Skip to main content

Advertisement

SpringerLink
Log in

Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million NTDC-related ED visits in 2010. Less than 1.0 % (children) and 2.1 % (adults) of all ED visits were for NTDC. There was no significant difference in NTDC-related ED visits or costs for children by ASD status. Adults with ASD had significantly lower odds of NTDC-related ED visits (OR 0.39; 95 % CI 0.29, 0.52; p < 0.001) but incurred significantly greater mean costs for NTDC-related ED visits (p < 0.006) than did adults without ASD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Agency for Healthcare Research and Quality. (2012). Introduction to the HCUP Nationwide Emergency Department Sample (NEDS): 2010. Rockville, MD: Agency for Healthcare Research and Quality.

    Google Scholar 

  • Aharonson-Daniel, L., Schwartz, D., Hornik-Lurie, T., & Halpern, P. (2014). Quality of coding diagnoses in emergency departments: Effects on mapping the public’s health. Israel Medical Association Journal, 16(1), 11–16.

    PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Arlington, VA: American Psychiatric Publishing.

    Book  Google Scholar 

  • Astrøm, A. N., & Samdal, O. (2001). Time trends in oral health behaviors among Norwegian adolescents: 1985–97. Acta Odontolologica Scandinavica, 59(4), 193–200.

    Article  Google Scholar 

  • Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators, Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, 14 sites, United States, 2008. Morbidity and Mortality Weekly Report. Surveillance Summaries, 61(No. SS-03), pp. 1–19.

  • Barbaresi, W. J., Katusic, S. K., & Voigt, R. G. (2006). Autism: A review of the state of the science for pediatric health care clinicians. Archives in Pediatrics and Adolescent Medicine, 160(11), 1167–1175.

    Article  Google Scholar 

  • Barry, S., O’Sullivan, E. A., & Toumba, K. J. (2014). Barriers to dental care for children with autism spectrum disorder. European Archives of Paediatric Dentistry, 5(2), 127–134.

    Article  Google Scholar 

  • Bigeard, L. (2000). The role of medication and sugars in pediatric dental patients. Dental Clinics of North America, 44(3), 443–456.

    PubMed  Google Scholar 

  • Brickhouse, T. H., Farrington, F. H., Best, A. M., & Ellsworth, C. W. (2009). Barriers to dental care for children in Virginia with autism spectrum disorders. Journal of Dentistry for Children, 76(3), 188–193.

    PubMed  Google Scholar 

  • Brugha, T. S., McManus, S., Bankart, J., Scott, F., Purdon, S., Smith, J., et al. (2011). Epidemiology of autism spectrum disorders in adults in the community in England. Archives of General Psychiatry, 68(5), 459–465.

    Article  PubMed  Google Scholar 

  • Capozza, L. E., & Bimstein, E. (2012). Preferences of parents of children with autism spectrum disorders concerning oral health and dental treatment. Pediatric Dentistry, 34(7), 480–484.

    PubMed  Google Scholar 

  • Casamassimo, P. S., Seale, N. S., & Ruehs, K. (2004). General dentists’ perceptions of educational and treatment issues affecting access to care for children with special health care needs. Journal of Dental Education, 68(1), 23–28.

    PubMed  Google Scholar 

  • Chi, D. L., & Ettinger, R. (2014). Prevention and non-surgical management of dental caries over the life course for individuals with special health care needs. Journal of the California Dental Association, 42(7), 455–463.

    PubMed  Google Scholar 

  • Chi, D. L., & Masterson, E. E. (2013). A serial cross-sectional study of pediatric inpatient hospitalizations for non-traumatic dental conditions. Journal of Dental Research, 92(8), 682–688.

    Article  PubMed Central  PubMed  Google Scholar 

  • Chi, D. L., Masterson, E. E., & Wong, J. (2014). U.S. emergency department admissions for non-traumatic dental conditions for individuals with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 52(3), 193–204.

