Emergency Department Use for Dental Problems among Homeless Individuals: A Population-Based Cohort Study

Objectives. To evaluate emergency department (ED) visits for dental problems among Toronto’s homeless population (Ontario, Canada). Methods. A random sample of 1,189 homeless was recruited from shelters and meal programs. Emergency department visits for non-traumatic dental problems (ICD-10-CA codes K00-K14) were identified using participants’ health insurance number, during 2005–2009. Age- and sex-matched controls were selected from low-income neighborhoods. Results. Homeless and matched controls had 182 and 10 ED visits for dental problems, respectively. Homeless people were more significantly more likely (OR=2.27, p=.007) to make ED visit for dental problems compared with controls. Over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. Conclusion. The high rate of ED visits for dental problems by people who are homeless suggests that access to dental care is inadequate. The large number of repeat visits indicates that ED settings are ineffective for treatment of dental problems.