More Florida children get treated in ERs for tooth pain than anywhere else in US

Last Wednesday morning, a toddler arrived at the emergency department of UF Health Shands Hospital in Gainesville with a swollen jaw.

When emergency doctor Brandon Allen examined the boy, he discovered the child's teeth had rotted to the point that they were infected and nerves were exposed. "He was in a lot of pain," Allen said.

Unfortunately, Allen said, children often arrive in his emergency room with painful dental problems that could have been avoided with preventive care.

Florida has the highest rate in the country of children going to hospital Emergency Departments for dental care, and the highest average charge for these visits, a new report reveals.

More than 17,600 children visited Florida's Emergency Rooms for non-traumatic dental conditions and and additional 3,500 children and adults had to be admitted for life-threatening infections, according to 2021 federal hospital care data compiled by CareQuest Institute, a national nonprofit.

"We need to have robust access to preventive dental care so people can feel that the emergency department is not their only option," Allen said. "In hospitals we don't do extractions. We're not dentists. We're open 24/7 so we are the default for access to care, but by the time they come to the emergency department, it's too late when comes to doing anything preventative."

The toddler, he said, most likely will need some, if not all, of his teeth removed.

Children brought to emergency departments for dental care are more likely to be uninsured or covered by Medicaid and live in lower-income households, CareQuest researchers reported.

"These children may have Medicaid, but they can't access care," said Dr. Frank Catalanotto, president and founder of Floridians for Dental Access. "They can't find dentists who take it, or the wait is too long, or parents have to travel an hour or two to find a dentist who might see them."

The new research by CareQuest shows Florida is next to last in the country for children with Medicaid who had a dental visit in 2021, the most recent year for which data is available. "Many children in Florida are walking around with rotten teeth," Catalanotto said. "Most people don't realize how important this really is. Children do not learn as well when they are in pain."

The most common diagnoses for the Florida children at the time of their emergency department visits were abscesses, dental caries, stomatitis, and chronic gingivitis—conditions that are largely preventable with routine oral health care, CareQuest researchers found.

"There's nothing for these children in the ER," Catalanotto said. "All they get is a prescription for antibiotics and pain medication and they are told to go to a dentist. The relief of antibiotics and pain pills is temporary."

In Florida, turning to a hospital ER for dental care is costly.

Florida had the highest average charge for emergency department visits, ranging from $1,900 to $2,600 depending on the age of the child, the CareQuest report shows. In Florida, Medicaid covered about 80% of those visits. By contrast, Maryland had the lowest average charge ranging from $600 to $700, depending on the age of the child. In that state, Medicaid covered only 69% of those visits.

"Dental disease is almost entirely preventable, yet cavities are the leading chronic illness among children in this country," said Dr. Myechia Minter-Jordan, president and CEO of CareQuest Institute.

Catalanotto said his organization, Floridians for Dental Access, plans to propose solutions to Florida legislators with the hopes they will pass laws or fund new programs to make dental care more affordable and accessible for children. Florida's Department of Health maintains a locator of providers who may offer reduced fees for dental services. And in June, Gov. Ron DeSantis signed into law a bill that increases the income threshold to qualify for subsidized coverage under the Florida KidCare program, which should give more families coverage. Florida KidCare covers dental, but services may differ with each plan and program.

"If more Florida children get dental insurance coverage, hopefully they will get a regular source of dental care that they can call even if they have a toothache on the weekend," said Lisa Heaton with CareQuest. "Right now, many children likely don't have that. Parents are going to the ER because they don't have anywhere else to go."

At UF Health Shands, Allen sees all the factors that result in children arriving at his hospitals with mouths full of decayed teeth and exposed nerves. Those factors, particularly in the low-income population, include lack of teeth brushing, poor access to dentists in their communities, transportation issues, and consumption of sugary drinks.

"Florida's rankings are disappointing but the report shows there is real opportunity," he said. "We are going to need a real investment in oral hygiene for our state's pediatric population."

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