ER Doctors Must Decide Whether Patients Claiming Dental Pain Really Need Painkillers

Many emergency room physicians say they see many patients who come in asking for painkillers for dental pain. These doctors must decide whether the patients are truly suffering from dental problems, or are simply seeking an easy way to collect painkillers, The New York Times reports.

Uninsured or impoverished dental patients may not seek care for dental problems until they face a medical emergency, the article notes. In many states, adult dental benefits under Medicaid have been cut back or eliminated. Many dentists will not accept Medicaid patients.

Dr. Gail D’Onofrio, Chairwoman of the Emergency Medicine Department at Yale School of Medicine, who has studied alcohol and drug abuse in emergency rooms, told the newspaper, “The overuse of narcotics is a huge problem, and when a patient presents, especially for dental pain, it’s difficult to make an objective assessment. It puts the physician in a difficult situation to assess whether or not someone truly needs pain medications. We err on the side of treating pain, and it is a huge potential for abuse.”

An analysis of the National Hospital Ambulatory Medical Care Survey found painkillers were prescribed in three out of every four visits to the emergency department for dental complaints, the newspaper notes. In the analysis, published in Medical Care, researchers found that between 1997 and 2007, the number of painkiller prescriptions for dental patients in emergency departments increased 26 percent.

Emergency room doctors say they have time pressures and heavy patient loads, making it difficult to take the time to determine if patients really have dental pain. They note that they do not have dental X-ray machines to determine if a tooth nerve is infected. Few are trained to give dental blocks—local anesthetic injections that can offer immediate pain relief.