Dentists and ER Doctors Work Together to Ease Patients’ Pain While Reducing Opioid Usage

Dentists and patients
Photo by More Smiles Wisconsin

According to the American Dental Association, approximately one person shows up in emergency rooms (ERs) every 15 seconds due to dental pain. Dental pain is the number six reason for people to seek ER care for pain. In Dane County, that translates to thousands (4,235 in 2015) of people every year who turn to ERs or urgent care to help relieve their pain.

“Dental pain is real,” says Dr. Steven Tyska, clinical associate professor at UW Health Department of Family Medicine and Community Health. “Even mild or moderate pain can make it difficult to sleep, eat, or work. And that sensitivity can quickly turn into a potentially serious condition that can turn into an intense, throbbing, debilitating pain. If left untreated, it can result in infection, and in the most serious cases, even death.”

Dr. Tyska says that in the past, ER docs focused primarily on addressing the infection with antibiotics and reducing pain, often prescribing opioids for immediate relief. “We’re trained to address the immediate medical issue. Unlike most acute medical issues, dental pain will come back until you deal with the underlying dental issue, so we knew that we needed to work together with our dental community to find a better way to help our patients. Doctors can’t solve dental problems—we’re not trained in that specialty. We do know that dental problems worsen over time, so getting people the care they need is critical to long-term relief.”

Photograph provided by More Smiles Wisconsin

A 2011 study in the Journal of the American Dental Association estimates that dentists are responsible for 12 percent of prescriptions for fast-acting opioid pain relievers—just below general practitioners and internal medicine doctors as top prescribers of common opioids. As public health officials and the medical community continue to seek ways to reduce opioid dependency, they are looking for solutions to alleviate patient pain without opioids.

Dr. Tyska and other ER physicians worked with the Dane County Oral Health Coalition and More Smiles Wisconsin, a nonprofit organization that serves several counties in southern Wisconsin to create new protocols for treating nontraumatic dental pain. Although the program started in 2015, training for the ER Diversion Program, which includes a community dental care coordinator, began in 2016. The program includes workflows and smart phrases in the electronic medical record, and special training workshops for ER clinicians. “The workshops have been wonderful, providing our ER clinicians with real-time skills to help us address the immediate infection and stop the pain cycle without relying on opioids. Nonsteroidal anti-inflammatory drugs—the Motrins, the Advils, the Aleves—can be very effective in addressing pain, if used correctly. Once the infection and pain are under control, we refer them [patients] to the Community Dental Care Coordinator at More Smiles Wisconsin to connect patients with dental treatment to address the underlying cause of the dental pain,” says Dr. Tyska.

Jeff Okazaki, executive director of More Smiles Wisconsin, says the ER Diversion Program is making a very real difference in Dane County. “Area ERs and urgent care facilities have our referral information. Many people have been in pain for a long time before they seek emergency treatment. Some have extremely low incomes and can’t afford ongoing care. People who may start with a relatively minor infection can quickly escalate into life-threatening situations if the underlying cause isn’t resolved.”

Photograph provided by More Smiles Wisconsin

More Smiles Wisconsin attempts to see patients as quickly as possible. “We hold several emergency slots each day,” says Jeff. “We also hold emergency clinics every Thursday night. Area dentists volunteer their time to help us address this issue, and it’s making a very real impact. But we need more dentists and resources to really address the needs of 65,000 people in Dane County who currently don’t have access to regular dental care.”

Dr. Tyska concurs that the program is reducing the number of visits to the ER. “We’re seeing great success by having these protocols in place. We are also seeing fewer return visits because this program addresses the underlying cause of the dental problem. We’re proud to be part of something that gets great results.”

Both Dr. Tyska and Jeff are proud of the success of the ER Diversion Program, but know there’s more work to do. “In 2015, we spent more than $2.5 million on preventable dental visits to ER departments,” Jeff says. “We’re already spending money on the issue, but we should be thinking more long term about how to improve our patients’ lives and reduce dependence on opioids. We need to create better policies and provide adequate funding to increase the care available to low-income patients. People should not be dying from untreated dental issues in 2018, but it happens. We know what we need to do to break the cycle of opioid dental pain management and improve the quality of care. We just need the will to make that happen.”

For more information on the ER Diversion Program, contact MoreSmilesWi.org/emergency-clinic .

Barbara Hernandez, APR , is president of BCH OnPoint. She works with many nonprofits in Wisconsin to tell their stories. For more, visit bchonpoint.com .