Calidad de la atención estomatológica de urgencia en tiempos de COVID-19

Introducción: La evaluación de la calidad de la atención de salud tiene sus particularidades respecto a la calidad industrial o de servicios en sentido general. Objetivo: Evaluar la calidad de la atención estomatológica de urgencia en tiempos de COVID-19. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 6 estomatólogos, quienes laboraban durante el estudio en el Servicio de Urgencia Estomatológica del Policlínico Docente Josué País García de Santiago de Cuba, y de 120 usuarios seleccionados mediante un muestreo sistemático, atendidos en dicho servicio, desde octubre del 2020 hasta enero del 2022. Las variables analizadas fueron estructura, calidad de la atención y satisfacción. Se efectuó una evaluación externa y concurrente de la calidad de los componentes estructura, proceso y resultado. Se tomaron como referencia criterios implícitos y explícitos, descriptivos y normativos, indicadores y estándares. Asimismo, se emplearon la encuesta como método para la recogida de la información y el porcentaje como medida de resumen. Resultados: Se obtuvo que los componentes estructura y proceso fueron evaluados de adecuados; el primero, con 76,4 %, cifra por encima del estándar, y el segundo, con 100,0 % respecto a la competencia profesional, así como 72,2 % en el desempeño profesional. En cuanto al componente resultado, se alcanzó 81,8 % de satisfacción de los usuarios; sin embargo, la satisfacción de los proveedores fue inadecuada. Conclusiones: La calidad de la atención en el Servicio de Urgencia Estomatológica del Policlínico Docente Josué País García resultó adecuada.

Introduction: The evaluation of health care quality has its particularities regarding the industrial or services quality in general sense. Objective: To evaluate the quality of the emergency dental care in times of COVID-19. Methods: An observational, descriptive and cross-sectional study of 6 dentists who worked during the study in the Emergency Dental Service of Josué País García Teaching Polyclinic was carried out in Santiago de Cuba, and 120 users selected by means of a systematic sampling, assisted in this service from October, 2020 to January, 2022. The analyzed variables were structure, care quality and satisfaction. An external and concurrent evaluation of the quality in the components structure, process and result was carried out. Implicit and explicit, descriptive and normative, indicators and standard approaches were taken as reference. Also, the survey as method for collecting the information and the percentage as summary measure were used. Results: It was obtained that the components structure and process were evaluated as appropriate; the first one, with 76.4%, above the standard, and the second, with 100.0% regarding professional competence, as well as 72.2% in the professional performance. As for the component result, 81.8% of the users' satisfaction was reached; however, the satisfaction of suppliers was inadequate. Conclusions: The care quality in the Emergency Dental Service of Josué País García Teaching Polyclinic was appropriate.

Pediatric Dental Emergencies during the COVID-19 Pandemic in Romania: A Retrospective Study.

Pediatric dental emergencies can occur as a result of untreated dental caries, or can be caused by trauma or periodontal issues. The lockdown imposed during the COVID-19 pandemic reduced the number of centers authorized to deliver dental services in Romania, with only a small number of dentists delivering dental emergency treatments. The aim of this study was to investigate the demographic characteristics of children and adolescent patients who were treated in the dental emergency department of Oradea, Romania and to compare the patients who were treated in the dental emergency department in the pre-lockdown (2019), lockdown (2020) and post-lockdown year (2021). All patients who were treated in the dental emergency department were included in the study except for adults and medical files that did not contain all relevant information. Several variables were investigated (age, gender, living environment, location of affected teeth, type of emergency). In 2019, 257 children and adolescents were treated, in 2020, 198, and in 2021, 136. Most patients were aged 7-12 years in all investigated years (2019-47.9%; 2020-50.5%; 2021-43.4%), and the most affected teeth were located in the lower posterior arch (2019-53.3%; 2020-53%; 2021-48.5%). The most frequent emergencies were pulpitis (2019-40.5%; 2020-43.9%) and acute apical periodontitis (2021-42.6%). It was observed that in 2019, patients aged between 0 and 6 years were more frequently associated with trauma (p < 0.001), and in 2019 and 2020, patients aged between 7 and 12 years were more frequently associated with periodontal emergencies (p < 0.001). In 2020, patients from rural areas were more frequently associated with pulpitis (p = 0.025), and in 2021, patients from rural areas were more frequently associated with pulpitis or acute apical periodontitis, and patients from urban areas were associated more frequently with periodontal emergencies (p = 0.042). Pediatric patients with ages between 7 and 12 years old, who lived in an urban environment were most affected. Teeth located in the lower and upper posterior dental arches were most affected, and pulpitis or acute apical periodontitis were the most common pathologies.

