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Patients crowd ER, as Medicaid suffers from toothache

Serious tooth problems that could have been prevented are increasingly showing up in Florida hospital emergency rooms, according to a report released today.

The number of patients who sought emergency-room care for dental problems was about 115,700 last year, up by about 10,000 patients since 2008, said the report from Florida Public Health Institute.

Total charges exceeded $88 million, up about $22 million over the same period, the report said. “When you think about it, we shouldn't have any ER admissions for dental care unless there's an accident,” said Dr. Claude Earl Fox, president of the institute. “To me, what it says is that these are people who have nowhere else to go."

Though spending went up across all types of insurance, the most dramatic increases were from patients enrolled in Medicaid, the state-run health program for the poor and disabled.

The state will not pay for preventive or restorative dental care for adults. While it pays for children, parents have a hard time finding dentists who will accept what Medicaid pays, about one-fourth of the private-pay rate.

While private dentists can choose whether to accept Medicaid patients, hospital emergency rooms cannot turn them away.

The numbers are considered a conservative estimate, the report said. The increases vary between counties, but the trend was statewide.

The analysis was commissioned by the institute and was carried out by the Health Council of Southeast Florida.

The health council reviewed the emergency department database for 2008 through 2010 kept by the Agency for Health Care Administration.

The 2011 Legislature changed licensure requirements so that dental hygienists can offer preventive services, such as teeth-cleaning, without direct supervision by a dentist in certain settings. 

Cox, chair of the Oral Health Florida Leadership Council, said the hygienists' services need to be expanded through health departments and other community settings where Medicaid patients can find them.

The trend is disturbing, but not surprising for the Florida Dental Association, which also helped work on the project.

The organization lobbies the Florida Legislature for higher payment rates and student loan forgiveness programs that encourage dentists to care for the under-served population, the release states.

"Much more still needs to be done to ensure that Florida citizens have access to routine dental care," said Dr. Cesar R. Sabates, FDA president.

AHCA spokeswoman Shelisha Coleman said she could not comment until the agency has time to review the data.

-- Health News Florida is an independent online publication dedicated to public-service journalism. Reporter Brittany Alana Davis can be reached at 954-239-8968 or by e-mail.