Effect of education and guidelines for treatment of uncomplicated dental pain on patient and provider behavior

Study objective: Patients with uncomplicated odontalgia use a significant proportion of emergency department (ED) resources. Some odontalgia patients are unaware that routine dental care is unavailable in most EDs. Using extensive input from regional dentists and oral surgeons, and after reviewing the dental literature, guidelines for the ED management of uncomplicated odontalgia were written for physician and patient use. The guidelines, which emphasize appropriate community dental clinic referrals and the use of nonsteroidal anti-inflammatory drugs, were developed to reflect community standard of care. We hypothesize that patient education and treatment guidelines will decrease the number of ED visits, return visits, and narcotic prescriptions written for odontalgia. Methods: This retrospective, observational study used primary Intenational Classification of Diseases, Ninth Revision codes to identify visits for odontalgia during the year before and the year after guideline implementation in a tertiary care teaching hospital with 161,181 ED visits during the 2-year period of our study. Results: There were 5,930 visits for odontalgia during the study. The proportion (95% confidence interval [Cl]) of visits with odontalgia decreased after guideline implementation from 4.3% (95% Cl 4.2% to 4.5%) to 3.1% (95% Cl 3.0% to 3.2%). The proportion of patients with return visits decreased from 19.8% (95% Cl 18.1% to 21.6%) to 9.2% (95% Cl 7.9% to 10.8%). The proportion of patients filling narcotic prescriptions for odontalgia decreased from 29.6% (95% Cl 28.1% to 31.2%) to 9.5% (95% Cl 8.5% to 10.8%). Conclusion: Implementing odontalgia guidelines and providing patients with written information about alternative treatments and a list of dental clinics can reduce the burden of uncomplicated odontalgia on EDs that do not provide routine dental care.