A Review of Medical Evacuations Related to Dental Emergencies and Oral-Maxillofacial Injuries.

A literature review was performed to determine the frequency of medical evacuations (MEDEVAC) that are required for dental emergencies (DE) and oral-maxillofacial (OMF) injuries. Fourteen studies were reviewed altogether - eight which quantified evacuation of DEs or OMF injuries in military personnel (from 1982-2013) and six studies that discussed medical evacuation of DEs occurring in civilians working in offshore oil and gas rigs and wilderness expeditions (from 1976-2015). Among military personnel, DE/OMF issues were frequently among one of the top categories of medical evacuations, ranging from 2-16% of all evacuations. Among oil and gas industry workers, 5.3-14.6% of evacuations were dental-related, while one study of wilderness expeditions found that DEs ranked as the third most frequent type of injury that required evacuation. Previous studies have shown that dental and OMF problems often account for one of most frequently cited reasons for evacuation. However, due to the limited study base of DE/OMF medical evacuations, further research is needed to determine their impact on the cost of health care delivery.

Interplay of pandemic and seasonal parameters in dental emergency service.

BACKGROUND: To evaluate the relationship between pandemic events and dental emergency service frequentation. Utilization patterns in the scope of the COVID-19 pandemic were analyzed and considered in regard of seasonal parameters. METHODS: All outpatients seeking treatment in a university hospital's dental emergency service were analyzed in the years 2019, 2019 and 2020 according to demographic data and emergencies were subdivided into "absolute" and "relative". The years 2018 and 2019 were used to compare COVID-19 and non-COVID-19 phases. Defined waves of the pandemic were compared with equivalent prior-year periods. RESULTS: Our study includes 11,219 dental emergency patients over a period of three years with a slight surplus of male patients. Comparing the pre-COVID-19 years and 2020 as a year of pandemic, the total count of cases decreased by more than 25%. The share of absolute emergencies in 2020 was higher than in the years before (p < 0.0001). The under-utilization during the waves was more pronounced during the first wave compared to the second waves. CONCLUSIONS: Additionally to the clear decrease by more than 25% in 2020, we found an inverse dependency of 7-day-incidence of COVID-19 and number of visits. This effect was more distinct for relative emergencies, while the number of patients with absolute emergencies remains rather constant. Probably, there is an acclimatization effect regarding the waves. Patients older than 60 years who suffered from relative emergencies showed an under-utilzation during 2020. During a pandemic such as COVID-19, the effect of under-utilization is more pronounced among elderly patients. However, a pandemic acclimatization effect seems to occur. This can be taken into account in the administration of this kind of circumstances in the future.

Dentistry where there is no Dentist: A retrospective analysis of urgent dental care reported through the British Antarctic Survey Medical Unit (BASMU), 2015 - 2020.

