Assessment of oral health and cost of care for a group of refugees in Germany: a cross-sectional study.

BACKGROUND: There is a research gap concerning the evaluation of the oral healthcare of refugees. Therefore, the aim of this study was to evaluate the oral health of refugees and to estimate the costs of oral care. METHODS: The study was conceptualized as a pilot study. The study participants were refugees who lived either in collective living quarters or at a reception center in a region of the federal state of Schleswig-Holstein, Germany. The cross-sectional design was complemented by dental screening. Data were collected from August 2016 until July 2017. The basic condition of the teeth was evaluated using a convenience sample by a single dentist. The assessment of caries was carried out visually in accordance with the International Caries Detection and Assessment System from code 3 and higher. The DMF-T (decayed, (D), missing, (M), filled (F), teeth (T)) index was calculated. The costs of oral care were analyzed for conservative treatment (filling or extraction) and for prosthetic treatment (missing teeth) in the form of a bridge or crown. RESULTS: The dental screening was attended by 102 refugees, with a mean age of 28 years. A total of 49% of the study sample suffered from toothache, and the DMF-T index had a mean of 6.89. For 92% of the study sample, treatment was indicated, and a cost estimate of the treatment could be calculated. The average cost of conservative treatment was estimated to be 205.86 EUR, and the average cost of prosthetic treatment was estimated to be 588.0 EUR. The oral healthcare costs of the different treatment procedures were higher for refugees that presented with toothache than for those without toothache, with the exception of prosthetic treatment procedures. CONCLUSIONS: There is a lack of population-based data that survey the oral health status of refugees. Therefore, the current study presents an initial overview regarding the oral health status and the potential costs of oral healthcare of refugees.

Dental pain in the medical emergency department: a cross-sectional study.

The aim of this study was to examine the number of patients attending a medical emergency department (MED) with dental problems over a three-year period. This cross-sectional study was carried out as part of a service evaluation. Data were collected via a database search of patient attendances at the MED using free text and the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for oral and dental diagnoses. Data were analysed using descriptive statistics, t-test and chi-squared tests. Over the three-year period, there were 2504 visits to the MED for dental-related complaints, accounting for 0·7% of all attendances. The majority of patients were male (53·9%), with a mean age of 29 (s.d. 19·4) years for men, and 32 (s.d. 19·7) years for females. The mean index of multiple deprivation per cent rank was 35·0%. The most common diagnosis was unspecified dental disorder. Ten per cent of dental attendances to MED were repeat attendances by the same patients. In conclusion, patient attendances at MED for dental problems account for 0.7% of all attendances. MED may not be the most appropriate place for these patients to attend, in terms of care pathways, and also for economic reasons. The reasons why patients attend MED for dental problems clearly warrant further research.

Dental pain in the ED: costs that hurt patients and EDs.

BACKGROUND AND OBJECTIVES: The objective of this retrospective study was to determine if the collection rates for dental related visits to the emergency department (ED) are less than collection rates for ED visits for other problems. METHODS: Data were analyzed from one Kentucky hospital's electronic health record system from April 2010 to April 2012. Collection rates for patients who received care in the ED for uncomplicated dental problems were compared to collection rates for all patients who received care in the ED for any reason. RESULTS: Each month during the study period, an average of 77 patients presented to the ED for dental problems. Compensation rates for physician fees were 9.8% for dental related care and 39% for all patients who received care for any reason. Compensation rates for hospital fees were 16% for dental related care and 20.1% for all patients who received care for any reason. Uninsured patients accounted for 68.8% of physician fees and 62.4% of hospital fees for dental related care. CONCLUSIONS: Using the ED as a dental safety net is costly to the patient because the underlying problem is typically not resolved and costly to the hospital because of very low collection rates. In addition, other patients who present to the ED for non-dental, high acuity problems may have delayed care or no care because of the number of patients using the ED for dental pain.

Individual dental expenditure by Australian adults.

