Determinants of emergency department utilization for non-traumatic dental conditions in Massachusetts

Objectives To study the determinants of emergency department (ED) utilization for non-traumatic dental conditions (NTDCs) by adults in Massachusetts. Methods We analyzed patient-level factors associated with ED utilization for NTDCs in Massachusetts during 2013, using the Massachusetts All Payer Claims Dataset. The primary independent variables of interest were use of preventive dental service in the year preceding the ED visit and dental insurance coverage. Key covariates included age, gender, income, day of the ED visit, payer type, and residing in a geographically designated dental health professional shortage area (DHPSA). A multilevel logistic regression model was used to estimate the odds of NTDC ED visits as compared to two other categories of ED visits. Results 1.1 percent of all ED visits in Massachusetts were for NTDCs in 2013. Preventive dental service use in the preceding year decreased the odds (OR = 0.72) of a NTDC ED visit, whereas having dental insurance coverage increased the odds (OR = 1.1) of a NTDC ED visit. Other patient-level characteristics that significantly increased odds of a NTDC ED visit included being between 26 and 35 years of age (OR = 1.2), male (OR = 1.3), uninsured (OR = 1.7) or enrolled in Medicaid (OR = 1.2), and visiting on a weekend (OR = 1.3). Conclusions Increased access to preventive dental services may lower likelihood of ED use for NTDCs. Interventions that target younger adults, Medicaid enrollees, and the uninsured, may be the most efficient way to lower NTDC ED use.