AIM: To evaluate the nature of dental related morbidity in British Antarctic Survey (BAS) deployed personnel, and to compare the findings to those in other deployed population groups. Additional aims include outlining the evidence-based approach to further developing a training programme for non-dentists, to manage dental emergencies. METHODS: A retrospective analysis of dental morbidity between 2015 - 2020 reported through the British Antarctic Survey Medical Unit (BASMU) database of dental reported morbidity recorded by deployed medical officers. RESULTS: Analysis and comparison of dental morbidity in deployed personnel to austere environments revealed similarity, in that relatively minor conditions led to the most significant number of presentations for personnel seeking dental advice when deployed. CONCLUSIONS: Dental morbidity for deployed personnel in austere conditions can present with a range of symptoms from relatively minor to severe. Use of best evidence to configure training packages to likely presentations, may limit likelihood of necessitating evacuation from remote locations, or limit morbidity when evacuation is not feasible.

Is tele-diagnosis of dental conditions reliable during COVID-19 pandemic? Agreement between tentative diagnosis via synchronous audioconferencing and definitive clinical diagnosis.

OBJECTIVES: To assess the reliability of synchronous audioconferencing teledentistry (TD) in making tentative diagnosis compared to definitive clinical face-to-face (CFTF) diagnosis; and whether agreement was influenced by dentist's experience, caller-patient relationship, and time of call. METHODS: All patients calling the TD hotline during COVID-19 pandemic, triaged as emergency/ urgent and referred for CFTF care were included (N=191). Hotline dentists triaged the calls, made tentative audio-dentistry (AD) diagnosis, while dentists at point of referral made the definitive CFTF diagnosis. Cohen's weighted kappa (κ) assessed the extent of agreement between AD vs CFTF diagnosis. RESULTS: There was significantly very good pair-wise agreement (κ = 0.853, P < 0.0001) between AD and CFTF diagnosis. AD diagnosis of pulpitis and periodontitis exhibited the most frequent disagreements. Tele-dentists with ≥ 20 years' experience exhibited the highest level of agreement (κ =0.872, P < 0.0001). There was perfect agreement when mothers mediated the call (κ = 1, P < 0.0001), and very good agreement for calls received between 7 am-2 pm (κ = 0.880, P < 0.0001) compared to calls received between 2-10 pm (κ = 0.793, P < 0.0001). CONCLUSIONS: Remote tentative diagnosis using AD is safe and reliable. Reliability was generally very good but varied by dentist's experience, caller-patient relationship, and time of call. CLINICAL SIGNIFICANCE: The findings suggest that using AD in the home environment is safe and reliable, deploying providers with variable years of experience. The findings have generalizability potential to a variety of similar circumstances, healthcare settings and epi/pandemic situations.

Dental Emergencies in an Italian Pediatric Hospital during the COVID-19 Pandemic.

Emergency rooms (ER) are largely used by patients with oral complaints, who choose the ER over private or public dental offices for oral prevention and treatment. During the COVID-19 pandemic, the activity of most dental facilities was limited, and most hospitals and ERs were dedicated to the treatment of COVID-19 patients. The present study analyzed the number of and reason for visits at the emergency room (ER) of Ospedale dei Bambini "Vittore Buzzi", the main pediatric hospital in Milano, Italy, between 2019 and 2020, with a particular focus on oral emergencies. In 2019, 25,435 children turned to the ER, compared to 16,750 in 2020. About 10% of the children were eventually admitted to the hospital in both years. The number of admissions for infectious diseases, other than COVID-19, signed an important decrease in 2020, while trauma/injuries decreased slightly in number but increased in proportion. The number and proportion of ER visits for oral complaints decreased in 2020 compared to 2019. Stomatitis was the most frequent condition, followed by traumatic injuries, which decreased in number and percentage between 2019 and 2020. Oral infections and painful caries accounted for about 15% of the cases in both 2019 and 2020. These data highlight the need to promote territorial services for the prevention and treatment of oral health complaints, including dental emergencies.

