Author: Oral Health Program, Department of Health 
Date Updated: April, 2019

The rate of emergency department visits for non-traumatic dental conditions per 1,000 Vermonters has decreased from 10.3 in 2010 to 8.2 in 2016. We’re not sure why there has been a decrease in this rate, but it could have something to do with the expansion of Medicaid in 2014. Vermont adult Medicaid beneficiaries have a dental benefit of $510 a year.  Rather than seeking care in an emergency room, some newly insured Vermonters may have sought care in dental practices.

Additionally, recent statewide efforts to reduce the number of opioids that are prescribed and increase participation in Vermont’s Prescription Monitoring System may have led to a decrease in the number of Vermonters who are seeking dental care in emergency departments to obtain opiates. 

Lastly, caution should be used when comparing data before, during, and after 2015 because on October 1, 2015, the United States transitioned from using ICD-9 to ICD-10 code sets. The transition to ICD-10 occurred because ICD-9 produced limited data about patients’ medical conditions and hospital inpatient procedures. Also, the structure of ICD-9 limited the number of new codes that could be created. For 2015, code sets determining ED oral condition visit outcomes will include both ICD-9 and ICD-10 codes. The comparability of estimates across the ICD-9 to ICD-10 transition is uncertain and may potentially over- or under-estimate various indicators. Whatever the cause, we are pleased to see this curve moving in the right direction. 

Partners include but are not limited to:

• Bi-State Primary Care Association 
• Department of Vermont Health Access
• Vermont Association of Hospitals and Health Systems
• Vermont Department of Health’s Alcohol and Drug Abuse Program 
• Vermont Department of Health’s Local Health Offices
• Vermont State Dental Society

The Association of State and Territorial Dental Director’s Best Practice Approach- Emergency department referral programs for non-traumatic dental conditions outlines a number of strategies that can be employed to reduce the number of Vermonters who access dental care in emergency departments. 

The Vermont Department of Health will explore multiple strategies to reduce the number of Vermonters who access dental care in emergency departments. Examples include: 

• Increase community health centers’ capacity, efficiency, and productivity to allow more people to access dental care
• Improve coverage and access to comprehensive primary dental care for Medicaid eligible adults
• Create access to comprehensive primary dental care for seniors enrolled in Medicare
• Promote effective federal-state-local partnerships. For example, work with state oral health coalitions to gather and analyze ED data and utilize findings to implement sustainable programs that reduce the use of EDs for non-traumatic dental conditions
• Support workforce development that creates improved access to dental care by increasing the racial and ethnic minority workforce to match local demographics

This is important for a number of reasons, including the expense of treatment in the ED and the fact that definitive dental treatment to address the underlying cause of the pain is not provided. Often patients are given recommendations for pain management, antibiotics, and a referral to a dentist. Unfortunately, many never seek care, leading them to return to the ED once the pain resumes. Additionally, Low-income and uninsured adults and racial/ethnic minorities are more likely to seek care in emergency departments for non-traumatic dental conditions (ASTDD, 2015). Dental pain and infection are almost entirely preventable; reducing the rate of emergency department visits for non-traumatic dental conditions may mean that more Vermonters are able to have their oral health needs met comprehensively, so they don’t get to the point where they are in pain and an ED visit seems like the only option. It could also mean that since health care providers are more judicious about prescribing, fewer Vermonters are accessing dental care in the ED to obtain opiates. 

The Vermont Uniform Hospital Discharge Data Set was used for this analysis. Emergency Department visits for non-traumatic dental conditions (NTDC) were based on the first listed diagnosis, following the diagnoses listed in the Association of State and Territorial Dental Directors’ “Guidance on assessing emergency department data for non-traumatic dental conditions.” According to their guidance, “NTDC includes caries, periodontal disease, erosion, occlusal anomalies, cysts, impacted teeth, teething, and all other non-traumatic conditions associated with the oral cavity. Diagnoses that are deemed due to trauma are excluded from this definition.”  

Caution should be used when comparing data before, during, and after 2015. On October 1, 2015, the United States transitioned from using ICD-9 to ICD-10 code sets. Therefore, for 2015, code sets determining ED oral condition visit outcomes will include both ICD-9 and ICD-10 codes. The comparability of estimates across the ICD-9 to ICD-10 transition is uncertain and may potentially over- or under-estimate various indicators.

Only Vermont residents are included in the analyses, including Vermonters visiting Vermont hospitals and some hospitals outside of Vermont. Data from other states are not available in all years. New Hampshire hospitals are excluded from all analyses. The timeliness of the annual data exchange between Vermont and New Hampshire has been seriously impacted by major changes in New Hampshire’s data collection and processing technologies. Data from Massachusetts have not been available since the 2013 discharge year.

These data are based on visits and not individuals. Individuals may have multiple visits and therefore the number of visits likely exceeds the number of individuals who visited the Emergency Department for non-traumatic dental conditions during the reporting year.