Burden of Hospital Stays for Dental Infection

Hospitalization for periapical abscesses linked to low access to dental care and insurance

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Oral health infections can usually be dealt with easily if found early by a dentist. However, many people often wait until hospital care is needed.

A recent study looked at the connection between hospital patient information (sex, race, diagnosis, etc.) and hospitalization outcomes for periapical abscess — a tooth infection defined by swelling and pus at the tip of the root. This condition can easily be found and treated with regular dental care, but it can be life-threatening if left untreated.

According to the study, the hospital charges and lengths of stay were generally increased by older age, minority race, non-private insurance, later year of study and living in the Northeast, Midwest or the South.

The researchers found that many people did not have access to regular dental care or dental insurance, and therefore waited for their condition to become an emergency to seek treatment.

The researchers concluded that there should be a business, public and governmental effort to increase overall access to dental insurance.

"See your dentist regularly."

This study was conducted by Min Kyeong Lee, DMD, of the Department of Developmental Biology at Harvard School of Dental Medicine in Boston, Massachusetts, and colleagues.

The researchers pulled participant data from the Nationwide Inpatient Sample (NIS) from the years 2000 to 2008 by selecting every hospitalization that was due primarily to a periapical abscess or a periapical abscess with sinus (air space above the upper teeth roots) problems.

The NIS is the largest dataset of all-payer hospitalizations that is available to the public. It provides information on patients such as race, age, sex, main reason for hospitalization, presence of other conditions, discharge information, length of stay and insurance status. It also provides information on hospitals, such as geographical location and region, bed size and whether or not it's a teaching hospital.

Presence of sinus issues, age, race, insurance, non-teaching hospitals, geographic region, other existing conditions and the year of study were determined to be the biggest characteristics that affected the amount of hospital charges a patient had.

The researchers found that there were a total of 61,439 hospitalizations for periapical abscesses over the nine years studied. Of these cases, 66 ended in death.

Sinus issues played a part in 3 percent of the hospitalizations, and the yearly percentage remained the same.

The average length of hospital stay was 2.96 days, and the researchers found this trend to stay relatively consistent each year.

The average age at hospitalization was 37 years, and the researchers discovered that each one-year increase in age was associated with a longer stay in the hospital.

White people represented 61 percent of the patients, but were found to have significantly lower hospital charges than any other race.

The data revealed that most people paid for their hospital stays with private insurance plans (33 percent). Medicaid represented 25 percent of payment, Medicare represented 19 percent and other insurance plans represented 4 percent. Uninsured people represented 19 percent of the patients.

Medicaid patients generally had greater hospital charges than private insurance patients. In all nine years, Medicaid and Medicare paid for 44 percent of all hospitalizations.

Non-teaching hospitals generally had bigger hospital charges when compared with teaching hospitals. The Western region of the country was found to have much lower hospital charges compared to the Northeast, Midwest and South.

The researchers concluded that a presence of other conditions at the same time of periapical abscess increased the hospital charges. The researchers also determined that the average hospital charge per visit increased by 36 percent from 2000 to 2008, despite the average number of days per visit staying the same. There was a 41 percent increase in hospitalized patients from 2000 to 2008 — from 5,757 to 8,141.

The researchers noted that the average cost of periapical abscess treatment is significantly lower when done in a dental setting.

According to the American Dental Association's 2009 Survey of Dental Fees, it costs roughly $1,112 for molar root canal therapy by an endodontist (dentist who specializes in diseases of the tooth pulp and nerve), or $259 for a tooth removal by an oral surgeon. The researchers found the average cost of one hospital visit in 2008 to be $16,521.

The researchers explained that dental access in the United States generally relies on dental insurance. According to the Centers for Disease Control and Prevention, one out of every four people under the age of 65 does not have any form of dental insurance, and therefore most likely does not receive regular dental care. Medicaid provides limited dental care to Medicaid-eligible people under 21, but stops offering any sort of dental care after 21.

The researchers stated that their findings highlight the importance of regular dental care as a way to avoid hospitalization for periapical abscesses. They believe that people should encourage the government, businesses and insurance companies to improve public access to dental insurance.

Overall, the researchers strongly support regular dental examinations, and argue that there is a need to remove the multiple barriers that block people from receiving routine dental care.

The researchers mentioned a few limitations of their study.

First, the reported percentages were averages and may not have applied to every patient. Second, this study only looked at the association between patient/hospital data, hospital charges and length of stay. Therefore, the actual cause-and-effect association could not be determined. Finally, the hospitals could have differed in how they coded information in the NIS.

This study was published in the September edition of the Journal of Endodontics.

Funding was provided by a grant from the American Association of Endodontics Foundation.

Review Date: 
September 3, 2013
Last Updated:
September 5, 2013