Nivel de conocimientos sobre la COVID-19 en pacientes con urgencias estomatológicas / Knowledge level concerning COVID-19 in patients with dental emergencies / Nível de conhecimento sobre COVID-19 em pacientes com emergências odontológicas

RESUMEN Introducción: Los conocimientos sobre COVID-19 que posean los pacientes aquejados por urgencias estomatológicas son de vital importancia, ya que pueden infectarse y contagiar al personal de salud. Objetivo: Describir el nivel de conocimientos sobre COVID-19 en pacientes atendidos en la consulta de Urgencias de la Clínica Estomatológica Provincial "Mártires del Moncada" de Santiago de Cuba. Método: Se realizó un estudio descriptivo transversal entre marzo y junio de 2020, con un universo de 180 pacientes seleccionados mediante un muestreo probabilístico aleatorio simple, de ambos sexos y mayores de 18 años, que dieron su consentimiento para participar en la investigación. Se excluyeron aquellos con síndrome respiratorio agudo evidente. Se evaluaron la edad, sexo, urgencias estomatológicas y nivel de conocimientos. Se empleó la prueba Chi-cuadrado, con un grado de significación α=0,05, para determinar la asociación entre nivel de conocimientos, la edad y el sexo. Resultados: Las odontalgias y los abscesos dentoalveolares agudos fueron las afecciones estomatológicas predominantes, el nivel de conocimientos sobre COVID-19 predominante en los pacientes atendidos por urgencias estomatológicas fue bueno. Conclusiones: A pesar de que los pacientes afectados por urgencias estomatológicas poseen conocimientos buenos sobre la COVID-19, el desconocimiento o incumplimiento de algunas de las medidas de prevención y control de esta infección, puede contribuir a la transmisión de esta enfermedad hacia el personal de salud que los asiste, al ignoran su potencial de contagio.

ABSTRACT Introduction: Knowledge concerning COVID-19 among patients with dental emergencies, it is of high importance since they can become infected and infect health care personnel. Objective: To describe the level of knowledge concerning COVID-19 in patients who were attended at the Clínica Estomatológica Provincial "Mártires del Moncada" in Santiago de Cuba. Method: A descriptive cross-sectional study was conducted between March and June 2020. A total of 180 patients, in both sex and older than 18 and who gave their consent to be part of this research, were selected by a probability simple random sampling. Those with obvious acute respiratory syndrome were excluded. Age, sex, dental emergencies and knowledge level were assessed. The Chi-square test was used (alpha level of 0.05) to determine the association between knowledge Level, age, and sex. Results: Odontalgia and acute dentoalveolar abscesses were the predominant dental conditions, and the level of knowledge concerning COVID-19 in patients with dental emergencies attended at the clinic was good. Conclusions: Despite the good knowledge concerning COVID-19 showed by the patients affected with dental conditions, the lack of knowledge or non-compliance of measurements for the prevention and control of this infection may be the start point to spread the COVID-19 to the health personnel in service.

RESUMO Introdução: O conhecimento sobre a COVID-19 que os pacientes em situação de emergência odontológica possuem é de vital importância, pois podem infectar e infectar o pessoal de saúde. Objetivo: Descrever o nível de conhecimento sobre o COVID-19 em pacientes atendidos no Pronto-Socorro da Clínica Provincial de Estomatologia "Mártires del Moncada" de Santiago de Cuba. Método: Estudo transversal descritivo realizado entre março e junho de 2020, com um universo de 180 pacientes selecionados por amostragem probabilística aleatória simples, de ambos os sexos e maiores de 18 anos. Foram avaliados idade, sexo, emergências odontológica e nível de conhecimento. Foi utilizado o teste Qui-quadrado, com grau de significância α=0,05, para verificar a associação entre nível de conhecimento, idade e sexo. Resultados: Odontalgias e abscessos dentoalveolares agudos foram as condições estomatológicas predominantes, o nível de conhecimento predominante sobre a COVID-19 nos pacientes atendidos nas emergências odontológicas foi bom. Conclusões: Apesar de os pacientes acometidos por emergências odontológicas possuírem bons conhecimentos sobre a COVID-19, o desconhecimento ou não cumprimento de algumas das medidas de prevenção e controle desta infecção, pode contribuir para a transmissão desta doença aos profissionais de saúde que auxilia-os, ignorando seu potencial de contágio.

