ADA comments on painkiller prescriptions for fake dental reasons

WASHINGTON, D.C.--A story in the May 1, 2012, issue of The New York Times points up a new aspect of the phenomenon of people who seek treatment for dental problems in hospital emergency rooms: patients claiming to be in agony from dental disease in order to procure prescription pain medication, and emergency room physicians trying to sort out which of them actually need these drugs.

This is part of the comment made by the American Dental Association in response to the article by the Times titled "E.R. Doctors Face Dilemma on Painkillers."

Also, according to the ADA, the Times did not explore the underlying problem--there is virtually no consistent, substantive dental safety net for low-income adults. Medicaid dental programs, which vary state by state, generally focus only on covering children. The children's programs range from pretty good to abysmal. There is less variation in states' Medicaid adult programs because there is no federal requirement for adult Medicaid coverage. It is virtually nonexistent.

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Uninsured and indigent people cannot get routine dental care, small problems become big ones, and the pain becomes intolerable. As a result, they flock to emergency rooms with dental pain. That they have dental problems is apparent to ER physicians. But whether they actually need pain medication is a judgment call.

The one certain thing, says the ADA, is that ERs, except in those rare cases where there are staff dentists, cannot actually treat dental problems. Patients are given antibiotics or pain medication and sent on their way, only to return with the same complaints because ER physicians cannot address the disease, only the symptoms.

The irony is that this revolving ER door costs Medicaid more than treatment by dentists would. States would actually save money by providing basic care, such as fillings and extractions, to these patients.

Ultimately, the ER/dental phenomenon points out the fundamental shortcomings in how this country provides and does not provide oral health care to those who can't afford regular dental visits. Virtually all dental disease, especially the advanced cases that show up in emergency rooms, is preventable.

According to the ADA, when the nation shifts to a prevention rather than surgical model of public oral health and provides basic dental services to more people who otherwise cannot afford them, the ER physicians' dilemma will be greatly diminished. Until then, we can expect more of the same.

In-depth ADA papers on breaking down the barriers that prevent Americans from achieving good oral health are available at www.ada.org/breakingdownbarriers.aspx.

For more information, go to www.ada.org.

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