A. Gupta1,2,3, W. A. Davis1,2,3, E. B. Schneider1,2,4 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3Harvard School Of Public Health,Boston, MA, USA 4Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction:
Drainage of periapical abscess is one of the 44 surgeries identified as essential by the World Bank in 2015; the procedure meets the specific World Bank criteria of addressing a substantial need, being cost effective and feasible to implement. Periapical abscess is easily preventable through timely dental intervention; however, if untreated, periapical abscesses can lead to Emergency Department (ED) presentation for treatment. We sought to describe the outcomes of patients who present to ED with periapical abscess, in terms of the procedures they receive in the ED and their subsequent disposition from ED. We also examined these outcomes with respect to patient insurance status and income level.
Methods:
Using the Nationwide Emergency Department Sample (NEDS) from 2006-2009 provided by Healthcare Cost and Utilization Survey (HCUP), we identified patients who presented with the primary ICD 9 Diagnosis Code 522.5 and 522.7. Analyses were performed using data weighted to represent national level estimates.
Results:
A total of 1,348,810 patients presented to the ED with a primary diagnosis of periapical abscess during the study period. Overall 10.5% presented at Level 1 trauma center. Most common procedure (37.65%) documented was ‘Brief Interview and Evaluation’. Next most common procedure was gum and alveolar incision (24.03%). Of those who received only Brief Interview and Evaluation, 80.41% did not undergo any other procedure during the ED visit and 35.32% of those were recorded as having symptoms representing moderately complex decision making along with symptoms classified as highly severe requiring urgent/immediate care. 99.2% of patients who received only Brief Interview and Evaluation, and underwent moderately complex decision making associated with symptoms requiring urgent or immediate care, were discharged routinely.
Of these who only received interview and evaluation and were routinely discharged, 85.6% were classified as having incomes below the 50th percentile. Nearly half (49.2%) of the patients whose only recorded treatment was interview and evaluation were classified as “self-pay” and 23.4% were classified as having private insurance.
Conclusion:
Most patients presenting with periapical abscess receive only symptomatic treatment or no procedure-based treatment at the ED. The majority of these patients were classified as low income and “self pay” leading to concerns that these patients may not seek timely definitive treatment for their condition at a dental clinic. This study highlights the possible importance of access to primary dental care to prevent ED visits for periapical abscess and reduce the need for oral-surgical intervention.