Impact of covid-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre.

To categorize and compare the dental emergencies along with status of health services received in the tertiary dental health care centre during the pre covid- 19 periods and period of the complete lockdown in COVID 19 pandemic. Methods: A retrospective cross-sectional observational survey was conducted. Four different groups period were studied on patients who visited for dental emergencies at tertiary care centre. April 14 to 13 May 2020 assigned and analyzed as a test period group or group IV. The control period group i.e. group III was 14 February 2020 to 17 March, pre lockdown COVID 19 month when there was no consideration of epidemic in India. Same as periods of group II and IV, group I and II from last year 2019 were also assigned and analyzed. The tertiary care centre provision of health services during this pandemic was also inquired and evaluated. The information was recorded regarding availability of health services like non-emergency dental treatments, emergency dental services, and online professional consultation. To compare four different time period of obtained data, Analysis of variance (ANOVA) and Chi square test were used. Results: The overall proportion and percentage of dental emergencies were raised. The reason for emergency visits to dental clinic were the main problem related with pulpal (46.0%) followed by abscess (16.6%), periapical lesions (15.0%), cellulitis (4.1%) or trauma (0.3%). In lockdown most of the dental emergencies 228(2 6 5) were endodontic related (86.1%) which managed mostly through '3A" approach (advise, analgesics and antibiotics) (60.1%) and remaining (26.0%) through extraction.

Rapid deployment of an algorithm to triage dental emergencies during COVID-19 pandemic.

COVID-19 quickly immobilized healthcare systems in the United States during the early stages of the outbreak. While much of the ensuing response focused on supporting the medical infrastructure, Columbia University College of Dental Medicine pursued a solution to triage and safely treat patients with dental emergencies amid the pandemic. Considering rapidly changing guidelines from governing bodies, dental infection control protocols, and our clinical faculty's expertise, we modeled, built, and implemented a screening algorithm, which provides decision support as well as insight into COVID-19 status and clinical comorbidities, within a newly integrated electronic health record (EHR). Once operationalized, we analyzed the data and outcomes of its utilization and found that it had effectively guided providers in triaging patient needs in a standardized methodology. This article describes the algorithm's rapid development to assist faculty providers in identifying patients with the most urgent needs, thus prioritizing treatment of dental emergencies during the pandemic.

Clinical Response to COVID-19 and Utilization of an Emergency Dental Clinic in an Academic Institution.

INTRODUCTION: The spread of coronavirus disease 2019 (COVID-19) in the spring of 2020 resulted in the temporary suspension of elective dental procedures and clinical dental education in academic institutions. This study describes the use of the Tufts University School of Dental Medicine emergency dental clinic during the peak surge in COVID-19 cases in Massachusetts, highlighting the number of endodontic emergencies. METHODS: Aggregate data from clinical encounters and call records to an emergency triage phone line from March 30 through May 8, 2020, were used to describe the characteristics of dental emergencies, clinical encounters, and procedures performed. RESULTS: A total of 466 patient interactions occurred during this period, resulting in 199 patients advised by phone and 267 clinical encounters. The most common dental emergencies were severe dental pain from pulpal inflammation (27.7% of clinical encounters) followed by a surgical postoperative visit (13.1%). The most frequent procedures were extractions (13.9% of clinical encounters) and surgical follow-up (13.5%); 50.2% of the clinical encounters were categorized as aerosol generating, and 86.1% of encounters would have required treatment in a hospital emergency department if dental care was not available. There were no known transmissions of severe acute respiratory syndrome coronavirus-2 among clinic providers, patients, or staff during this period. CONCLUSIONS: These results highlight the importance of endodontic diagnosis and treatment in the provision of emergency dental care during a pandemic and demonstrate that dental treatment can be provided in a manner that minimizes the risk of viral transmission, maintaining continuity of care for a large patient population.

