I was speaking with a medical doctor recently about oral health. Specifically, I asked him if he had patients who complained about dental pain. Yes, about four a week he said.  Then I asked him what happens with these patients after they visit his medical practice. Commonly they go to the ER of the local hospital, he said. And at the ER?  Well, these patients reportedly get pain relievers (opioids) and antibiotics. And most disturbingly, they return to this same physician in about 2 months with the same complaint.  These adults rarely go to a dentist.

This doctor practices in a lower income, immigrant community in west Toronto. His observations about dental pain need to be considered in this context.

But the ERs around Canada all report that dental pain is a common complaint. Indeed, dental pain is a major contributor to opioid use and antibiotic abuse in our communities.

So, how do we deal with this public health problem?

Let’s look to a remarkable experiment in the US. It is simple and effective in lowering ER use and inpatient hospitalization.

It involves setting up an integrated healthcare clinic in a city recreational center in a low income neighborhood of Dallas, Texas.

Emergency department (ED) and inpatient care use was examined over twelve months after initiation of services at the center. People who used the center’s services showed a reduction in ED use of 21.4 percent and a reduction in inpatient care use of 36.7 percent, with an average cost decrease of 34.5 percent and 54.4 percent, respectively.

Now, it seems that dental care is not part of the services at this Dallas rec center. But if it were, quite likely ER use (and opioid and antibiotic abuse) would have declined even more.

A dental clinic at the local rec center is now a possibility. Mobile hygienists can set up their services in the gym in about 5 minutes, can begin screening for risk, and then can deliver prevention and Prevora in a half hour appointment, without pain. And for those visitors needing dental surgery, perhaps a dentist can come along too.

Would the patients pay for this service? Some will if it is priced appropriately.

More to come on this.




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