BACKGROUND: While dental service use in Australia has been extensively reported, little is known about associated costs. The aim of this article was to describe the annual individual dental expenditure of Australian adults. METHODS: Self-reported service use and expenditure data were sourced from a sample of 3000 adults aged 30 to 61 years who were randomly selected from the electoral roll. Bivariate associations between total individual dental expenditure and out-of-pocket expenditure (fees less insurance rebate) and a range of participant characteristics were explored. RESULTS: Response rate for the baseline questionnaire was 39.4% and of these, 53.1% responded at 12-month follow-up. The mean total dental expenditure was $702 and mean out-of-pocket expenditure was $489. Toothache was associated with total dental expenditure; adults experiencing toothache had higher median expenditure ($445) than adults who hardly ever/never had toothache ($308) (p < 0.05). Dental insurance status was not associated with total expenditure, but insured had lower median out-of-pocket expenditure ($146) than uninsured adults ($320) (p < 0.01). CONCLUSIONS: Affordability variables typically associated with access to dental care, such as insurance status, were not associated with total expenditure, while poorer oral health was associated with higher total expenditures.

Early childhood caries-related visits to emergency departments and ambulatory surgery facilities and associated charges in New York state.

BACKGROUND: The authors assessed the extent of early childhood caries- (ECC-) related visits to emergency departments (EDs) and ambulatory surgery facilities (ASFs) in children younger than 6 years and associated treatment charges in New York state from 2004 through 2008. METHODS: The authors obtained data from the New York state's Statewide Planning and Research Cooperative System (Albany) and calculated descriptive statistics and rates according to selected indicators, as well as total and average per-visit treatment charges. RESULTS: From 2004 through 2008, the number of ECC-related visits to EDs and ASFs increased by 349 and 1,039, respectively. Most ECC-related visits were to ASFs. The total annual treatment charges increased from $18.5 million to $31.3 million from 2004 to 2008, and average per-visit charges increased from $4,237 to $5,501 during the same period. CONCLUSIONS: ECC-related visits to EDs and ASFs by children younger than 6 years and the associated treatment charges increased substantially from 2004 through 2008 in New York state. Practice Implications. Dental professionals need to determine the reasons parents seek dental care for their children in EDs and ASFs and effective strategies for preventing ECC to avoid the subsequent need for seeking dental care in EDs and ASFs.

Demographic and socio-economic factors associated with dental health among older people in NSW.

OBJECTIVE: To investigate the association between oral health status and social, economic and demographic factors in community-dwelling older people in New South Wales (NSW). METHODS: Binary and multinomial logistic regression analyses were used to examine the associations between measures of oral health status (edentulous/dentate, and the frequency of toothache or mouth or denture problems in the previous 12 months) and demographic and socio-economic factors using data from the NSW Older People's Health Survey 1999. RESULTS: After adjusting for other factors, being edentulous was associated with being older, having no private dental insurance, being female, leaving school at less than 15 years of age, not being financially comfortable, not being a homeowner, living in a rural area, and being unable to travel alone. Among both dentate and edentulous people, increasing age and being able to travel independently were associated with decreased reporting of toothache, mouth or denture problems; while not being financially comfortable was associated with increased reporting of toothache or mouth or denture problems. The frequency of mouth or denture problems was not found to be independently associated with having private dental insurance nor with holding a health concession card. CONCLUSIONS: Among older people in NSW, oral health is associated with a range of demographic and socio-economic factors. The results suggest that better oral health among older people is associated with a capacity to pay out-of-pocket dental expenses rather than with private dental insurance or having access to public-funded dental care.

The dental care pathway of welfare recipients in Quebec.

