- Email: [email protected]
Emergency room visits and hospitalization
Fig 3.—A fall without a pacifier (left) may dispose to lip lesions and tooth fractures (arrows), whereas an impact in a patient using a pacifier may protect the lips and distribute forces to a larger front area, resulting in luxation. (Courtesy of Østergaard BH, Andreasen JO, Ahrensburg SS, et al: An analysis of pattern of dental injuries after fall accidents in 0- to 2-year-old children – does the use of pacifier at the time of injury make a difference? Int J Pediatr Dent 21:397-400, 2011.)
Discussion.—Using a pacifier seems to influence the type of traumatic injury that results from a fall in children aged %2 years. Use of a pacifier is more likely to produce tooth displacement than tooth fracture. It appears that the theory that a blunt impact to anterior primary teeth tends to cause displacement, whereas a sharp object impact tends to produce fracture is correct (Fig 3).
Clinical Significance.—Pediatric dentists need to know what factors may lead to specific traumatic injuries in young children. Having a pacifier in place apparently guards against fracture and reduces soft-tissue injury but
produces more injuries with displacement, such as intrusions, lateral luxations, extrusions, or avulsions.
Østergaard BH, Andreasen JO, Ahrensburg SS, et al: An analysis of pattern of dental injuries after fall accidents in 0- to 2-year-old children – does the use of pacifier at the time of injury make a difference? Int J Pediatr Dent 21:397-400, 2011 Reprints available from BH Østergaard, Dept of Pediatric Dentistry, Faculty of Health Sciences, School of Dentistry, Aarhus Univ, Vennelyst Blvd 9, DK-8000 Aarhus C, Denmark; e-mail: birthe.ostergaard@ odontologi.au.dk
Periodontal Disease Emergency room visits and hospitalization Background.—Few studies have examined the characteristics of emergency department (ED) visits made for periodontal conditions. Persons who ignore regular dental care and those with medical conditions are more likely to come to a hospital ED for care than other persons. Accurate information on this problem can help in shaping oral healthcare delivery to target populations with untreated dental conditions. The epidemiology of hospital-based ED visits in 2006 that were attributed to periodontal conditions, such as gingivitis and chronic periodontitis was noted, along with risk factors for hospitalizations related to these visits. Methods.—Data were obtained from the Nationwide Emergency Department Sample for 2006. The patients
had primary diagnoses of acute gingivitis, chronic gingivitis, gingival recession, aggressive or acute periodontitis, chronic periodontitis, periodontosis, accretions, other specified periodontal disease, or unspecified gingival and periodontal disease. Relationships were noted between patient characteristics and the odds of being hospitalized. Results.—Primary diagnostic codes for gingival and periodontal conditions were given for 85,039 ED visits, with female patients in 53% of these visits. Nearly 36% of the visits involved persons from the lowest income group. Mean patient age was 32 years. A total of 1167 visits resulted in inpatient admission to the same hospital.
Volume 57
Issue 4
2012
219
Table 3.—Hospital Charges and Length of Stay (LOS) of Hospital-Based ED Visits Attributed to Periodontal Conditions in the United States
Characteristics
ED – hospital charges ED þ inpatient hospital charges Inpatient – LOS in days
Mean
Standard error
Total United States Hospital Charges/LOS
$456.31 $15,248
24.14 1,060.84
$33,283,477 $17,515,928
3.05
0.186
3,553
(Courtesy of Elangovan S, Nalliah R, Allareddy V, et al: Outcomes in patients visiting hospital emergency departments in the United States because of periodontal conditions. J Periodontol 82:809-819, 2011.)
