significant linear relationship between the GNI quartile income levels and outcome metrics (p ≤ 0.007). Countries which were highly politically stable were associated with significantly higher dental research productivity (p < 0.0001). CONCLUSIONS: There appears to be a regional concentration of articles with just five countries contributing to over 50% of all articles. The human development and economic development of a country are linearly correlated with dental research productivity. Dental research productivity also increases with increasing political stability of a country.

Epidemiology and Outcomes of Hospital-based Emergency Department Visits with Tooth Fractures.

PURPOSE: The purpose of this study was to identify characteristics of hospital-based emergency department (ED) visits for tooth fracture and subsequent dentally related hospital admissions. METHODS: This was a retrospective analysis of the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project for the years 2008 to 2010. All children up to 21 years old, with a diagnosis of tooth fracture due to trauma, were selected. Hospital ED charges, occurrence of concurrent injuries, and hospitalization following ED visits were examined. RESULTS: A total of 199,061 ED visits were attributed to broken or fractured teeth; males comprised 63 percent of ED visits. Skull and facial fractures were present in seven percent and intracranial injuries in four percent of ED visits. The most frequent causes for ED visits and for subsequent hospitalization, respectively, were falls and motor vehicle accidents. The mean charge for each ED visit was $1,441. Total charges for the entire United States were $241.8 million. Following an ED visit, 7,233 patients were admitted as inpatients. CONCLUSIONS: Males comprised a majority of these emergency department visits. Occurrence of concomitant bodily injuries appears to be common and is a significant predictor of hospitalization and hospital ED charges.

Prevalence of the posterior superior alveolar canal in cone beam computed tomography scans.

OBJECTIVE: This study was primarily aimed at determining the prevalence of the posterior superior alveolar (PSA) canal in cone beam computerized tomography (CBCT) scans in a North American population. MATERIALS AND METHODS: Cone beam computed tomography scans were selected on the basis of predetermined eligibility criteria from a pool of 976 data sets. Two calibrated examiners assessed the presence of PSA canal on the postero-lateral wall of the maxillary sinus using coronal sections. One examiner also recorded the presence of images compatible with sinus disease. Associations between the presence of PSA canal and sinus disease were investigated for males and females separately using statistical methods. RESULTS: A total of 254 CBCT scans were selected. The pooled prevalence of the PSA canal in CBCT scans was 94.4% and 91% on the right and left side, respectively. The ability to detect the presence of the canal was not significantly affected by the presence of intrasinusal disease. Males are more likely than females to present signs of maxillary sinus pathoses on the right (63.3% vs. 36.7%) and the left side (59.2% vs. 40.8%). CONCLUSIONS: The prevalence of the PSA canal on CBCT images in the selected population is high. The PSA canal can be consistently visualized on CBCT scans with a high level of reproducibility regardless of the presence of radiographic signs of intrasinusal pathoses.

Pathways for foreign-trained dentists to pursue careers in the United States.

With the U.S. population growing ever more diverse and the need for dentists in many areas of the United States, there is increasing opportunity for foreign-trained dentists to pursue dental careers in this country. This article provides a broad overview of dental education and career pathways available for foreign-trained dentists in the United States. Educational opportunities include pursuing advanced standing dental degree programs and advanced graduate education (residency programs). Career pathways include working in academic and private practice settings. This article also describes the licensure and visa requirements foreign-trained dentists must satisfy to work legally in the United States.

An overview of characteristics of registered studies on dental implants.

