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Characteristics of patients who visit the dental emergency room in a dental college hospital

Background Emergencies in dentistry can be classified as medical and dental. Medical emergencies occur mainly during dental treatment in patients with a systemic disease. Dental emergency departments are largely divided into dental emergency rooms located in dental college hospitals and medical emergency rooms located in medical institutions. This study aimed to analyze the characteristics of and provide help to dental emergency patients in a dental hospital. Methods Overall, 1806 patients admitted to a dental emergency room at Yonsei University Dental Hospital for 1 year were included. The data collection period was from October 1, 2014 to September 30, 2015. An investigator reviewed medical records from the electronic medical record (EMR) system and radiographs. Results The patients were 1,070 men and 736 women. The sex ratio was 1.45:1. The commonest age group was of 0–9 years, including 451 (25.0%) patients, followed by 20–29 years, including 353 (19.5%) patients, and 30–39 years, including 277 (15.3%) patients. Of the 108 patients transferred to the Severance emergency department, 81 had trauma, 19 were in pain, 4 were bleeding, and 4 had other complaints. Among chief complaints, 1,079 patients (60.3%) had trauma, 564 (31.5%) had pain, and 75 (4.2%) had bleeding. Twenty-three cases (1.3%) were caused by temporomandibular disorder (TMD). Conclusion Dentists should be able to adequately assess patients in a dental emergency room and treat trauma, pain, and bleeding.


INTRODUCTION
Emergencies in dental hospitals can be broadly divided into medical and dental emergencies. Life-threatening medical emergencies usually occur during the dental treatment of patients with systemic diseases [1], while dental emergencies are associated with the dental procedures that involve trauma, pain, and bleeding. Therefore, analyzing the characteristics that cause an emergency in patients helps better resolve their chief complaint by changing the treatment.
Depending on their timing and nature, dental emergencies can be divided into those that occur during the dental treatment, those that occur after the treatment, and those that are independent of the treatment. Most of the emergencies during the dental treatment are medical emergencies such as syncope, while emergencies after the   as dental, periodontal tissue, and jawbone traumas, and with acute dental pain including acute pulpitis and acute periodontitis caused by not receiving dental treatment in addition to the trauma [2]. When an emergency occurs in the morning or afternoon, patients can visit the nearest private dental clinic for outpatient treatment, but it is difficult to find dental emergency rooms in Korea in the evening and night when outpatient treatment is impossible. Therefore, it is very important to properly analyze the characteristics of patients visiting at night because without appropriate initial measures, patients may suffer pain or a delay in treatment, which leads to aftereffects on oral tissue functions such as the masticatory, articulative, and aesthetic functions [3][4][5][6].
The research on emergency patients who visit dental hospitals has been chiefly associated with the general emergency rooms of hospitals and has been concentrated on oral and maxillofacial surgery centered around maxillofacial trauma [7][8][9][10][11][12][13]. This study aimed to analyze the characteristics of dental emergency patients who visited dental hospital emergency rooms instead of general emergency rooms, particularly those who visited at night, to help with effective dental emergency care.

