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Dental and oral health conditions are widespread in the US population. Among children and teenagers, 46% have dental cavities; among adults, more than 90% have cavities and 46% have periodontal disease. In 2015, more than $117 billion was spent on dental care in the United States, with a significant share delivered in emergency departments (EDs). Common nontraumatic dental conditions seen in EDs include dental pain and infection. Less than one-third of patients seek follow-up dental care. The mildest form of oral disease is dental cavities. Gingivitis is inflammation of the gums. Left unmanaged, it can lead to necrotizing ulcerative gingivitis, periodontitis, and periodontal abscesses. Acute periodontal abscess can be managed by a nondental physician with simple incision and drainage. Rarely, patients will develop orofacial space infections from unrecognized or unmanaged dental infections. These medical emergencies require immediate surgical consultation. Initial management of postextraction bleeding consists of application of constant pressure for more than 30 min at the bleeding site. Dental conditions and their complications are preventable. Family physicians play a role in providing oral health education. The primary areas of needed intervention are continuity of dental care, healthy nutritional habits, oral hygiene education, systemic disease management, and smoking cessation.

Case 3. Michael is a 59-year-old man with diabetes and depression who comes to your office for a wellness examination. He reports bleeding of the gums, teeth that are sensitive to cold, and diffuse pain with chewing for the past 6 months. He takes insulin, atorvastatin, and nortriptyline. Results from pre-examination laboratory tests show an A1c level of 7.5. Michael has a 30-pack-year history of cigarette smoking. He has not undergone a dental cleaning or examination in more than 5 years because of self-reported discomfort.

Costs and Health Burden

In 2015, more than $117 billion was spent on dental care in the United States, with a significant share of care delivered in emergency departments (EDs).50 In 2010, there were more than 2 million ED visits for dental-related conditions, with more than 98% of patients treated and released.51,52

Common nontraumatic dental conditions seen in EDs include dental pain and infection.53 Acute management typically is limited to pain and infection control because most EDs are not equipped to provide definitive dental management. Patients evaluated in the ED incur an average cost of $750, compared with the average cost of tooth extraction of $130 to $250, and less than one-third of patients seek follow-up dental care.54,55

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