  • Chi, D. L., McManus, B. M., & Carle, A. C. (2013). Caregiver burden and preventive dental care use for US children with special health care needs: A stratified analysis based on functional limitation. Maternal and Child Health Journal. doi:10.1007/s10995-013-1314-x.

  • Chi, D. L., Momany, E. T., Jones, M. P., & Damiano, P. C. (2011a). Timing of first dental visits for newly Medicaid-enrolled children with an intellectual or developmental disability in Iowa, 2005–2007. American Journal of Public Health, 101(5), 922–929.

    Article  PubMed Central  PubMed  Google Scholar 

  • Chi, D. L., Momany, E. T., Kuthy, R. A., Chalmers, J. M., & Damiano, P. C. (2010). Preventive dental utilization for Medicaid-enrolled children in Iowa identified with intellectual and/or developmental disability. Journal of Public Health Dentistry, 70(1), 35–44.

    Article  PubMed Central  PubMed  Google Scholar 

  • Chi, D. L., Momany, E. T., Neff, J., Jones, M. P., Warren, J. J., Slayton, R. L., et al. (2011b). Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Medical Care, 49(2), 180–192.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cohen, L. A., Manski, R. J., Magder, L. S., & Mullins, C. D. (2002). Dental visits to hospital emergency departments by adults receiving Medicaid: Assessing their use. Journal of the American Dental Association, 133(6), 715–724.

    Article  PubMed  Google Scholar 

  • Davis, E. E., Deinard, A. S., & Maïga, E. W. (2010). Doctor, my tooth hurts: The costs of incomplete dental care in the emergency room. Journal of Public Health Dentistry, 70(3), 205–210.

    Article  PubMed  Google Scholar 

  • Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators. (2014). Prevalence of autism spectrum disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report. Surveillance Summaries, 28(63 Suppl 2), 1–21.

    Google Scholar 

  • Filipek, P. A., Accardo, P. J., Baranek, G. T., Cook, E. H, Jr., Dawson, G., Gordon, B., et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders, 29(6), 439–484.

    Article  PubMed  Google Scholar 

  • Friedlander, A. H., Yagiela, J. A., Paterno, V. I., & Mahler, M. E. (2006). The neuropathology, medical management and dental implications of autism. Journal of the American Dental Association, 137(11), 1517–1527.

    Article  PubMed  Google Scholar 

  • Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.

    PubMed Central  PubMed  Google Scholar 

  • Hong, L., Ahmed, A., McCunniff, M., Liu, Y., Cai, J., & Hoff, G. (2011). Secular trends in hospital emergency department visits for dental care in Kansas City, Missouri, 2001–2006. Public Health Reports, 126(2), 210–219.

    PubMed Central  PubMed  Google Scholar 

  • Hulland, S., & Sigal, M. J. (2000). Hospital-based dental care for persons with disabilities: A study of patient selection criteria. Special Care in Dentistry, 20(4), 131–138.

    Article  PubMed  Google Scholar 

  • Kleinman, J. M., Ventola, P. E., Pandey, J., Verbalis, A. D., Barton, M., Hodgson, S., et al. (2008). Diagnostic stability in very young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(4), 606–615.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kuhanek, H. K., & Chisholm, E. C. (2012). Improving dental visits for individuals with autism spectrum disorders through an understanding of sensory processing. Special Care in Dentistry, 32(6), 229–233.

    Article  Google Scholar 

  • Lai, B., Milano, M., & Roberts, M. W. (2012). Unmet dental needs and barriers to dental care among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(7), 1294–1303.

    Article  PubMed  Google Scholar 

  • Lee, H. H., Lewis, C. W., Saltzman, B., & Starks, H. (2012). Visiting the emergency department for dental problems: Trends in utilization, 2001 to 2008. American Journal of Public Health, 102(11), e77–e83.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lewis, C., Lynch, H., & Johnston, B. (2003). Dental complaints in emergency departments: A national perspective. Annals of Emergency Medicine, 42(1), 93–99.

