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Study: Less MassHealth Dental Coverage Means More ER Visits for Tooth Pain - Particularly for Those Over 55

Study: Less MassHealth Dental Coverage Means More ER Visits for Tooth Pain - Particularly for Those Over 55

May 27, 2014

Have you ever experienced a long wait in an emergency room?  Did it ever push you to the brink of frustration that you wanted to pull your hair out? Or your teeth? 

That may be because the elimination of most MassHealth adults' dental care resulted in more trips to Massachusetts emergency rooms for dental issues. In addition to adding to the overcrowding of emergency departments, those dental visits were expensive, costing way more than the charge for regular dental care.

In 2010, MassHealth adult dental benefits were severely cut. Until recently, if a MassHealth member has a case of tooth decay causing some serious pain they only have a few covered options: go to the emergency room for the pain, or visit a dentist who could only diagnose the problem and ultimately pull the tooth. Fillings, dentures, and many other services were not covered. This year, coverage for fillings was restored, but many other services are still not available.

Following the cut in benefits, oral surgeons at BU School of Dental Medicine noticed that the Boston Medical Center Emergency Department was being flooded with patients seeking dental care. They just published a study in The American Journal of Public Health looking at the data. The study (here is BU's summary, and the full report (pdf)) analyzed dental-related Emergency Department visits to BMC, comparing data collected three years before and two years after MassHealth adult dental benefits were significantly cut (July 1, 2007 to June 30, 2012).

Comparing average visits and spending in 2007-2009 to 2011, the study found:

  • Dental-related ER visits for adults increased by 14%. The greatest growth was among those 55 to 64 years old, which jumped an astonishing 50%. ER visits by seniors 65 and older went up by 45%.
  • The average cost per dental-related ER visit also soared by 27%. Combine more visits and increased costs per visit, and total dental spending in the BMC emergency department increased by 44%, from $8.4 million to $12.1 million.

The study's conclusions are clear:

This study found the largest increases in people with caries and soft tissue pathologies. These conditions are best treated in dental practices and community health centers. Importantly, individuals seeking dental treatment in EDs do not receive definitive treatment. Most dental treatments provided in the ED are transitory or palliative (temporary treatment, analgesics and antibiotics, or referral to a dental care provider) and have significant implications in terms of cost

One of the study co-authors commented pointedly, using researcher understatement: “Use of EDs for dental care points to an inappropriate use of resources and lack of continuity of dental care,”

The findings of the report support what oral health advocates have been saying for years: lack of treatment options causes the state to waste millions on emergency room care for dental issues. As the cuts continue, the state will continue to spend more and more on palliative care.

The just-concluded Senate budget includes funds to restore coverage for dentures as of April 1, 2015. This would be another step to ending this cruel, costly cut. Soon a House-Senate conference committee will meet to craft the final budget. Please call your representative and senator today (find yours here), and urge them to support this small step towards restoring MassHealth dental coverage.

   -Courtney Chelo