Emergency Utilization and Trends in a Community Dental Clinic in Northern Manhattan: A Retrospective Study.

Purpose: To evaluate utilization and trends associated with patients who presented with emergencies at a community dental clinic at Columbia University Medical Center, New York, NY. Study design: Data from deidentified dental records of patients aged 0-12 years old who presented as emergencies for oral and dental reasons for 2012, 2013, and 2014 were collected. Variables analyzed included demographic information, oral diagnosis, and current health status. Frequency distributions analysis, chi-square test and analysis of variance (ANOVA) test were performed using Stata 13.0. Results: There were 4,328 dental and oral-related emergencies with a mean age of 6-years-old. Approximately 50% were females, 71% were Hispanic, and 90% had Medicaid managed care. Most emergencies (49%) were caries-related, 41% were considered atraumatic in nature, and approximately 10% were traumatic. About 10% of patients presented with comorbidities and 37% were either first-time patients or patients that presented exclusively for emergencies. Acute tooth pain (45%) caused by dental caries was the most common chief complaint. The trends for emergency presentations showed a significant decrease (p<.001) between years 2012-2014 for caries-related visits and a significant increase (p<.001) between 2012-2013 and 2012-2014 for atraumatic visits. Conclusions: Caries-related dental diagnoses were more common than trauma-related diagnoses. The most common caries-related diagnosis was pulp necrosis for both primary and permanent dentitions while the most common traumarelated diagnosis was subluxation for the primary dentition and enamel-dentin fracture for the permanent dentition.

Gender-Specific Differences of Dental Emergency Patients and the Use of Antibiotics: A 4-Year Retrospective Study.

PURPOSE: To evaluate the clinical characteristics of dental emergency patients with special regard on gender-specific differences related to the utilisation and use of antibiotics. MATERIALS AND METHODS: A retrospective analysis of all patients who presented to the emergency service of a university hospital in from 2010 to 2013 was performed. Demographic data, diagnosis, conducted treatment and the prescription of antibiotics were recorded and further analysed. RESULTS: Altogether, 16,296 patients visited the emergency service. Of these patients, only one-fourth (25.7%; n = 4185) suffered from a diagnosis with urgent treatment needs. Gender-specific differences were found in the reason of visit. Males presented significantly more often with severe diagnoses, like abscess or trauma. Females presented significantly more often with non-urgent diagnoses, not directly connected to oral hygiene habits, like temporomandibular disorders (TMD), denture sore or dolor post extractionem. Moreover, an overuse of antibiotics was found among emergency patients, with every fifth patient (20.2%; n = 3291) being prescribed an antibiotic. CONCLUSION: Better public education on dental emergencies and constant updates for dentists about the use of antibiotics in dental emergency care is necessary to secure adequate medical supply for severe dental emergencies and to avoid an inappropriate use of antibiotics.

A new framework to identify dental emergencies in the COVID-19 era.

In order to reduce the spread of COVID-19 (Coronavirus Disease 2019), it is crucial to take extraordinary prevention and safety measures in dental offices, and to defer all elective and non-urgent procedures. Dental emergencies are defined through oral symptoms but, the systemic and psychological conditions of each patient should be considered. The present short communication proposes a multilevel evaluation (oral, systemic and psychological) and risk assessment score for the management of dental emergencies following the SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) outbreak. A comprehensive categorization and score scale assessment for dental emergencies allows a better identification of patient's treatment needs and avoids unnecessary contact between dental health care providers and patients during the SARS-CoV-2 pandemic.

Utilization of and Dental Students' Perceived Benefits of an Urgent Care Clinic in a Dental School.

