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​Toothache piling financial pressure on A&E

6 January 2017  

New study reveals cost of dental patients at A&E could be ten times official Government estimates. Dental leaders say costs to NHS could now be as much as £18 million.

The British Dental Association (BDA) has said dental patients seeking free care at Accident and Emergency departments could be costing the NHS as much as £18 million, as new research shows the government is massively underestimating patient numbers. 

The study from Newcastle University's Centre for Oral Health Research, reveals that patients attending A&E with dental problems are now approaching 1% (0.7%) of all attendances. This is ten times official government figures – with over half of the cases identified related to toothache.

Around 14,500 patients with dental problems attended England's A&Es according to official stats in 2014/15. The BDA has estimated that systematic under-reporting could conservatively place dental attendees at closer to 135,000 patients per year at an annual cost of nearly £18 million - with over 95,000 cases of toothache coming in at £12.5 million.

The BDA recently estimated that 600,000 patients a year are seeking treatment from GPs, who like A&E medics are not equipped to treat dental pain. Dentists' leaders have called on Ministers to show leadership and provide a coherent strategy for oral health, and stop pushing patients away with inflation busting increases in NHS charges.

Henrik Overgaard-Nielsen, Chair of General Dental Practice at the BDA, said:

"Ministers keep underestimating how much their indifference to dentistry has knock-on effects across the health service. GPs and A&E medics are having to pick up the pieces, while government's only strategy is to ask our patients to pay more in to plug the funding gap.

"We are seeing patients who need our care pushed towards medical colleagues who aren't equipped to treat them. As long as government keeps slashing budgets, and ramping up charges we will keep seeing more of the same."

Dr Justin Durham, NIHR Clinician Scientist, Senior Lecturer in Oral Surgery and Orofacial Pain, Newcastle University and Honorary Consultant at Newcastle upon Tyne Hospitals NHS Foundation Trust, the senior author on the study said:

"If you experience toothache without significant other symptoms, then heading to a hospital's A&E department isn't always the best option. Ensuring that patients are treated in the right place, at the right time, by the right team is essential for both the patient and the wider public, not just to ensure appropriate diagnosis and treatment but also reduce unnecessary care, and personal costs.

"This paper and other recently published data from Newcastle University's Orofacial pain research team suggest there are potentially significant problems in the care pathways both for toothache, and also the group of conditions that cause persistent mouth and face pain such as Temporomandibular Disorders, and Trigeminal Neuralgia."

Underestimating patient numbers
  • New data from Newcastle University's Centre for Oral Health Research shows that the number of patients attending A&E with dental problems is approaching 1% (0.7%) of all A&E attendances. This figure is ten times official government figures and over half of the attendances identified were related to toothache. (Dental pain in the medical emergency department: a cross-sectional study, C. C. Currie, S. J. Stone, J. Connolly & J. Durham, Journal of Oral Rehabilitation 2016)
  • Research excluded individuals who required emergency dental treatment as inpatients (0.1% of all attendees) and therefore none of the remainder (0.7%) required admission, and it is likely that those with toothache related complaints could have been managed in primary care. 
  • Researchers examined coding data for attendance for dental problems over a three-year period at Newcastle upon Tyne Hospitals NHS Foundation Trust's A&E department (a level one trauma centre), and identified 2,504 attendances for dental problems that did not require admission. This equates to over 800 attendances per year – or approximately 2/day. The majority of patients in this group were men and 10% of those attending had also attended previously for dental problems.  
  • The A&E department operates in an area well served by NHS dental out-of-hours emergency care. Researchers estimate if numbers attending A&E are this high in this hospital and area, the figures could well be higher in areas less well-served by emergency care. 
  • Reasons for non-attendance may include access, financial barriers to treatment, dental anxiety and signposting of services. As lead author of the paper, Charlotte Currie, Orofacial Pain research team, Newcastle University's Centre for Oral Health Research, said: "We simply do not have sufficient understanding of why patients choose to use U.K. healthcare services in this way for dental problems and beginning to understand why they make these choices is important to help these patients into routine preventative dental care, which is likely to have help prevent the dental problem occurring in the first place".
Measuring the cost of toothache at A&E
  • The BDA says this research reveals a systematic under-reporting of dental problems at A&E departments.  Official national figures for England place the annual number of dental investigations at A&E at 14,468. With an average tariff for A&E attendance of £132 this generates an official cost of just £2 million. The BDA has estimated this new research could conservatively place attendees in England at closer to 135,000 patients per year at an annual cost of nearly £18 million-- with over 95,000 cases and over £12.5 million specifically for toothache related problems.
  • Over 600,000 patients in England are already estimated to be heading to GPs for dental treatment. The BDA previously revealed these appointments cost the NHS over £26 million a year, even though practitioners are not equipped to treat them.
  • The BDA has consistently criticised the government for discouraging patients on modest incomes through increases in the patient charge.  The last Adult Dental Health Survey reports that just over a quarter of adults (26%) say that the type of dental treatment they opted for has been affected by cost - and almost one-fifth (19%) say that they had delayed dental treatment for the same reason. 
  • Direct government investment in the service in England has fallen by £170 million since 2010, while the gross budget has been topped up by inflated patient charges. England now leads the field for basic treatment charges, with a £19.70 charge for an examination, compared to £13.50 in Wales. In Scotland check-ups are free of charge. In Northern Ireland examinations charges start at £6.68.