MATERIALS AND METHODS
In this study, the medical records of the 1806 patients who visited the dental emergency department of Yonsei University College of Dentistry in 1 year were reviewed.       The most frequent route to the hospital was a direct visit to the dental emergency room by 1430 (78.5%) patients, followed by Severance Emergency Room by 225 (12.5%) patients, and the ambulance service by 100 (5.5%) patients (Fig. 5).
After the treatment in the dental emergency room, 1671 (92.5%) returned home and 108 (6.0%) were transferred to the Severance Emergency Room. Of the 108 patients transferred to the Severance Emergency Room, 81 had trauma, 19 were in pain, 4 were bleeding, and so on.
In the case of trauma patients, post-dental treatment was performed for additional systematic evaluation including CT. Under the age of 10 years, most of the cases required a sedative method for dental treatment. All 15 children under 10 years of age who were transferred to the Severance Emergency Room were sedated to treat trauma ( Fig. 6).
Based on chief complaints, majority of the emergencies were due to trauma (1079 patients, 60.3%), followed by pain (564 patients, 31.5%), and bleeding (75 patients, 4.2%) (Fig. 7). Twenty-three cases (1.3%) were caused by TMD, and there were cases of prosthesis dropout. The rate of trauma was highest in patients aged under 10 years  The goal in dental emergencies is to conduct an accurate early diagnosis and perform emergency treatment accordingly, to reduce pain and possible complications, and in turn, improve the patient's quality of life [2]. Until now, most of the studies associated with dental emer-gencies have been epidemiological surveys on all of the patients who visit the emergency room or has been centered around trauma patients, which is probably because the studies focused on emergencies in the field of oral and maxillofacial surgery. We performed this retrospective study because patients who visit dental hospitals at night may have different characteristics.
According to the study of emergencies in dental college hospitals by You et al. in 2012 [14], out of 1,129 patients, 58.5% had trauma, 30.7% had pain, 8.5% had bleeding, and 2.3% had other characteristics, which is similar to this study, showing no regional characteristics. The total number of patients was 1,806 in this study, which is slightly more than the previous study, and it can be attributed to the regional demographic characteristics of Seoul and Cheonan. to the studies is considered to be because of the study of emergency rooms in general hospitals without a dental emergency room and the analysis of independent emergency rooms in dental hospitals. In other words, if the patient only has a dental injury, the patient will visit the dental emergency room, but if the patient has a dental trauma accompanied by jawbone or head and neck trauma, the patient will visit the medical emergency room.
In addition, if the patient feels pain in the teeth, the patient believes that the pain can be controlled by visiting a dental emergency room rather than a general hospital's medical emergency room, so dental emergency rooms should be equipped with diagnostic equipment and treatment tools and materials to treat emergency patients with pain.
Overall, the successive order of age distribution of patients in this study was ages of under 10 years, 20s, and 30s; that of trauma patients was ages of under 10 years, 20s, and 30s, and that of pain patients was ages of 20s, 30s, and 40s. In the study by You et al. [14], the order of patients was in their 20s, under 10 years old, and 40s, and in the case of trauma, the order of patients was under 10 years old, in their teens, and 20s, which accounted for 67.6% of the total number of trauma patients. Unlike trauma, patients with pain were in the order of 20s, 40s, and 30s, so the age distribution of trauma and pain was different. The trend was similar in this study. In the case of trauma patients under 10 years old, parents only have 1-2 children because of the low fertility rate, and they take their children to the emergency room even in the case of minor trauma. Therefore, dentists in charge of dental emergency rooms should be familiar with dental trauma in the primary and mixed dentition. In particular, behavior control is difficult in terms of children with trauma, and since guardians can be sensitive and anxious, dentists should be well-trained for the behavioral control of the patient and guardian, their prognosis, and follow-up measures. If necessary, knowledge of drugs and emergency treatment is also required, as pediatric patients may need to be sedated through medication. There was no significant difference in the distribution by time period in all of the studies, as 20.5% of the patients visited between 9 pm-12 am and between 6 pm-9 pm, followed by 15.9% between 12 am-3 am, and there was no difference according to the trauma and pain group.
As for the monthly distribution of emergency patients, this study reported more emergency patients in May, September, and October, which was similar to other studies [9,11,15,16]. You  dental and medical emergency rooms because these patients cannot be treated by the dental emergency room alone. In case of children, behavioral control is important during emergency treatment, and if sedation is necessary, the medical emergency room needs to monitor the patient because it is difficult to perform sedation in the night-time emergency room. Therefore, it is important for dentists working in the dental emergency rooms to understand these cases and to develop the ability to transfer them quickly to the medical emergency room if necessary.
In this study, a total of 1,079 patients (60.3%) had trauma, but their detailed assessment could not be performed. In the study by You et al. [14], the order was subluxation (16.48%), laceration (13.70%), and crown fracture without pulp exposure (11.95%). Keum et al. (2009 [15]) reported the order was crown fracture, subluxation, concussion, avulsion, and alveolar bone fracture. Kim et al. (2001) [9] reported the order was avulsion, tooth fracture, tooth loss, and alveolar bone fracture. In the case of trauma, it is difficult to compare the study results, as they may differ in terms of patient perspective and odontology, since soft tissue and alveolar bone damage are frequently accompanied by multiple tooth damages. It is important to evaluate the prognosis after emergency treatment, and further research is required to examine the characteristics of trauma patients when they visit for treatment and the changes in the follow-up process after trauma. Detailed information on emergency patients associated with pain and bleeding should also be analyzed through further research.
The patients who visit dental emergency rooms are characterized trauma, pain, and bleeding, in that order.
Dentists in dental emergency rooms should properly evaluate the patients to differentiate bleeding associated with extensive trauma, head and neck infections, and systemic diseases, including jawbone fractures that should be referred to the medical emergency room and should develop skills for emergency treatment associated with dental pulp, periodontal, and temporomandibular dislocations. Further studies on trauma, pain, and bleeding are necessary to determine the correct treatment and prognosis of patients who visit the dental emergency room.