OBJECTIVE: Clinical trials serve as the empirical basis for clinical decision making. The objective of the current study is to provide an overview of clinical trials examining dental implant outcomes. METHOD: All registered studies on Dental Implants were selected for analysis. The clinicaltrials.gov website was used to query the characteristics of registered studies. The search term used was dental implants. RESULTS: As of the study conduct date (01/01/2014), a total of 205 studies on dental implants were registered. These included 168 interventional and 37 observational studies. Results were available for only 14 studies. All observational studies and 98.8% of interventional studies included both male and female subjects. Close to 60% of studies had sample sizes between 1 and 50. NIH was listed as funding source in only 5 interventional studies and 3 observational studies. 80% of interventional studies were randomized. However, double masking was reported in only 15% of interventional studies with majority being open labeled. CONCLUSION: ClinicalTrials.gov registry was created with the intention of increasing the transparency of conducted or ongoing clinical studies and to minimize publication bias commonly seen with industry-sponsored studies. Results of the current study showed that a predominating number of registered studies are funded by industry and other sources, very few registered studies have made their results public, and the ClinicalTrials.gov registry does not provide sufficient information on the quality of study design and thus precluding the public and researchers to judge on the quality of registered studies and publication bias.

Hospital-based ED visits with dental conditions among geriatric patients.

OBJECTIVE: To provide nationally representative estimates of all hospital-based emergency department (ED) visits with dental caries, pulp and periapical lesions, gingival/periodontal lesions, and mouth cellulitis occurring among the older population groups (aged 60 years and above). METHODS: The 2008 Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project was used. This database provides weighted estimates of all ED visits in the United States (approximately 150 million). Hospital discharges with primary procedure ICD-9-CM codes for dental conditions in adults aged 60 and older were evaluated. All estimates obtained from the sample were projected to national levels. RESULTS: A total of 50,881 ED visits had a dental condition including dental caries (33.6%), pulpal lesions (10.4%), periapical abscess (36%), gingival conditions (11%), and cellulitis (6.7%). Close to 72.7% were discharged routinely and 25.1% were admitted as inpatients into the same hospitals. About 63.4% of ED visits were covered by Medicare. Close to 40% of all ED visits occurred in the southern regions. The mean charge per ED visit was $1,114, and the total charges across the entire United States were $44.8 million. CONCLUSIONS: In comparison to other age groups, older adults are hospitalized more frequently after ED visits for dental conditions. As the U.S. population ages, innovative programs are necessary to manage dental conditions in dental offices and reduce the number of ED visits and hospitalizations for dental complaints by older adults.

Economics of facial fracture reductions in the United States over 12 months.

OBJECTIVE: The face is a complex architectural structure in the body and is a high-risk site for fractures. Hospitalization is necessary for adequate treatment. The objective of this study is to examine hospitalization outcomes associated with reduction in facial fractures in the United States. METHODS: The Nationwide Inpatient Sample (NIS) of the health care cost and utilization project for 2008 was used. This database provides weighted estimates of all hospitalizations in the United States, which approximates 39.88 million admissions in the entire United States. Hospital discharges with primary procedure ICD-9-CM codes for reduction in facial fractures were selected. Outcomes examined included hospitalization charges, length of stay, and causes of injuries. All estimates obtained from the sample were projected to national levels. RESULTS: Reduction in facial fractures was performed as primary procedure in 21,244 hospitalizations. The total hospitalization charges were about $1.06 billion, and total hospitalization days was 93,808. About 80% of all hospitalizations occurred among men. The frequently occurring external causes of injuries leading to hospitalization for reduction in facial fractures include assault (36.5% of all hospitalizations), motor vehicle traffic accidents (16%), falls (15%), and other transportation accidents (3.5%). The frequently performed procedures were open reduction in mandibular fractures (52.2%), open reduction in facial fractures including those of orbital rim or wall (14.7%), closed reduction in mandibular fractures (12.1%), and open reduction in malar and zygomatic fractures (11.8%). CONCLUSIONS: National hospitalization outcomes related to reduction in facial fractures indicate an extensive consumption of hospital resources. If hospital emergency room protocols and inpatient protocols relating to the most expensive fractures and longest hospital stays that we have identified can improve, this may lead to improved outcomes and a reduction in hospital charges for facial fractures.

Hospitalizations primarily attributed to dental conditions in the United States in 2008.