The aims of this study were to describe patient utilization of an urgent care clinic (UCC) in a dental school for one year and to assess dental students' perceptions of the benefits of training in this clinic. Aggregate clinic data from July 3, 2017, through July 6, 2018, were used to determine number of patients, number of new patients, number of new patients who elected to transfer their primary dental care to the university, number who were seen for a follow-up, and service/clinic to which each patient was referred. Student evaluations were used to determine the benefits students perceived in their training in the UCC. Results showed that 1,674 patients were seen in the UCC during the study period. Of these, 67% were new patients, and 53% of these new patients opted to transfer their primary dental care to the university. An average of 7.03 patients were treated per day, and 2.48 new patients per day were generated for the predoctoral student clinic. The most common referrals were to oral surgery (37%), endodontics (30%), and the predoctoral dental clinic (28%). Among these patients, 39% scheduled follow-up appointments, and the attendance rate was 69%. About 80% of eligible students (40/50) completed the questionnaire, and many provided optional comments. Over 80% of the responding students responded favorably regarding the learning experiences and assessments during the UCC rotation. This study found that establishment of the UCC increased the pool of patients and provided students the necessary experiences in triaging and treating dental emergencies.

Hospital-based Emergency Department Visits with Periapical Abscess: Updated Estimates from 7 Years.

INTRODUCTION: The impact of the Affordable Care Act (ACA) on the utilization of the emergency department (ED) for periapical abscess (PA) is unknown. The objectives of this study were to provide nationwide estimates of hospital-based ED visits with PA and to examine the effect of the ACA on the use of EDs for PAs. METHODS: We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS) for 2008 to 2014. All ED visits with a diagnosis of PA were selected. The International Classification of Diseases, Ninth Revision-Clinical Modification code was used to identify PA. Patient- and hospital-level characteristics were examined. Descriptive statistics were used to summarize the data. RESULTS: From 2008 to 2014, a total of 3,505,633 ED visits for PA occurred. The proportion of ED visits with PA significantly increased over the study period (from 460,260 in 2008 to 545,693 in 2014). Medicaid was the primary payer (30.3%) and more than 40% were uninsured. Mean charge per PA-related ED visit was $1080.50 and total PA-related ED charge across the United States was $3.4 billion. Among those hospitalized following PA-related ED visits, mean hospitalization charges were $34,245 and total hospitalization charges were $5.7 billion. CONCLUSION: Oral health continues to be overlooked in health care. A large proportion of ED visits with PA were made by those covered by Medicaid and uninsured. The passing of the ACA has not reduced the number of ED visits with PA.

Emergency Department Utilization related to dental conditions and distribution of Dentists, Nebraska 2011-2013.

PURPOSE: This study aims to provide estimates of hospital-based emergency department (ED) visits due to dental conditions in Nebraska and to examine patient-related characteristics associated with ED charges. In addition, this study provides dental-related ED visits and distribution of dentists by county. METHODS: For the study, we used the State Emergency Department Database for Nebraska for the years 2011 through 2013 and the Health Resources and Services Administration's Area Health Resource File. All ED visits with dental conditions in Nebraska were selected. The primary outcome variable was hospital-based ED charges. Multivariable linear regression model was used to examine the effects of patient-related factors on ED charges. RESULTS: During the study period, a total of 9943 dental-related ED visits occurred. Of these, 55.5% patients aged between 25 and 44 years. Thirty-nine percent of all dental ED visits had patients who were self-financed or uninsured. Twenty counties in Nebraska do not have a dentist, and nine counties had more than 50 ED visits per 10,000 population. Patients residing in urban areas paid significantly higher charges than those living in rural towns, small rural towns, or isolated rural areas. The mean and total ED charges attributed to dental conditions for the entire study period were $934 and $9.3 million, respectively. CONCLUSION: Patients who are uninsured, aged 25-44 years, covered by private insurance, and residing in urban areas are identified to be at high risk. There is a need to develop health policies and programs to improve access to dental care in rural states.

