Emergency Room Use for Dental Pain: The Path to Opioid Abuse and Addiction

Hospital emergency room entrance outsideIf you’ve ever experienced a toothache, you understand that this kind of pain impacts much more than your mouth. The nerve endings inside the gums are sensitive, and the pain can last for a day, or for years. A toothache can have a negative impact on your overall well-being. Without regular dental care, a preventable oral health issue can escalate into unbearably painful and dangerous complications. Recent research has indicated possible associations between chronic oral infections and diabetes, heart and lung disease, stroke, and even low birth weight or premature births.

But for many people, making an appointment to see the dentist isn’t easy. Seeing the dentist might be too expensive, too far away, or otherwise inaccessible. While some basic services are covered by Medicaid in North Carolina, many other states have cut or eliminated adult dental benefits for Medicaid programs. Furthermore, finding a dentist locally that accepts Medicaid is challenging.  Additionally, fewer employers are offering dental insurance, and often times, dental benefits cover very little of the overall costs of dental care. Consequently, the emergency department may be the first (and only) choice for treatment for painful oral health issues, and as a result, the number of people using the emergency department with gum disease, cavities or abscesses has almost doubled in just the ten years from 2000 to 2010.

White pills spilling onto tableThe main problem with this increase is that the emergency department it isn’t the best place to treat long-term oral health problems. Emergency departments lack the staff and training to provide solutions other than treatment for the pain, leading to over half of patients being sent home with a prescription for an opioid, even if they don’t need it. Evidently, an increasing over-prescription of opioids from emergency rooms has become clear, as shown by the 10% increase in emergency room visits resulting in opioid prescriptions between 2001 to 2010. This increase has prompted the National Institutes of Health (NIH), for the first time, to begin funding various research projects that will help shed light on how this rise in opioid prescriptions from emergency rooms’ is contributing to the continuing abuse of these narcotics in the United States.

Recently, it was estimated that 5 to 23 percent of all prescription opioid doses dispensed are used non-medically, and one study shows that two-thirds of emergency room visits involving overdoses are due to prescription drugs. With that being said, ensuring safe methods of prescribing opioids across all medical settings is important to preventing patients, especially the young and vulnerable, from developing or maintaining an addiction. While the solution to this growing problem is not simple, it is one the North Carolina Oral Health Collaborative is working to solve.

The North Carolina Oral Health Collaborative works to resolve these types of issues by addressing oral health disparities that drive people to the emergency department in the first place. Zulayka Santiago, the Collaborative’ s Director says that, “although these issues are complex requiring systems and policy changes, we are clear that the best solutions are those that harness the brilliance of many.” It is essential that solutions to these problems are rooted in and informed by those individuals who grapple with these realities on a daily basis with evidence-based scientifically sound methods. To that end, the NCOHC is partnering with individuals and organizational representatives who have a vested interest in ensuring all North Carolinians enjoy good oral health.”  To learn more about the NCOHC’s work, please visit: www.oralhealthnc.org

NC Oral Health Collaborative Logo

“You just don’t know how magnificent you might be. Think big.” 
Dr. John Tyler Caldwell, 
8th Chancellor of
 NC State University (1959-1975)

Maggie-SauerI recently ran across this quote from Dr. Caldwell from NC State and it reminded me of the opportunity we all have as we begin 2015.  It also reminds me of the work and passion of the Bernstein Fellows present and alumni…they think BIG and challenge us all to do the same!  There is no work worth doing unless we do it together…partnerships, team-based care, community…these are not separate discussions, it’s inclusive.  It’s not new but it is hard!  The Fellows continue the ideals, passion and courage demonstrated by Jim Bernstein to be bold, think big and work in communities to “imagine how magnificent” they can be.

In the past year, I’ve attended numerous meetings that focus on what communities (rural in particular) don’t have, lack and need.  Hmm…recalling Dr. Caldwell’s words, is that really the place to start?  The NC Institute of Medicine’s Task Force on Rural Health released its NC Rural Health Action Plan in August.  As a participant, it was wonderful to see a variety of community members not always included in healthcare discussions: public safety officers, county managers, and church council members, to name a few, working together with a common goal.   I enjoyed the comradery of my fellow participants, particularly their passion for their communities and their sense of pride, fellowship and commitment.  In fact, the group was insistent that the report reflect a balance of strength and opportunities for improvement.  This quote from the report perhaps best represents this sentiment:

 “NC’s rural communities face many challenges, but they are also quite resilient. There is a strong sense of place and an understanding of community assets. Rural people know the needs of their community. They know what strategies to improve health and well-being will not work and are also open to learning from others. While rural communities are often under-resourced, there is an innate sense of commitment to the community and to each other. And because of this, rural communities are often able to accomplish a great deal with limited resources.” 

Since the report was released the work has continued. The Foundation is working with a large group of stakeholders across North Carolina as part of the NC Rural Health Leadership Alliance.  This group has met for over 20 years beginning with a small group that included Jim Bernstein, Gene Mayer of AHEC, Harvey Estes, MD and Tom Irons, MD.  The Alliance is restructuring its work to address the goals set out in the recommendations of the NCIOM report.  Stay tuned….

The new Rural Forward NC program at NCFAHP works with communities as part of the Kate B. Reynolds Trust Healthy Places NC to highlight and identify the strengths in community with the community.  Calvin Allen and Brandy Bynum are working in partnership with communities in Halifax and Rockingham Counties to begin.

While we have a lot of work to do, I will keep Dr. Caldwell’s words firmly fixed within my view.  As we continue this work together, let’s see just how magnificent we can be: think big!

-Maggie Sauer, CEO & President