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Dental Problems at A&E: why it matters

Charlotte Currie, Clinical Fellow in Oral Surgery at the Centre for Oral Health Research, School of Dental Sciences at Newcastle University, explains what led to their recent project investigating the number of patients attending hospitals for dental problems, and what we still need to discover to encourage patients to visit the dentist before they end up in A&E:

Just under 10% of the UK population reports experiencing current dental pain, and as dentists, we often see patients who are suffering with toothache, and have been for a while. The patients often delay seeing a dentist “at all costs”.

Their “toothache” pain is intense and affects their day-to-day life. However, they go on living with it, often for months. I’ve treated many of these patients and find their stories astonishing to hear.

I’ve listened to reports of patients extracting their own teeth, taking unintentional paracetamol overdoses, and being admitted to hospital with life threatening infections. Some patients also report that they try various other health care professionals first, before eventually visiting a dentist.

In addition, a large group of these patients are relying heavily on the emergency services for dental care, and attend on a regular basis, sometimes for the same problem over and over again.

Yet, despite these “problem-orientated attenders” being well known to dentists and doctors, surprisingly little is really known about them: where do they seek help, why there, who are they, and why attend in this manner?

These unanswered questions, coupled with the impact the pain has on these patients’ lives, prompted the start of our research project at Newcastle University.

Initially, we took a look at our local dental emergency services and found that around one-third of patients attending were regular problem-orientated attenders, and in addition 13% were coming back for the same problem.

We were aware that these patients also attended A&E departments, but were unsure as to the scale of this, leading us to examine the number of attendances at our local department. We were surprised to find the number of dental attendances at A&E as high as 0.7%, with the most common diagnoses being that of acute dental pain.

Startlingly, 10% of these attenders were repeat attenders for dental pain at A&E. In addition, from both of these studies the overwhelming majority of patients were men, in their 20’s and 30’s, and from the lower socio-demographic groups.

Commenting on our research in the Guardian, Barbara Ellen, suggests ‘that dentistry could turn out to be another poverty indicator, with many of the poorest unable to afford to maintain basic dental health’. She believes that the poorest in society are too afraid to go to the dentist, not just because of the treatment, but because of the cost.

What isn’t clear from the research we’ve done yet, is why these patients seek care in the way that they do, and other than emergency dentists and A&E departments, where else do they go and why?

Previous findings from our pain research team at Newcastle shows that incorrect care pathways within oral and facial pain can have huge direct and indirect economic impacts, which may be the case for these problem-orientated attenders.

Also, by delaying treatment for their dental pain, the success of potential treatment can be reduced and the potential for post-treatment complications such as persisting pain increased.

If we want to help these patients seek care from a dentist, and ideally attend for routine preventative dental care, we need to find the answer to these questions, so that we can improve both the care and experience for our patients and ensure NHS money is spent as wisely as possible.

Toothache piling financial pressure on A&E

In response to Newcastle University’s research, we’ve said that the cost of dental patients at A&E could be ten times official Government estimates: costs to NHS could now be as much as £18 million.

General Dental Practice Committee Chair, Henrik Overgaard-Nielsen gives his views on these figures and highlights the lack of a strategy for oral health, leaving dentistry only with cuts to budgets and the expectation that patients will plug the dental funding gap by increasing NHS charges.

This news item was originally posted on the British Dental Association website.


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