Emergency department visits for dental problems are rising nationwide, highlighting gaps in preventive care and straining hospital resources. Experts say most visits are for conditions that could be treated by dentists — not ERs — and that teledentistry can steer many patients away from costly, symptom-focused emergency care.
U.S. ER visits for dental conditions reached about 2.1 million by 2012. When patients go to hospital emergency rooms for dental pain they typically receive painkillers or antibiotics rather than definitive dental treatment; roughly 39% return to the ER. An ER visit for a dental issue averages $749 if the patient is not admitted — about three times the cost of a typical dental visit — producing an annual bill of about $1.6 billion, about one-third of which is paid by Medicaid.
Teledentistry — remote dental care delivered through telecommunications — offers a practical alternative. It covers real-time video consultations, store-and-forward exchanges of images and records, remote patient monitoring, and mobile app–based services. The American Dental Association introduced two teledentistry billing codes in 2018: D9995 for synchronous (live) visits and D9996 for asynchronous (store-and-forward) encounters.
Providers can also use diagnostic and imaging codes (for example, D0190/D0191 and D0350/D0351) and should document telehealth services with Place of Service code 02 while maintaining HIPAA compliance.
A simple triage framework helps identify which ER dental cases can be diverted. Four levels of urgency map expected wait times and diversion potential:
Level 1 — Immediate (10–15 minutes): 4.6% of ER dental visits; unlikely to divert.
Level 2 — Urgent (15–75 minutes): 16.8%; could be diverted with current workforce.
Level 3 — Semi-urgent (1–3 hours): 54.8%; potentially divertible with outside dental support.
Level 4 — Nonurgent (2–24 hours): 23.9%; likely divertible to external dental care.
Levels 3 and 4 account for about 79% of dental ER visits and often occur outside standard dental office hours, which average roughly 35 hours per week with limited weekend availability. Those facts make teledentistry a realistic option for reducing ER traffic.
Two primary teledentistry models are being proposed for hospital integration:
Scenario A — Real-time (synchronous): A dentist connects live with an ER patient using portable equipment. The clinician can assess pain, view intraoral images or radiographs, provide a diagnosis, and arrange follow-up care at an affiliated dental practice. Relevant codes include D0191, D0350/D0351 and D9995.
Scenario B — Store-and-forward (asynchronous): ER staff or dental auxiliaries collect radiographs, photos and clinical notes and send them securely to an off-site dentist for later review. Codes such as D0190, D0350/D0351 and D9996 apply.
Both approaches require secure data handling and compliance with state licensure rules.
Beyond technology, community partnerships can further reduce ER reliance. The American Dental Association’s Emergency Department Referral Initiative recommends coordinating local dentists, clinics, community leaders and low-income residents. Volunteer dentists and clinics could accept nonurgent and semi-urgent referrals.
Programs might offer reduced-cost care in exchange for community service, and dental students could gain supervised clinical experience. Organizers say this model can cut dental ER visits by as much as 72–79%, lower repeat visits, curb unnecessary prescriptions, and reduce Medicaid expenditures.
The financial case is significant. Using 2012 cost figures, one hypothetical hospital that handled 50,000 dental ER visits could divert 39,500 semi-urgent and nonurgent patients to teledentistry or community clinics, trimming nearly $29.6 million in ER costs. Those savings could fund extended-hour community clinics or mobile dental units, improving access during nights and weekends.
Hospitals commonly lack in-house dental specialists, so ER staff often treat symptoms rather than the root cause. That results in recurring visits and continued patient suffering. Teledentistry — combined with community clinics and volunteer efforts — aims to provide timely dental diagnoses, reduce unnecessary ER visits, and improve outcomes while lowering costs.
Policymakers and health systems face practical hurdles: aligning reimbursement rules, ensuring secure and licensed telehealth practice across state lines, training ER personnel to capture usable dental images, and expanding evening and weekend dental capacity. Advocates argue these hurdles are solvable and that the potential benefits — reduced ER burden, lower costs, and better patient care — make teledentistry a strategy worth scaling.
As local dentists, hospitals and community groups pilot these models, the hope is to turn avoidable ER visits into timely, effective dental care — delivered remotely when appropriate and in clinics when required — improving patient outcomes and