OBJECTIVE: The objective of this study was to provide estimates of hospitalizations attributed to oral health related conditions in the United States (US). STUDY DESIGN: The nationwide inpatient sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) for 2008 was used. Hospital admissions with a primary diagnosis of dental/oral health-related conditions were identified using ICD-9-CM diagnosis codes. RESULTS: A total of 50,658 hospital admissions were primarily attributed to oral health-related conditions in 2008. Total US hospitalization charges were $1.218 billion. Total US hospitalization days were 174,496 days. CONCLUSIONS: The current study examines outcomes in patients hospitalized primarily for dental/oral health-related conditions. Of 39,885,120 hospitalizations that occurred in the US, a total of 50,658 (1.27%) were primarily attributed to dental-related conditions. Substantial resources are spent in treating dental-related conditions in hospital settings.

Burden of facial cellulitis: estimates from the Nationwide Emergency Department Sample.

OBJECTIVE: Multitude of maxillofacial infections from odontogenic and nonodontogenic origins can progress to facial cellulitis, which may require an emergency department (ED) visit for appropriate care. The aim of this study was to investigate national prevalence of ED visits attributed primarily to facial cellulitis, to quantify the associated hospital charges, and to identify a cohort of population presenting to the ED with facial cellulitis. STUDY DESIGN: The Nationwide Emergency Department Sample (NEDS) for the year 2007, a component database of the health care cost and utilization project was used for this study. All ED visits that had a primary diagnosis of facial cellulitis (ICD-9-CM code 682.0) were selected for analysis. All estimates were projected to national levels using the discharge weight variables. RESULTS: In 2007, a total of 302,507 ED visits were attributed primarily to facial cellulitis in the USA. The average age of the patients was 35.0 years. The mean hospital charge for each ED visit was $1,024, with a total charge of $241,541,694. A total of 17.8% of ED visits were admitted into the same hospital for inpatient care, and 78.5% of ED visits were discharged routinely; 67.6% of ED visits occurred on weekdays. Private insurance payers comprised the largest proportion (31.6%). CONCLUSIONS: This study highlights the prevalence of hospital-based ED visits primarily due to facial cellulitis in the USA in year 2007, its significant associated hospital resource utilization for treatment, and characteristics of the patient population who are likely to visit a hospital-based ED for treatment of facial cellulitis.

Factors associated with hospitalization charges for cleft palate repairs and revisions.

PURPOSE: The objective of this study is to provide nationally representative estimates of cleft palate correction and revision procedures performed in hospitalized patients, as well as to examine patient- and hospital-level factors associated with hospitalization charges. MATERIALS AND METHODS: The Nationwide Inpatient Sample for the year 2007 was used. All hospitalizations that had a cleft palate correction or revision of cleft palate repair were selected. Estimates of concomitant procedures performed during the index hospitalization were obtained. The roles of different patient- and hospital-level variables on hospitalization charges were examined by use of multivariable linear regression analysis. RESULTS: A total of 5,969 repairs and/or revisions of cleft palate procedures were performed in hospitals in the entire United States. The mean age per hospitalization was 3.2 years. Whites accounted for 51.3% of procedures, whereas blacks, Hispanics, Asian/Pacific Islanders, Native Americans, and other races accounted for 4.9%, 26.4%, 9.2%, 3.2%, and 5%, respectively. The mean charge per each hospitalization was $19,227, and the total hospitalization charge for the entire United States was $112.96 million. Patients aged less than 1 year (P = .02) and those aged between 8 and 12 years (P = .03) had significantly lower charges compared with those aged 18 years or older. Use of bone morphogenetic protein was associated with higher hospital charges (P = .0006). Compared with the uninsured, those covered by Medicaid (P = .04), private insurance plans (P = .02), and other insurance plans (P = .0005) were associated with higher charges. CONCLUSION: This study identified an association between hospital charges and insurance payer, race, treatments performed, and age. Our results provide insights into nationally representative estimates on management of cleft palate corrections and revisions.

