Section 4. Scheduling

Emergency Appointments

Dental emergencies will likely be common in your service population. Many safety net dental clinics make time available for emergencies by keeping one or more appointment slots open each day until 24 hours in advance of the appointment time. If no one calls for an emergency visit, then the appointment can be scheduled for a regular patient, perhaps one on your waitlist. You may choose to differentiate between patients of record (who receive priority for the emergency time slots) and those who have never been seen in the program. Failure to accommodate patients of record with urgent needs, especially if those needs are post-operative problems from services that your clinic provided, can lead to poor customer satisfaction and possible concerns about patient abandonment.

Considerations for Dental Emergency Patients

 Proper management of emergency patients and/or walk-ins can make the clinical day more predictable for safety net dental clinics. Following are four recommendations that many clinics have found helpful in terms of emergency care:

• Ask emergency patients to call back for their follow-up treatment when definitive care cannot be provided at the patient’s emergent visit. Definitive care should always be provided as soon as possible. However, as dental emergencies are unpredictable, sometimes care must be deferred, because there is not enough time for the dentist to treat the patient, the infection is too acute, or the care is too complex and the patient requires referral to a specialist. In the first case, where the patient will need to return for care because the dentist did not have sufficient time, rather than providing the follow-up appointment at the conclusion of the emergency visit, place the ball in the patient’s court. Many emergency patients are episodic users who will accept a follow-up appointment but then fail to keep it. If the program ordinarily is able to provide appointments on demand, a convenient way to present this to patients is to ask them to call in a day or two to let the staff know how they are doing, and when they call they will be given a follow-up appointment for definitive treatment. An exception to the rule would be patients with severe infections who mustbe given a follow-up appointment.
• If the emergency patient has an abscessed tooth, the dentist should explain the sequence of treatment necessary to save the tooth with an RCT so the patient can decide if he or she is willing to go through the required steps. The patient should be informed that basic treatment will be provided before completion of the RCT. If the sequence is accepted by the patient, the tooth is opened for RCT during the emergency visit. If the patient is unable or unwilling to commit to the treatment sequence, the alternative of an immediate extraction can be offered so the patient will not have to needlessly endure any more pain. If the patient is on the fence when deciding how to proceed, then it is best to err on the conservative side and open the tooth for RCT. Usually at the return visit, the patient will find it easier to make a decision because he or she is no longer in pain. If the patient does not keep the follow-up appointment and then returns later re-infected, the best decision is offer extraction. No one likes to see patients lose teeth, but in the case of episodic users it is often the choice that patients find most realistic for themselves.
• In general, perform the necessary emergency treatment at that emergency visit whenever possible rather than providing only pain medication and/or antibiotics and asking the patient to return on another day. Avoid prescribing narcotic medications whenever possible; these medicines should be prescribed judiciously for patients for whom you have provided surgery and who are experiencing moderate to severe post-operative pain.