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A survey of the need for emergency dental services
PubL Hhh, Lond. (1976) 90, 231-233
A Survey of the Need for Emergency Dental Services Nairn H. F. Wilson B.D.S.*
Department of Conservative Dentistry, Turner Dental School, Bridgeford Street, Manchester, M 15 6FH. A survey o f the dental emergencies treated in two hospitals' casualty departments has shown that the need and demand for such treatment is greatest at weekends and on public holidays. The organization and location o f emergency dental services will be discusscd.
Introduction General dental practitioners are under no obligation to provide emergency dental services. However, it is believed that many dentists do meet especially their own patients' emergency treatment needs (Estimates Committee, 1963). The reports on "Adult Dental Health" in England and Wales (Gray et al., 1968) and in Scotland (Todd & Whitworth, 1974) indicated that, o f the population who still had some natural teeth, at least 60 % did not obtain regular care. Children's dental attendance patterns have subsequently been shown to be closely related to those of their parents (Todd, I975). It is believed that those people who neglect to seek regular dental treatment may be more liable to develop dental emergencies and that they may find more difficulty in obtaining palliative dental care in areas where emergency dental services are not readily available outside normal working hours. The Estimates Committee in 1963 concluded that the setting-up of special dental emergency arrangements in each area could not be justified. This conclusion may be seen to be supported by the relatively small number of complaints concerning inadequate emergency dental care facilities reported by the Working Party on Dental Services (1973). However, where emergency care facilities do exist, there is considerable demand for treatment (Downie, 1975). The need and demand for emergency dental services is believed to be similar in each o f the areas where no special arrangements for dental emergencies have been made. To test the need for such facilities in one such area--Lothian--the demand for dental emergency care in the accident and emergency department of Edinburgh's Royal Infirmary, (R.I.E.) and in the casualty department of Edinburgh's Royal Hospital for Sick Children (R.H.S.C.) was investigated over three months during a recent survey of in-patients' dental needs and of hospital dental services (Wilson, 1975). Methods and Materials The last three months of [974 were randomly selected for investigation. Details of the dental emergencies which presented during this period were collected from the casualty registers of the investigated hospitals along with the information on the date and time of each patient's treatment. Where the required information had not been recorded, individual patient's records were retrieved and consulted.
*Formerly of the Department of Restorative Dentistry, University of Edinburgh.
232
N. H. F. Wilson
Results Details of the dental emer~,encies treated in the investigated casualty departments during the last :hree months of 1974 are ahown in Table 1. TABLE 1
Nature of emergency Month
Hospital
October October November November December December Totals Percentage
R.I.E. R.H.S.C. R.I.E. R.H.S.C. R.I.E. R.H.S.C.
Post-extraction T o o t h a c h e haemorrhage 32 I 22 0 28 2 85 60-7~/o
11 1 7 3 7 2 31 22-1 ~
Dental abscess 3 1 1 4 7 6 22 15-7o/,
Other acute conditions
Total
1 ! 0 0 0 0 2 1"5~
47 4 30 7 42 I0 140 100
During the period selected for study, these emergency departments treated 17,370 patients of whom 140 (0"8~o) presented with a dental emergency. Of these 140 cases, 119 ( 8 5 ~ ) were seen and treated in the accident and emergency department of the Royal Infirmary. Analysis of the date and time of treatment revealed that 84 (60~o) of these 140 patients were seen on Saturdays, Sundays or public holidays; that 75 (89~o) o f these latter patients sought treatment in the Royal Infirmary and that such patients did not tend to seek treatment at any particular time of the day. Discussion Most emergency dental services which are run on a voluntary basis often lack adequate publicity and are liable to collapse (Downie, 1975). The services which are continuing to function are generally located in densely-populated wide catchment areas and are subject to an increasing treatment demand. However, it is not known to what extent patients present with conditions which do not fall within the range of emergency treatment prescribed by the General Dental Services Regulations. It is suggested that any abuse of existing or envisaged services by either such patients or general dental practitioners who unnecessarily fail to meet their own patients' urgent treatment needs should be discouraged. The Working Party on the Dental Services (1973) considered that the greatest need for emergency dental services existed at weekends and on public holidays and recommended that a properly designed and monitored experiment should be organized to assess the need for such facilities. The findings of this survey indicate that such a pilot study would be justified in the Lothian area, especially since it hzs many of the features indicated as desirable in the Working Party's Report. It is believed that any envisaged services could be advantageously at~liated to well-known hospital casualty centres in densely populated areas. Locating such services in centrally placed hospitals would have several advantages. Facilities for medical emergencies would be readily available, existing hospital staff could receive and aid in the treatment of patients and any dental premises and equipment which may be necessary could also be used as treatment facilities for hospital in-patients (Wilson, 1975). Furthermore, centrally placed hospitals are usually readily accessible and well-served by public transport at weekends and on public holidays.
