MLHU - Health Status Resource

Dentist and Emergency Department Visits

Dentist and Emergency Department Visits
Key Findings: 

Regular dental visits are important for maintaining optimal oral health and preventing acute oral health conditions that may result in the use of the health care system. In 2013/14, about three-quarters of residents in Middlesex-London reported having been to the dentist in the past year. About 28% of residents had not been to a dentist in one or more years or had never been to the dentist. Males and those living in rural areas were less likely to report regularly visiting a dentist.

In 2018, the age standardized rate of visits to the emergency department (ED) for non-traumatic oral health conditions (NTOHC) was higher among Middlesex-London residents (486.3 per 100,000) compared to provincial and Peer Group rates. However, the difference was not statistically significant.

Dental visit in past year Emergency Department visit for non-traumatic oral health condition
Dental visit for check-up at least once a year  

Dental visit in past year

About three-quarters (73.5%) of residents in Middlesex-London reported having recently visited the dentist (in the past year) in 2013/14. This was higher than the percentage of Ontarians and those residing in the Peer Group regions, but not by a significant amount (Figure 8.3.1).

Although the percentage of Ontarians who recently visited a dentist in urban and rural areas were quite similar in 2013/2014, this was not the case in Middlesex-London. The percentage of residents in rural (59.7%) locations reported less recent visits in comparison to residents in urban (75.3%) locations (Figure 8.3.2). However, this difference was not statistically significant.

Further, school-aged children (aged 12−17) had the highest percentage of recent visits to the dentist (87.9%), while only about two-thirds of residents aged 18−24 years reported visiting a dentist in the past year (Figure 8.3.3). This is inconsistent with Ontario and the Peer Group, which both had lower percentages of individuals 65 and over reporting a recent visit to the dentist (64.8% and 63.7%, respectively) rather than in the 18 to 24 age group. These differences are not statistically different.

As household income increased, so did the percentage of Middlesex-London residents who visited the dentist in the past year. The highest percentage was among the top income quintile, where 89.9% of residents reported having been to the dentist in the past year. These significant differences were also observed in Ontario and the Peer Group (not shown).

Interpretation

Having visited the dentist in the past year (as well as a regular dental check-up every year) is one of the key components of preventing most oral health diseases and conditions.1 This is highlighted in Middlesex-London by the slightly higher percentage of residents reporting having visited the dentist in the past year and a lower percentage of oral or facial pain in the past year (compared to Ontario and the Peer Group).

In addition, the lower percentage of rural residents who recently visited a dentist could suggest that residents in rural locations in Middlesex-London have limited access to dental health services in comparison to Ontario and other regions, which is often associated with limited access to oral care.2 This highlights an area of focus for public health moving forward, ensuring accessibility to oral health services to all and in turn, reducing health equity disparities in our community.

Dental visit for check-up at least once a year

In contrast to the higher percentage of recent visits to the dentist in Middlesex-London, the percentage of routine visits was lower in Middlesex-London (71.5%) in comparison to Ontario (74.5%) and the Peer Group (73.2%) in 2013/14 (Figure 8.3.4).

Female residents in Middlesex-London reported visiting the dentist at least once a year more often (74.3%) than males (68.5%) in 2013/14. However, the difference was not statistically significant (Figure 8.3.5). This pattern is similar to Ontario and the Peer Group. However, the difference in Middlesex-London was not statistically significant.

Similar to having been to the dentist in the past year, as household income increased, so did the percentage of residents visiting the dentist at least once a year. The highest percentage was among the top income quintile, where 84.7% of residents reported annual visits. However, these differences were not statistically significant. This was also the case in Ontario and the Peer Group (not shown). Unlike Middlesex-London, differences in Ontario and the Peer Group (aside from between the top two quintiles) were statistically significant.

No significant differences were seen by age, urban/rural residence, employment status, or education level (not shown).

Interpretation

Regular visits to the dentist is an important preventative behaviour which keeps teeth and gums healthy by cleaning any buildup of plaque and treating any small caries early-on.1

Those with lower income often report only visiting the dentist in the case of an emergency.2 This was the case in Middlesex-London with the lowest percentages of annual dentist visits occurring among residents with low household income. This highlights the existence of health inequities in oral health and an area for improvement moving forward.

Emergency Department visits for non-traumatic oral health conditions

Between 2001 and 2015, an average of 51,861 visits to the emergency department (ED) were made each year for non-traumatic oral health conditions across Ontario.4 This increased significantly to approximately 68,000 visits in 2018, representing an age standardized rate of 472 visits per 100,000 population in Ontario. This increasing trend is also evident in Middlesex-London, which had about 1,700 visits to the ED for non-traumatic oral health conditions in 2018. This represents an age-standardized rate of 486.3 visits per 100,000 population (Figure 8.3.6).

Middlesex-London residents between the ages of 18−24 and 25−44 had the highest rates of ED visits compared to other age groups (Figure 8.3.7). The differences within both age groups were statistically significant from other age groups but not from each other. Further, percentages for 18−24 and 25−44 year olds were higher than the percentages seen in both Ontario and the Peer Group. Although only the difference among the 18−24 age groups were statistically significant.

A higher rate of ED visits was seen among rural residents of Middlesex-London (587.3 visits per 100,000) in comparison to urban residents (498.5 visits per 100,000) (Figure 8.3.8).

Interpretation

The use of the health care systems for non-traumatic oral health conditions poses a significant strain on the health care system and is not cost-effective and often ineffective for the treatment of oral health conditions as many EDs are not equipped to provide definitive dental care.3-5

Although there are many explanations, the higher rate of ED visits in Middlesex-London may be partially explained by the fact that a lower percentage of residents’ report having dental insurance as compared to Ontario and the Peer Group. The high rate of ED visits for non-traumatic oral health conditions in Middlesex-London creates a need to determine what other options can be employed in the region to provide emergency and essential dental health services and decrease the financial impact on the health care system.

Ontario Public Health Standard: 

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability−Chronic Disease Prevention and Well-Being (page 28)

Population Health Assessment and Surveillance Protocol, 2018

References:

1. Public Health Ontario [Internet]. Toronto (ON): [2012] Report on access to dental care and oral health inequalities in Ontario; [cited 2019 Oct 10]. Available from: https://www.publichealthontario.ca/-/media/documents/dental-oral-inequal...

2. Canadian Dental Association [Internet]. Ottawa (ON): [2017 Mar] The state of oral health in Canada; [cited 2019 Oct 10]. Available from: https://www.cda-adc.ca/stateoforalhealth/

3. VanMalsen, J.R., Figueiredo, R., Rabie, H., & Compton, S.M. Factors associated with emergency department use for non-traumatic dental problems: Scoping review. J Can Dent Assoc 2019 85: j3. Retrieved from: https://jcda.ca/j3

4. Singhal, S., Quinonez, C., & Manson, H. Visits for nontraumatic dental conditions in Ontario’s health care system. JDR Clinical & Translational Research 2019 4(1): 86-95. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/2380084418801273

5. Seu, K., Kendall K. Hall, K.K., & Moy, E. Emergency Department Visits for Dental-Related Conditions, 2009. Healthcare cost and utilization report 2012 [cited 2019 Oct 10]. Retrieved from: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb143.pdf

Last modified on: November 19, 2019

Jargon Explained: 

Non-traumatic Oral Health Conditions
These are conditions causing pain and infection as a result of untreated dental caries or improper oral health preventative procedures.4,5