Reducing the burden of dental patients on the busy hospital emergency department.

PURPOSE: Studies have shown that there is a current trend for many patients with dental problems to seek care in a hospital emergency department (ED). This may contribute to an already overcrowded and overburdened situation. The purpose of this study was to determine the volume and characteristics of the patients seeking care in the ED of a large metropolitan level I trauma center. PATIENTS AND METHODS: Using ICD-9 diagnosis codes for dental complaints, the following ED data were collected for the years 2007 through 2009: the number of patients, the age of patients, the day and time the patients presented, the number of visits patients made to the ED for a dental-related complaint, and the insurance status of the patients. This information was then used to develop a pilot program to divert these patients from the ED to a special Urgent Dental Care Clinic located in the hospital Oral and Maxillofacial Surgery Clinic, and data on number of patients treated in the following year were compared with the number treated in the ED the previous year. RESULTS: There were 173,648 emergency department visits between 2007 and 2009. Of these, 4.3% were dental-related. The majority of the patients presented between 7 am and 6 pm on Monday through Thursday, with the highest percentage on Monday. The insurance status showed that 39.7% had Medicaid or Medicare, 52.7% were uninsured, and only 7.6% had private insurance. Sixty-seven percent had tooth-related ailments. The treatment in most cases was limited to a prescription for pain medicine and an antibiotic. In the year prior to initiation of the pilot program there were 2,618 patients with dentally related problems managed in the ED. This decreased more than 52% during the first year of the pilot program. Return to the ED for a subsequent dental problem was also reduced by more than 66%. CONCLUSION: A diversion plan for dental patients can be effective in reducing their impact on the busy ED.

The effects of reactive species on the tumorigenic phenotype of human head and neck squamous cell carcinoma (HNSCC) cells.

Sustained inflammation up-regulates the reactive species (RS) generating enzymes inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). While clinical data show that levels of iNOS and COX-2 are increased in epithelium during the transformation of dysplasia to overt head and neck squamous cell carcinoma (HNSCC), the mechanisms by which their overexpression contributes to HNSCC development have not been completely delineated. This study assessed the effects of RS on parameters associated with the HNSCC tumorigenic phenotype inclusive of activation of NF-kappaB (in situ immunostaining and reporter assay) and production of proinflammatory and proangiogenic proteins (ELISA analyses). Our data, which show both reactive oxygen and nitrogen species activated NF-kappaB, and that all RS donors evaluated increased HNSCC cellular production of vascular endothelial growth factor, IL-8 and epidermal growth factor receptor proteins, imply inflammation associated RS promote HNSCC by their abilities to modulate intracellular signaling and affect gene expression.