    Article  PubMed  Google Scholar 

  • Lokhandwala, T., Khanna, R., & West-Strum, D. (2012). Hospitalization burden among individuals with autism. Journal of Autism and Developmental Disorders, 42(1), 95–104.

    Article  PubMed  Google Scholar 

  • Loo, C. Y., Graham, R. M., & Hughes, C. V. (2008). The caries experience and behavior of dental patients with autism spectrum disorder. Journal of the American Dental Association, 139(11), 1518–1524.

    Article  PubMed  Google Scholar 

  • Lowe, O., & Lindemann, R. (1984). Assessment of the autistic patient’s dental needs and ability to undergo dental examination. Journal of Dentistry for Children, 52(1), 29–35.

    Google Scholar 

  • Mandell, D. S., Morales, K. H., Xie, M., Lawer, L. J., Stahmer, A. C., & Marcus, S. C. (2010). Age of diagnosis among Medicaid-enrolled children with autism, 2001–2004. Psychiatric Services, 61(8), 822–829.

    Article  PubMed Central  PubMed  Google Scholar 

  • Marí-Bauset, S., Zazpe, I., Mari-Sanchis, A., Llopis-González, A., & Morales-Suárez-Varela, M. (2013). Food selectivity in autism spectrum disorders: A systematic review. Journal of Child Neurology. doi:10.1177/0883073813498821.

  • McCormick, A. P., Abubaker, A. O., Laskin, D. M., Gonzales, M. S., & Garland, S. (2012). Reducing the burden of dental patients on the busy hospital emergency department. Journal of Oral and Maxillofacial Surgery, 71(3), 475–478.

    Article  PubMed  Google Scholar 

  • Morinushi, T., Ueda, Y., & Tanaka, C. (2001). Autistic children: Experience and severity of dental caries between 1980 and 1995 in Kagoshima City, Japan. Journal of Clinical Pediatric Dentistry, 25(4), 323–328.

    PubMed  Google Scholar 

  • Nalliah, R. P., Allareddy, V., Elangovan, S., Karimbux, N., & Allareddy, V. (2010). Hospital based emergency department visits attributed to dental caries in the United States in 2006. Journal of Evidence Based Dental Practice, 10(4), 212–222.

    Article  PubMed  Google Scholar 

  • Newacheck, P. W., Hughes, D. C., Hung, Y., Wong, S., & Stoddard, J. J. (2000). The unmet health needs of America’s children. Pediatrics, 105(4 Pt 2), 989–997.

    PubMed  Google Scholar 

  • Nicolaidis, C., Raymaker, D., McDonald, K., Dern, S., Boisclair, W. C., Ashkenazy, E., et al. (2013). Comparison of healthcare experiences in autistic and non-autistic adults: A cross-sectional online survey facilitated by an academic-community partnership. Journal of General Internal Medicine, 28(6), 761–769.

    Article  PubMed Central  PubMed  Google Scholar 

  • Nowak, A. J., & Casamassimo, P. S. (2002). The dental home: A primary care oral health concept. Journal of the American Dental Association, 133(1), 93–98.

    Article  PubMed  Google Scholar 

  • Okunseri, C., Pajewski, N. M., Brousseau, D. C., Tomany-Korman, S., Snyder, A., & Flores, G. (2008). Racial and ethnic disparities in nontraumatic dental condition visits to emergency departments and physician offices: A study of the Wisconsin Medicaid program. Journal of the American Dental Association, 139(12), 1657–1666.

    Article  PubMed Central  PubMed  Google Scholar 

  • Orellana, L. M., Silvestre, F. J., Martinez-Sanchis, S., Martinez-Mihi, V., & Bautista, D. (2012). Oral manifestation in a group of adults with autism spectrum disorder. Medicina Oral, Patologia Oral y Cirugia Bucal, 17(3), e415–e419.