Trends in dental-related use of hospital emergency departments in Florida.

OBJECTIVES: The inability to access regular dental care may lead to care seeking at hospital emergency departments (EDs). However, EDs generally are not equipped or staffed to provide definitive dental services. This study examined trends and patterns of hospital ED use for dental-related reasons in Florida, a large, diverse state with serious barriers to accessing dental care. METHODS: Data for this study were drawn from ambulatory ED discharge records compiled by Florida's Agency for Health Care Administration for 2005-2014. Visits for dental-related reasons in Florida were defined by the patient's reported reason for seeking care or the ED physician's primary diagnosis using ICD-9-CM codes. We calculated frequencies, age-specific and age-adjusted rates per 100,000 population, and secular trends in dental-related ED visits and their associated charges. RESULTS: The number of dental-related visits to Florida EDs increased each year, from 104,642 in 2005 to 163,900 in 2014; the age-adjusted rate increased by 43.6 percent. Total charges for dental-related ED visits in Florida increased more than threefold during this time period, from $47.7 million in 2005 to $193.4 million in 2014 (adjusted for inflation). The primary payers for dental-related ED visits in 2014 were Medicaid (38 percent), self-pay (38 percent), commercial insurance (11 percent), Medicare (8 percent), and other (5 percent). CONCLUSIONS: Dental-related visits to hospital EDs in Florida have increased substantially during the past decade, as have their associated charges. Most patients did not receive definitive oral health care in EDs, and this trend represents an increasingly inefficient use of health care system resources.

How Effective is a Dental Workshop at Improving the Knowledge and Confidence of Medical Students in the Management of Dental Emergencies?

The purpose of this study was to evaluate the effect of a three-hour hands-on workshop for medical students and residents on their pre- and postcourse knowledge and confidence in managing dental emergencies. A 1-hour lecture followed by four 20-minute "hands-on" skill stations on dental mannequins was administered to a group of 30 medical students and residents. Pre- and postworkshop questionnaire surveys were conducted. There was a significant increase in the percent of attendees who responded correctly to three of the four knowledge questions following the workshop (P-value < 0.005). Confidence, as expressed in various statements, about treating dental emergencies was significantly improved after the lecture for eight of the nine statements. These findings indicate that dental knowledge is generally not provided during medical training. Our interactive workshop appeared to be effective in increasing this knowledge and self-reported confidence in handling dental emergencies. These findings clearly indicate the need for additional dental education during medical school. The use of a hands-on workshop may be one model for achieving this goal.

General Dental Practitioners' Knowledge about the Emergency Management of Dental Trauma.

INTRODUCTION: The aim of this descriptive cross-sectional study was to assess the general dental practitioners (GDPs)'s knowledge regarding the emergency management of traumatic dental injuries (TDI) in Isfahan, Iran. METHODS AND MATERIALS: In this study a two-part questionnaire consisting of 14 questions was distributed among 241 GDPs. Part 1 included seven questions focusing on personal and professional information and part 2 asked questions about seven given cases of dental traumas. One score was dedicated to each correct answer; the total score of 0 to 4 was considered as poor knowledge, while scores 5-8, 9-11 and 12-14 were assigned as moderate, good and excellent knowledge, respectively. The data were analyzed using the Student's t-test and one-way ANOVA. Spearman's and Pearson's correlation coefficient were used to determine the associations between the emergency treatment knowledge and dentists' professional information. RESULTS: With regards to the level of GDP's knowledge, the mean score was 7.61±2.68 suggesting a moderate score; a total of 177 (73.2%) of the dentists showed a moderate level of knowledge. A significant association was found between the frequency of dental trauma cases that were encountered and treated by GDPs in their daily practice (P=0.004, r=0.2). CONCLUSION: The overall knowledge of GDPs about the emergency management of TDI in the selected community was moderate.