The mean cost of each ED visit was $456.31, for a total nationwide charge of nearly $33.3 million. The mean uninsured charge was $410.99, with a total uninsured nationwide charge of $10.06 million. For those requiring hospitalization, the mean hospitalization charge (including the ED charge) was $15,248 and mean length of stay was 3.05 days. Thus, the total nationwide hospitalization charge was $17.51 million (Table 3). These expenditures did not include the costs of medications, outpatient care, postdischarge care, or treatment for other dental conditions. The comorbid conditions found most often were hypertension (6.80% of visits), diabetes without chronic complications (3.36%), chronic pulmonary disease (2.58%), depression (1.09%), and neurologic disorders (0.75%). After adjusting for several confounding factors, the ED visits for acute and aggressive periodontitis had higher odds of resulting in hospitalization. Among the comorbid conditions associated with significantly higher odds of hospitalization were congestive heart failure, valvular disease, hypertension, paralysis, neurologic disorders, chronic pulmonary disease, hypothyroidism, liver disease, AIDS, coagulopathy, obesity, deficiency anemia, alcohol abuse, and drug abuse. Patients residing in areas whose median household income level was less than $61,999 had higher odds of
being hospitalized than those in areas whose median household income was between $47,000 and $61,999. Discussion.—More than $33 million is spent each year on ED visits for gingival and periodontal disease. About onethird of these visits are made by persons who are in the lowest income group and by those without insurance. Uninsured persons were charged about $10 million. A total of 1167 visits resulted in an inpatient admission that further increased the cost of care to a total of $17.51 million. Often those who are hospitalized have comorbid conditions, but a primary diagnosis of acute or aggressive periodontitis by itself is associated with significantly higher odds of being hospitalized subsequent to an ED visit.
Clinical Significance.—The periodontium can be reliably maintained long-term in most persons by periodic dental care and maintenance to control local etiologic factors. Patients who do not make regular dental visits are more likely to develop severe tissue destruction, tooth loss, functional limitations, discomfort, and disability related to periodontal disease. Patient compliance can be adversely affected by cost factors, lack of insurance, and lack of access to a personal dentist or dental clinic. Comorbid conditions also play a role, making hospitalization more likely. It was suggested that persons in the Midwest were less likely to be hospitalized for periodontal disease than those in Western areas, but the data are insufficient to accurately estimate practice patterns related to geographic factors.
Elangovan S, Nalliah R, Allareddy V, et al: Outcomes in patients visiting hospital emergency departments in the United States because of periodontal conditions. J Periodontol 82:809-819, 2011 Reprints available from V Allareddy, Dept of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115; e-mail: [email protected]
Restorative Dentistry Post systems Background.—Posts are designed to retain the coronal restoration in an endodontically treated tooth that has lost extensive crown structure. Various post systems of different materials are available, including metallic prefabricated, cast
220
Dental Abstracts
posts, nonmetallic dowels, epoxy resin posts reinforced with fibers of various types, zirconia posts, and polyethylene fiber-reinforced posts. The most recent and reliable evidence related to the post systems was gathered from the literature.
Discussion.—Using a pacifier seems to influence the type of traumatic injury that results from a fall in children aged %2 years. Use of a pacifier is more likely to produce tooth displacement than tooth fracture. It appears that the theory that a blunt impact to anterior primary teeth tends to cause displacement, whereas a sharp object impact tends to produce fracture is correct (Fig 3).
Clinical Significance.—Pediatric dentists need to know what factors may lead to specific traumatic injuries in young children. Having a pacifier in place apparently guards against fracture and reduces soft-tissue injury but
produces more injuries with displacement, such as intrusions, lateral luxations, extrusions, or avulsions.
Østergaard BH, Andreasen JO, Ahrensburg SS, et al: An analysis of pattern of dental injuries after fall accidents in 0- to 2-year-old children – does the use of pacifier at the time of injury make a difference? Int J Pediatr Dent 21:397-400, 2011 Reprints available from BH Østergaard, Dept of Pediatric Dentistry, Faculty of Health Sciences, School of Dentistry, Aarhus Univ, Vennelyst Blvd 9, DK-8000 Aarhus C, Denmark; e-mail: birthe.ostergaard@ odontologi.au.dk
Periodontal Disease Emergency room visits and hospitalization Background.—Few studies have examined the characteristics of emergency department (ED) visits made for periodontal conditions. Persons who ignore regular dental care and those with medical conditions are more likely to come to a hospital ED for care than other persons. Accurate information on this problem can help in shaping oral healthcare delivery to target populations with untreated dental conditions. The epidemiology of hospital-based ED visits in 2006 that were attributed to periodontal conditions, such as gingivitis and chronic periodontitis was noted, along with risk factors for hospitalizations related to these visits. Methods.—Data were obtained from the Nationwide Emergency Department Sample for 2006. The patients
had primary diagnoses of acute gingivitis, chronic gingivitis, gingival recession, aggressive or acute periodontitis, chronic periodontitis, periodontosis, accretions, other specified periodontal disease, or unspecified gingival and periodontal disease. Relationships were noted between patient characteristics and the odds of being hospitalized. Results.—Primary diagnostic codes for gingival and periodontal conditions were given for 85,039 ED visits, with female patients in 53% of these visits. Nearly 36% of the visits involved persons from the lowest income group. Mean patient age was 32 years. A total of 1167 visits resulted in inpatient admission to the same hospital.
