Oral Emergencies Burden Pharmacies

Dentistry Today


When patients don’t have access to a dentist for an oral issue, they turn to their general physician’s office or the emergency room. Generally unequipped to provide appropriate treatment, these venues often write a prescription that may solve the immediate pain or infection but fail to resolve its underlying cause. These efforts also burden the healthcare system with unnecessary costs.

According to Queen Mary University of London, pediatric visits to pharmacies and other non-dental health services instead of the dentist cost England’s National Health Service (NHS) £2.3 million a year. For example, a study of more than half of all the pharmacies in London and nearly 7,000 parents found that most pharmacy visits for children’s pain medications in London are to treat oral pain. 

“The fact that only 30% of children with oral pain had seen a dentist before going to a pharmacy highlights a concerning underuse of dental services. Children with oral pain need to see a dentist for a definitive diagnosis and to treat any tooth decay. Not treating a decayed tooth can result in more pain, abscesses, and possible damage to children’s permanent teeth,” said lead researcher Vanessa Muirhead, BDS, MSc, PhD, of the school’s Institute of Dentistry.

“These children had not only failed to see a dentist before their pharmacy visit, they had seen GPs and a range of other health professionals outside dentistry. This inappropriate and overuse of multiple health services including accident and emergency is costing the NHS a substantial amount of money at a time when reducing waste is a government priority,” said Muirhead. 

Previous research has found that the main cause of planned hospital admissions for children age 5 to 9 years in England is to have their decayed teeth extracted under general anesthesia. Meanwhile, a quarter of 5-year-olds in England have tooth decay in their baby teeth, one in five 12-year-olds has tooth decay in their adult teeth.

Only 58% of children in England and 49% of children in London had visited a dentist in 2016, though dental care is free in the United Kingdom for children under the age of 18 years and national guidelines recommend dental visits at least every year for children. The latest study, conducted among 951 pharmacies with information collected from 6,915 parents seeking pain medication for their children between November 2016 and January 2017, also found: 

  • 65% of parents seeking pain medications for their children were doing so to relieve their children’s oral pain
  • Only 30% of children with oral pain had seen a dentist before the pharmacy visit, while 28% had seen between one and four different health professionals
  • Nearly one in 10 children had signs and symptoms indicating a dental emergency, and community pharmacy staff signposted them to emergency services 
  • The cost to the NHS of children contacting health professionals outside dentistry over the period was £36,573, with an annual cost of £373,288. Replicating these findings across all pharmacies in England could mean that the NHS spends an estimated £2.3 million annually when children with oral pain inappropriately use multiple health services
  • 41% of the children had toothache, 20% had pain from a newly erupting tooth, and 15% had a painful mouth ulcer
  • Saturdays and Sundays were the peak days for parents to visit pharmacies for pain medication for children’s oral pain, possibly partly explaining why some parents had not seen a dentist due to limited urgent dental care services over the weekend

“We need to develop integrated systems and referral processes where general practitioners, community pharmacists, and dentists talk to each other to make sure that children with toothache see a dentist as soon as possible for treatment. We also need better training for community pharmacy staff giving parents advice and look at how dentists manage children who have toothache,” Muirhead said. 

The researchers also highlight the need to work toward preventing tooth decay from happening in the first place. This includes rolling out Scotland’s Childsmile program more widely, where fluoride toothpaste is distributed to all preschool children, all nurseries have supervised toothbrushing every day, and early years’ settings have healthy, low-sugar meals and snacks.

The study limitations include the extrapolation of cost estimations which contained several assumptions. The researchers also possibly underestimated the number of children with oral pain in London because only community pharmacies were used as a means of identifying children and parents. 

The study, “Children’s Toothache Is Becoming Everybody’s Business: Where Do Parents Go When Their Children Have Oral Pain in London, England? A Cross-Sectional Analysis,” was published by BMJ Open.

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