What started as a toothache from a lost filling became a raging infection that landed Christopher Smith in the University of Louisville Hospital emergency room, then in intensive care on a ventilator and feeding tube.
"It came on so quickly and violently. I was terrified," said Smith, 41, of Jeffersonville, Indiana, who lacked dental insurance and hadn’t been to a dentist for years before the problem arose this month. "I had no idea it could get this serious this quickly."
Smith is one of a growing number of patients seeking help in the ER for long-delayed dental care. An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds. ADA officials, as well as many dentists across the nation say the problem persists despite health reform.
"This is something I deal with daily," said Dr. George Kushner, director of the oral and maxillofacial surgery program at U of L. "And there is not a week that goes by that we don’t have someone hospitalized. â ¦ People still die from their teeth in the U.S."
Often, pain is what drives people to the ER, "like a cavity that hurts so much they can’t take it anymore," said Dr. Jeffery Hackman, ER clinical operations director at Truman Medical Center-Hospital Hill in Kansas City, who has noticed a significant rise in dental patients coming to his department in recent years.
Limited insurance coverage is a major culprit; all but 15 percent of dental ER visits are by the uninsured or people with government insurance plans.
The Affordable Care Act requires health plans to cover dental services for children but not adults. Medicaid plans for adults vary by state, and offer only a short list of dental services in Kentucky.
Medicare generally doesn’t cover dental care at all.
By law, ERs have to see patients even if they can’t pay. But although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn’t hospitalized – and costing the U.S. health care system $1.6 billion a year.
"If we were going to the dentist more often, we could avoid a lot of this," said Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA.
"Prevention is priceless."