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Delineating Factors Surrounding Emergency Dental Access Behavior for Nontraumatic Dental Conditions Among Patients
Ingrid Glurich1, Aloksagar Panny2, Neel Shimpi1
1Marshfield Clinic Research Institute (MCRI), 1000 North Oak Avenue, Marshfield, Wisconsin, USA.
Objectives:
A case-control study examined factors contributing to emergency dental clinic access for nontraumatic dental conditions (ED-NTDC) among individuals residing within 20 miles of 10 networked dental clinics comprising a dental safety net.
Materials And Methods:
Phase I: using dental diagnostic codes for ED-NTDC visits and dental prophylaxis visits that occurred from January 1, 2019 through May 19, 2019, interrogation of an integrated medical-dental electronic health record (EHR) identified cases (n = 1784) and controls (n = 18,612), respectively, matched by dental center. Unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) and chi-squared p-values were determined using unadjusted bivariate logistic regression analysis for each demographic variable by comparing subgroup-specific proportions of cases and controls to a designated reference subgroup. Phase II: survey tools were designed and targeted to Phase I cases (n = 84) and controls (n = 113). Applying descriptive statistics, variability identified between case and control survey question responses defined additional potential candidate variables contributing to risk for ED-NTDC visits.
Results:
Statistically significant risk variables ORs were graphically depicted in a forest plot and included: age 18-35 (OR 1.4), 36-50 (OR 1.2), sex (male: OR 1.2), race (non-White: (OR 1.7)), payer status (self-pay: (OR 2.4); Medicaid: (OR 1.6), sliding fee: (OR 1.8)), and E-NTDC visits in medical (OR: 2.8) or dental (OR 2.0) settings in the prior 2 years. Twice-annual dental visit rates were higher among controls vs. cases. Cases vs. controls more frequently indicated: (1) a preference for pulling painful teeth; (2) dental visits were only necessary for dental emergencies; (3) delay in seeking dental care for emergent dental pain; (4) higher rates of dental fear. Economic factors, ("could not afford dental care" and "lack of insurance") especially in younger age tiers, strongly contributed to ED-NTDC visits.
Conclusions:
Barriers to oral health access for vulnerable populations persist. Public health initiatives targeting dental health maintenance and literacy require expansion.
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