A survey o f the need f o r emergency dental services
233
The recorded emergency cases were irregularly spaced over weekends and public holidays. It is believed that dental personnel could initially meet such treatment needs by being "'on call". However, once a service had been established, it may prove necessary or simpler to run regular sessions at set times, since emergency facilities appear to generate a demand. The few dental personnel and ancillaries who would be required to staff emergency services could be recruited from any branch of dentistry and from the many non-practising married women, if suitable facilities, remuneration and flexible duty rota could be provided by the employing Health Board. It is believed that few personnel would undertake such work o n a voluntary basis. The cost o f such services should be met by the patients who could be expected to pay the full apnropriate National Health Service charge, unless they belong to one of the recognized priori~ groups, who are exempt from charges. Charging patients may cause administrative proble~ in hospital and would only partly offset the full cost of establishing and running such set r:eS; however, charging would probably discourage abuse of any such facilities.
Acknowledgements I am indebted to Mr F. H. Robarts Consultant Surgeon at the Royal Hospital for Sick Children, and Mr A. J. Duff, Consultant Surgeon at the Royal Infirmary, Edinburgh, for allowing me access to their hospitals" casualty registers; Mr J. W. Craig, C.A.D.O., Lothian Area, for his advice, and Professor D. M. Watt, Department of Restorative Dentistry, University of Edinburgh, for his help and encouragement during this survey.
References Downie, C. F. A. (1975). Emergency Dental Services. Glasgow Dental Journal, 5, 20-1. Estimates Committee (1963). Report on Dental Services Session, 1962-63. London: Her Majesty's Stationery Office. Gray, P. G. et al. (1970). Adtdt Dental Health in England and Wales ht 1968. London: Her Majesty's Stationery Office. Todd, J. E. & Whitworth, H. A. (1974). Adult Dental Health in .Scotland in 1972. London: Her Majesty's Stationery Office. Todd, J. E. (1975). Children's Dental Health in l:)Igland attd Wales, London: Her Majesty's Stationery Office. Wilson, N. H. F. (1975). An investigation of urgent dental treatment needs of short-term in-patients and of the dental care required by both long-stay and dental priority in-patients in a selected group of Edinburgh hospitals. Report from the Department of Restorative Dentistry, University of Edinburgh. Working Party on Dental Services (1973). Emergency Dental Services. London: Her Majesty's Stationery Office.
A Survey of the Need for Emergency Dental Services Nairn H. F. Wilson B.D.S.*
Department of Conservative Dentistry, Turner Dental School, Bridgeford Street, Manchester, M 15 6FH. A survey o f the dental emergencies treated in two hospitals' casualty departments has shown that the need and demand for such treatment is greatest at weekends and on public holidays. The organization and location o f emergency dental services will be discusscd.
Introduction General dental practitioners are under no obligation to provide emergency dental services. However, it is believed that many dentists do meet especially their own patients' emergency treatment needs (Estimates Committee, 1963). The reports on "Adult Dental Health" in England and Wales (Gray et al., 1968) and in Scotland (Todd & Whitworth, 1974) indicated that, o f the population who still had some natural teeth, at least 60 % did not obtain regular care. Children's dental attendance patterns have subsequently been shown to be closely related to those of their parents (Todd, I975). It is believed that those people who neglect to seek regular dental treatment may be more liable to develop dental emergencies and that they may find more difficulty in obtaining palliative dental care in areas where emergency dental services are not readily available outside normal working hours. The Estimates Committee in 1963 concluded that the setting-up of special dental emergency arrangements in each area could not be justified. This conclusion may be seen to be supported by the relatively small number of complaints concerning inadequate emergency dental care facilities reported by the Working Party on Dental Services (1973). However, where emergency care facilities do exist, there is considerable demand for treatment (Downie, 1975). The need and demand for emergency dental services is believed to be similar in each o f the areas where no special arrangements for dental emergencies have been made. To test the need for such facilities in one such area--Lothian--the demand for dental emergency care in the accident and emergency department of Edinburgh's Royal Infirmary, (R.I.E.) and in the casualty department of Edinburgh's Royal Hospital for Sick Children (R.H.S.C.) was investigated over three months during a recent survey of in-patients' dental needs and of hospital dental services (Wilson, 1975). Methods and Materials The last three months of [974 were randomly selected for investigation. Details of the dental emergencies which presented during this period were collected from the casualty registers of the investigated hospitals along with the information on the date and time of each patient's treatment. Where the required information had not been recorded, individual patient's records were retrieved and consulted.
*Formerly of the Department of Restorative Dentistry, University of Edinburgh.