    Article  PubMed Central  PubMed  Google Scholar 

  • Pajewski, N. M., & Okunseri, C. (2014). Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid. Journal of Public Health Dentistry, 74(1), 34–41.

    Article  PubMed Central  PubMed  Google Scholar 

  • Peacock, G., Amendah, D., Ouyang, L., & Grosse, S. D. (2012). Autism spectrum disorders and health care expenditures: The effects of co-occurring conditions. Journal of Developmental and Behavioral Pediatrics, 33(1), 2–8.

    Article  PubMed  Google Scholar 

  • Pettinato, E. S., Webb, M. D., & Seale, N. S. (2000). A comparison of Medicaid reimbursement for non-definitive pediatric dental treatment in the emergency room versus periodic preventive care. Pediatric Dentistry, 22(6), 463–468.

    PubMed  Google Scholar 

  • Rosenberg, R. R., Landa, R., Law, J. K., Stuart, E. A., & Law, P. A. (2011). Factors affecting age at initial autism spectrum disorder diagnosis in a national survey. Autism Research and Treatment, 2011, 874619.

    PubMed Central  PubMed  Google Scholar 

  • Spence, S. J., Sharifi, P., & Wiznitzer, M. (2004). Autism spectrum disorder: Screening, diagnosis, and medical evaluation. Seminars in Pediatric Neurology, 11(3), 186–195.

    Article  PubMed  Google Scholar 

  • Stein, L. I., Polido, J. C., & Cermak, S. A. (2012a). Oral care and sensory concerns in autism. American Journal of Occupational Therapy, 66(5), e73–e76.

    Article  PubMed  Google Scholar 

  • Stein, L. I., Polido, J. C., Najera, S. O. L., & Cermak, S. A. (2012b). Oral care experiences and challenges in children with autism spectrum disorders. Pediatric Dentistry, 34(5), 387–391.

    PubMed  Google Scholar 

  • Sun, B., & Chi, D. L. (2014). Emergency department visits for non-traumatic dental problems in Oregon State. Report to the Oregon Oral Health Funders Collaborative. March 2014.

  • Wallace, N. T., Carlson, M. J., Mosen, D. M., Snyder, J. J., & Wright, B. J. (2011). The individual and program impacts of eliminating Medicaid dental benefits in the Oregon Health Plan. American Journal of Public Health, 101(11), 2144–2150.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wang, L., & Leslie, D. L. (2010). Health care expenditures for children with autism spectrum disorders in Medicaid. Journal of the American Academy of Child and Adolescent Psychiatry, 49(11), 1165–1171.

    PubMed Central  PubMed  Google Scholar 

  • White, H. R., Lee, J. Y., & Rozier, R. G. (2008). The effects of general anesthesia legislation on operating room visits by preschool children undergoing dental treatment. Pediatric Dentistry, 30(1), 70–75.

    PubMed  Google Scholar 

  • Wolff, A. J., Waldman, H. B., Milano, M., & Perlman, S. P. (2004). Dental students’ experiences with and attitudes toward people with mental retardation. Journal of the American Dental Association, 135(3), 353–357.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was made possible by the National Institute of Dental and Craniofacial Research (NIDCR) and National Institutes of Health (NIH) Grant Numbers TL1TR000422 and K08DE020856 and Health Resources and Services Administration (HRSA) Grant Number R40MC26198.

Author information

Authors and Affiliations

  1. Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195-7475, USA

    Sy Nakao, Erin E. Masterson & Donald L. Chi

  2. Department of Pediatric Dentistry, University of Washington School of Dentistry, Seattle, WA, 98195, USA

    JoAnna M. Scott

Authors
  1. Sy Nakao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. JoAnna M. Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erin E. Masterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald L. Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donald L. Chi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakao, S., Scott, J.M., Masterson, E.E. et al. Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders. J Autism Dev Disord 45, 1396–1407 (2015). https://doi.org/10.1007/s10803-014-2298-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-014-2298-0

Keywords

Search

Navigation