IN Quebec (Canada), the utilization of dental care services varies greatly from one social class to another: whereas the well-to-do visit the dentist often for check-ups, those most in need demonstrate a "wait-and-see" attitude. The objective of our research was to describe the dental care pathway of the underprivileged when confronted with symptoms, and to understand how this pathway might be interrupted and possibly lead to tooth extractions. We arranged 16 one-on-one interviews with adult Montrealers who had experienced a dental problem during the 12 months preceding the interview. These participants, 9 women and 7 men aged between 30 and 48, lived in great poverty: all were welfare recipients, and as such, enjoyed the benefits of a government programme that entitled them to free basic dental care. During the interviews, the interviewers asked the participants to describe their latest dental problem and their subsequent behaviour. The dental care pathway of our participants was characterized by a strategy of adapting to the symptoms. This process of adapting, which can last several months, is essentially an individual process in which the individuals often resort to self-medication to soothe their pain. They decide to visit a dentist when the pain is too great and self-medication is no longer effective. Once this decision is made, their dental care pathway may nevertheless be interrupted in two ways: first, in the failure to find a dentist, and second, later, in the failure to complete treatments that are not covered by the welfare program, such as endodontic treatment. The fragmented character of these dental care pathways refers us to two features of accessibility: financial accessibility and acceptability. With regard to financial accessibility, our study shows that the public coverage intended for welfare recipients presents major gaps. As for acceptability, our participants are strongly critical of the dental profession, and develop a culture of rejection of it.

A Medicaid population's use of physicians' offices for dental problems.

OBJECTIVES: This study evaluated how the elimination of Medicaid reimbursement to dentists for the treatment of adult dental problems affected patients' visits to physicians. METHODS: Data tapes describing physicians' claims for adult Medicaid patients were obtained from the Maryland Medicaid Management Information System. The database contains information on all claims made to Maryland Medicaid, including date, provider, International Classification of Diseases, Ninth Revision, Clinical Modification Manual code, and payments. RESULTS: A total of 5334 individuals made physician's office claims related to dental problems sometime during the 4-year study period. The rate of dental-related claims by physicians decreased by 8% after the policy change. CONCLUSIONS: Visits to physicians' offices decreased even though an increase might have been expected because of the elimination of access to dentists in private practice. Patients might have assumed that if visits to dentists would no longer be paid for, neither would visits to physicians' offices.

Dental visits to hospital emergency departments by adults receiving Medicaid: assessing their use.

BACKGROUND: Pain from toothaches represents a significant problem. People lacking access to private dental services may use hospital emergency departments, or EDs. In 1993, Maryland eliminated Medicaid reimbursement to dentists for adult emergency services. METHODS: The authors used the change in Medicaid policy that eliminated dentist reimbursement to establish two study periods. Data tapes describing patients' use of EDs were obtained from the Maryland Medicaid Management Information System. A total of 3,639 people visited EDs for dental problems sometime during the four-year study period. RESULTS: After controlling for age, race and sex, the authors found that the rate of ED claims was 12 percent higher in the postchange period than in the prechange period. Comparisons between periods show significant rate increases during the postchange period for men, whites, African-Americans and patients aged 21 through 44 years and 45 through 64 years. CONCLUSIONS: The change in Medicaid policy that eliminated dentist reimbursement and participation in the program appears to have increased the use of EDs for the treatment of dental problems. Practice Implications. Many EDs lack dental services and are not capable of providing definitive treatment. When definitive treatment is not provided, this pattern of care may be repeated if patients are forced to return for treatment.

Does the elimination of Medicaid reimbursement affect the frequency of emergency department dental visits?

In an attempt to save costs, the state of Maryland in February 1993 eliminated Medicaid reimbursement to dentists for treatment of adults with dental emergencies. The authors analyzed data from the University of Maryland Hospital's emergency department to determine if this change resulted in increased use of the emergency department by Medicaid recipients for treatment of dental conditions. After the policy change, the rate of dental visits to the emergency department by Medicaid recipients increased by 21.8 percent. This increase occurred during the same period in which the percentage of all emergency department visits by Medicaid recipients was decreasing.