Before she retired a few years ago at age 78, my mother was the oldest practicing dental hygienist in Berks County, Pa., and possibly the state. Growing up in our home, oral health was a frequent — though admittedly not a terribly scintillating — topic of conversation. Mom made a habit of inspecting my siblings' and my own mouths on a regular basis for signs of tooth decay or gum issues. Failing to brush our teeth first thing in the morning and last thing at night would have been almost as deadly a sin as sloth or gluttony. Deadlier, maybe, since on one or two occasions, in a weakened moral state, I committed both sloth and gluttony and am still around to confess to it. But I never went a day without brushing my teeth, and there was no getting out of the dreaded, twice-a-year trips to the town dentist — Butcher Bailey, as he was known in certain circles.

Which is why I cringe when I hear about families who so neglect their oral health or can't afford primary dental care that the children end up in the hospital emergency department with oozing gums or paralyzing toothaches. ED physicians aren't qualified to pull teeth or treat the underlying causes of dental disease. Usually, all they can do is give the kids painkillers and send them someplace more appropriate.

It's a big problem. The American Academy of Pediatrics reports that early childhood cavities are the No. 1 chronic disease affecting young children, five times more common than asthma and seven times more common than hay fever. Disturbingly, 25 percent of American children account for nearly 80 percent of all the cavities, according to the American Academy of Pediatric Dentistry.

And that's just the kids. Lack of access to primary dental care is also a big issue among adults. The American Dental Association says women ages 21 to 34 are the highest users of EDs for dental problems. All told, there are more than 2 million visits every year to hospital EDs for dental pain, and they come with a huge price tag. For instance, the ADA reports that in the state of Washington, "dental disorders are the most common primary diagnosis for ER visits for the uninsured, costing more than $3 million, according to a 2010 study."

In her latest Clinical Management article, H&HN contributing writer Geri Aston lays out the scope of the problem and the burden on the nation's EDs. Then she describes how a number of hospitals around the country are striving to improve primary dental access in their communities.

Swedish Medical Center in Seattle worked with local federally qualified health centers and others to build, outfit and staff dental procedure rooms in its Community Specialty Clinic. Children's Hospital Colorado set up a dental clinic that averages 33,000 visits a year; 85 percent of the patients are on Medicaid. Baystate Health helped a local nonprofit group launch a program that provides on-site dental care at early childhood education centers and elementary schools around Springfield, Mass.

These and the other successful hospital-led initiatives described in Geri's article provide valuable lessons for every health care organization hoping to get people the dental care they need before they have no choice but to show up at the emergency department. The story begins on Page 44.

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