Incidental findings on cone beam computed tomography images.

Background. Cone beam computed tomography (CBCT) has gained widespread acceptance in dentistry for a variety of applications. Most dentists who are not radiologists/trained in radiology are generally not familiar with interpretation of anatomical structures and/or pathosis outside their area of primary interest, as often this was not within the scope of their training. Objectives. To assess that the number of incidental findings on a CBCT scan is high both within and outside of the primary area of interest, thereby emphasizing the importance of interpretation of all areas visualized on the scan. Materials and Methods. An oral and maxillofacial radiologist reviewed 1000 CBCT scans (382 males and 618 females) for findings both in- and outside the area of interest. Results. Of the 1000 subjects that were reviewed, 943 scans showed findings in the primary regions of interest and/or outside the regions of interest, and 76 different conditions were visualized in these scans both in and outside the areas of interest. Conclusion. From the wide scope of findings noted on these scans, it can be concluded that it is essential that a person trained in advanced interpretation techniques in radiology interprets cone beam computed tomography scans.

Prevalence and impact of complications on outcomes in patients hospitalized for oral and oropharyngeal cancer treatment.

OBJECTIVE: We studied the association between presence of complications and hospitalization outcomes, including hospital charges, length of stay in hospital, and in-hospital mortality. METHODS: The Nationwide Inpatient Sample for 2008 was used. All hospital discharges with a primary diagnosis of oral and oropharyngeal cancers were selected. Presence of complications was determined by using ICD-9-CM codes. The association between the presence of complications and outcomes (hospital charges, length of stay, and in-hospital mortality) was examined by multivariable linear and multivariable logistic regression analyses. The effects of several patient- and hospital-related confounders were adjusted in the regression analyses. RESULTS: A total of 17,632 hospitalizations were attributed to oral and oropharyngeal cancers. A total of 519 (2.9%) patients died in the hospitals. The total hospitalization charges were close to $1.08 billion. Oral and oropharyngeal cancers accounted for 117,472 hospitalization days (mean length of stay 6.6 days). The overall complication rate was 14.95%. The most frequently present complication was hemorrhagic complications. Among the different complications, septicemia was associated with the worst outcomes. Patients with septicemia were associated with the highest odds for in-hospital mortality (OR = 13.06, 95% CI = 3.81-48.50, P = .0001). CONCLUSIONS: Presence of complications was associated with poor outcomes, such as high in-hospital mortality rates, excess hospitalization charges, and longer length of stay in hospital. Among the different complications, septicemia was associated with the worst outcomes.

Hospital emergency department visits attributed to pulpal and periapical disease in the United States in 2006.

BACKGROUND: Relatively localized conditions such as infection of the pulp or periapical tissues if left untreated could spread and require hospital care. The objectives of this study were to assess the prevalence of such hospital-based emergency department (ED) visits, to quantify hospital charges associated with those visits, and to identify characteristics of those members of the population who are likely to make such visits. METHODS: The experimental design of this study involves the use of The Nationwide Emergency Department Sample for the year 2006. All discharges with a primary diagnosis code for pulpal and periapical diseases (International Classification of Disease, Clinical Modification [ICD-9-CM] code of 522) were selected for analysis. All estimates were projected to national levels using the discharge weight variables. RESULTS: In the United States, during the year 2006, a total of 403,149 ED visits had a primary diagnosis code for pulp and periapical diseases. The average patient age was 32.9 years. The mean hospital charge for ED visits was $480, and the total charges for all the ED visits in the United States was $163,692,957. Among the ED visits, 5,721 were admitted to the same hospital for inpatient care. The mean length of stay after hospitalization was 2.95 days. The uninsured (39.92%) constituted the largest proportion of all ED visits. CONCLUSIONS: This study identifies high-risk groups that are likely to present to hospital-based EDs for the treatment of pulp and periapical diseases. This highlights the need for significant resources to treat such patients in a hospital care setting.