A study published earlier this year looked at 26 million emergency room visits across 14 states. It asked a simple question: who is using the ER over and over again for the same dental problem?
Arkansas stood out.
We are one of the states where adults cycle through the emergency room for the same tooth, again and again. Four or more visits in a single year. The researchers call them “superutilizers.”
For a long time, we assumed that pattern was rare. It is not. At Mint for More, it is the story almost every patient tells us when they show up for an extraction. They went to the ER. The ER gave them pain medication and told them to see a dentist. A few months later, they were back at the ER. Same tooth.
This is not a story about ER physicians failing. They cannot fix a tooth in the emergency department. There is no dentist on staff. There is no operatory in the back. The system routes dental emergencies to the one place that cannot solve them.
Why Medicaid does not catch them
The next layer of the system is supposed to catch the patients the ER cannot help. In Arkansas, that catch is incomplete by design.
Adult Medicaid dental coverage in Arkansas reimburses dentists at rates that mostly do not work for the practice doing the work. Take a denture, the most time-consuming procedure we routinely do. Arkansas Medicaid requires the denture to be fabricated at an outside lab. The dentist gets paid nothing for the chair time, the impressions, the fittings, or the follow-up adjustments. Only the lab gets reimbursed.
Inflation has been making that math worse every year.
Some older offices with in-house labs made it work for a while. Most cannot anymore.
So what actually happens to a Medicaid adult who needs a denture?
They get the tooth pulled. When the next tooth flares up, they go to the ER. They get antibiotics and a pain prescription. Three months later, they are back in the ER for the same tooth. The cycle in the Santoro study is the cycle we see in our chairs every Thursday.
What it looks like on the ground
A patient told us recently that, before he came to us, he had been to the emergency room several times for the same tooth.
“They really didn’t have anything that they could do. They just said, here’s something for the pain, hopefully it gets better, go see a dentist.”
He said he tried the community clinic. He was right under the income threshold for the subsidized rate. At about $80 a tooth, the work he needed was out of reach.
That is the gap. Not poor enough to qualify for the lowest-cost option. Not insured enough for private care. Working full time. Cycling through the ER.
What Mint for More does about it
For denture work, we chose to leave Medicaid out of our model entirely. We do not bill Medicaid for the denture itself or for any of the chair time around it. We use our own lab of choice, at no cost to the patient and no reimbursement to chase. That is the only way the math works on dentures, given how Arkansas Medicaid reimburses (or does not reimburse) the dentist side of that procedure.
We are one doctor, one day a week, plus the whole team for four full days a year on Free Dental Days.
That is not a solution to the access gap in Northwest Arkansas. We know that. It is a signal of what is possible.
The real answer is a dental home built into the places where the access gap shows up first. Hospitals. Community clinics. The nonprofit partners who already serve people in crisis. We have started early conversations with health systems in Northwest Arkansas about what a dental diversion partnership could look like. If you work at a health system that sees the same patients come through your ER for dental pain over and over, we would like to talk.
How you can help
Donate. Your gift goes further here. Last year, less than $70,000 in grants and donations supported more than $1 million in dental care delivered, because Mint Dental Care contributes the clinical infrastructure, the staff time, and the supplies. Give to Mint for More
Reach out, if you work in healthcare in Northwest Arkansas. If you sit in a hospital, a community clinic, or a nonprofit that serves families who are cycling through the ER for dental pain, we would like to start a conversation. Contact us through the contact page.
Follow the work. New stories and updates go up regularly. Read the blog
*Source: Santoro M, Heaton LJ, Sonnek AC, Preston RA, O’Malley JJ, Tranby EP. “Repeated Use of Emergency D