Volume 57
Issue 4
2012
219
Table 3.—Hospital Charges and Length of Stay (LOS) of Hospital-Based ED Visits Attributed to Periodontal Conditions in the United States
Characteristics
ED – hospital charges ED þ inpatient hospital charges Inpatient – LOS in days
Mean
Standard error
Total United States Hospital Charges/LOS
$456.31 $15,248
24.14 1,060.84
$33,283,477 $17,515,928
3.05
0.186
3,553
(Courtesy of Elangovan S, Nalliah R, Allareddy V, et al: Outcomes in patients visiting hospital emergency departments in the United States because of periodontal conditions. J Periodontol 82:809-819, 2011.)
The mean cost of each ED visit was $456.31, for a total nationwide charge of nearly $33.3 million. The mean uninsured charge was $410.99, with a total uninsured nationwide charge of $10.06 million. For those requiring hospitalization, the mean hospitalization charge (including the ED charge) was $15,248 and mean length of stay was 3.05 days. Thus, the total nationwide hospitalization charge was $17.51 million (Table 3). These expenditures did not include the costs of medications, outpatient care, postdischarge care, or treatment for other dental conditions. The comorbid conditions found most often were hypertension (6.80% of visits), diabetes without chronic complications (3.36%), chronic pulmonary disease (2.58%), depression (1.09%), and neurologic disorders (0.75%). After adjusting for several confounding factors, the ED visits for acute and aggressive periodontitis had higher odds of resulting in hospitalization. Among the comorbid conditions associated with significantly higher odds of hospitalization were congestive heart failure, valvular disease, hypertension, paralysis, neurologic disorders, chronic pulmonary disease, hypothyroidism, liver disease, AIDS, coagulopathy, obesity, deficiency anemia, alcohol abuse, and drug abuse. Patients residing in areas whose median household income level was less than $61,999 had higher odds of
being hospitalized than those in areas whose median household income was between $47,000 and $61,999. Discussion.—More than $33 million is spent each year on ED visits for gingival and periodontal disease. About onethird of these visits are made by persons who are in the lowest income group and by those without insurance. Uninsured persons were charged about $10 million. A total of 1167 visits resulted in an inpatient admission that further increased the cost of care to a total of $17.51 million. Often those who are hospitalized have comorbid conditions, but a primary diagnosis of acute or aggressive periodontitis by itself is associated with significantly higher odds of being hospitalized subsequent to an ED visit.
Clinical Significance.—The periodontium can be reliably maintained long-term in most persons by periodic dental care and maintenance to control local etiologic factors. Patients who do not make regular dental visits are more likely to develop severe tissue destruction, tooth loss, functional limitations, discomfort, and disability related to periodontal disease. Patient compliance can be adversely affected by cost factors, lack of insurance, and lack of access to a personal dentist or dental clinic. Comorbid conditions also play a role, making hospitalization more likely. It was suggested that persons in the Midwest were less likely to be hospitalized for periodontal disease than those in Western areas, but the data are insufficient to accurately estimate practice patterns related to geographic factors.
Elangovan S, Nalliah R, Allareddy V, et al: Outcomes in patients visiting hospital emergency departments in the United States because of periodontal conditions. J Periodontol 82:809-819, 2011 Reprints available from V Allareddy, Dept of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115; e-mail: [email protected]
Restorative Dentistry Post systems Background.—Posts are designed to retain the coronal restoration in an endodontically treated tooth that has lost extensive crown structure. Various post systems of different materials are available, including metallic prefabricated, cast
220
Dental Abstracts
posts, nonmetallic dowels, epoxy resin posts reinforced with fibers of various types, zirconia posts, and polyethylene fiber-reinforced posts. The most recent and reliable evidence related to the post systems was gathered from the literature.