232
N. H. F. Wilson
Results Details of the dental emer~,encies treated in the investigated casualty departments during the last :hree months of 1974 are ahown in Table 1. TABLE 1
Nature of emergency Month
Hospital
October October November November December December Totals Percentage
R.I.E. R.H.S.C. R.I.E. R.H.S.C. R.I.E. R.H.S.C.
Post-extraction T o o t h a c h e haemorrhage 32 I 22 0 28 2 85 60-7~/o
11 1 7 3 7 2 31 22-1 ~
Dental abscess 3 1 1 4 7 6 22 15-7o/,
Other acute conditions
Total
1 ! 0 0 0 0 2 1"5~
47 4 30 7 42 I0 140 100
During the period selected for study, these emergency departments treated 17,370 patients of whom 140 (0"8~o) presented with a dental emergency. Of these 140 cases, 119 ( 8 5 ~ ) were seen and treated in the accident and emergency department of the Royal Infirmary. Analysis of the date and time of treatment revealed that 84 (60~o) of these 140 patients were seen on Saturdays, Sundays or public holidays; that 75 (89~o) o f these latter patients sought treatment in the Royal Infirmary and that such patients did not tend to seek treatment at any particular time of the day. Discussion Most emergency dental services which are run on a voluntary basis often lack adequate publicity and are liable to collapse (Downie, 1975). The services which are continuing to function are generally located in densely-populated wide catchment areas and are subject to an increasing treatment demand. However, it is not known to what extent patients present with conditions which do not fall within the range of emergency treatment prescribed by the General Dental Services Regulations. It is suggested that any abuse of existing or envisaged services by either such patients or general dental practitioners who unnecessarily fail to meet their own patients' urgent treatment needs should be discouraged. The Working Party on the Dental Services (1973) considered that the greatest need for emergency dental services existed at weekends and on public holidays and recommended that a properly designed and monitored experiment should be organized to assess the need for such facilities. The findings of this survey indicate that such a pilot study would be justified in the Lothian area, especially since it hzs many of the features indicated as desirable in the Working Party's Report. It is believed that any envisaged services could be advantageously at~liated to well-known hospital casualty centres in densely populated areas. Locating such services in centrally placed hospitals would have several advantages. Facilities for medical emergencies would be readily available, existing hospital staff could receive and aid in the treatment of patients and any dental premises and equipment which may be necessary could also be used as treatment facilities for hospital in-patients (Wilson, 1975). Furthermore, centrally placed hospitals are usually readily accessible and well-served by public transport at weekends and on public holidays.
A survey o f the need f o r emergency dental services
233
The recorded emergency cases were irregularly spaced over weekends and public holidays. It is believed that dental personnel could initially meet such treatment needs by being "'on call". However, once a service had been established, it may prove necessary or simpler to run regular sessions at set times, since emergency facilities appear to generate a demand. The few dental personnel and ancillaries who would be required to staff emergency services could be recruited from any branch of dentistry and from the many non-practising married women, if suitable facilities, remuneration and flexible duty rota could be provided by the employing Health Board. It is believed that few personnel would undertake such work o n a voluntary basis. The cost o f such services should be met by the patients who could be expected to pay the full apnropriate National Health Service charge, unless they belong to one of the recognized priori~ groups, who are exempt from charges. Charging patients may cause administrative proble~ in hospital and would only partly offset the full cost of establishing and running such set r:eS; however, charging would probably discourage abuse of any such facilities.
Acknowledgements I am indebted to Mr F. H. Robarts Consultant Surgeon at the Royal Hospital for Sick Children, and Mr A. J. Duff, Consultant Surgeon at the Royal Infirmary, Edinburgh, for allowing me access to their hospitals" casualty registers; Mr J. W. Craig, C.A.D.O., Lothian Area, for his advice, and Professor D. M. Watt, Department of Restorative Dentistry, University of Edinburgh, for his help and encouragement during this survey.
References Downie, C. F. A. (1975). Emergency Dental Services. Glasgow Dental Journal, 5, 20-1. Estimates Committee (1963). Report on Dental Services Session, 1962-63. London: Her Majesty's Stationery Office. Gray, P. G. et al. (1970). Adtdt Dental Health in England and Wales ht 1968. London: Her Majesty's Stationery Office. Todd, J. E. & Whitworth, H. A. (1974). Adult Dental Health in .Scotland in 1972. London: Her Majesty's Stationery Office. Todd, J. E. (1975). Children's Dental Health in l:)Igland attd Wales, London: Her Majesty's Stationery Office. Wilson, N. H. F. (1975). An investigation of urgent dental treatment needs of short-term in-patients and of the dental care required by both long-stay and dental priority in-patients in a selected group of Edinburgh hospitals. Report from the Department of Restorative Dentistry, University of Edinburgh. Working Party on Dental Services (1973). Emergency Dental Services. London: Her Majesty's Stationery Office.