A retrospective observational study of the management of non-traumatic dental presentations at a tertiary centre in New Zealand: a Choosing Wisely approach.

Aims: Non-traumatic dental presentations (NTDPs) commonly present to emergency departments (EDs) and may receive orthopantomograms (OPGs, plain X-rays), opiates and antibiotics. "Choosing Wisely" is an international healthcare campaign that aims to reduce unnecessary and low-value patient care. This study aims to identify low-value management of NTDPs.

Methods: Presentations to the Christchurch Hospital ED with dental pain or dental abscess in 2020 were included. Data collected included patient demographics, management and discharge medications. Descriptive statistics were calculated.

Results: There were 931 NTDPs during the study period, with over-representation of young adults, Māori, Pacific Peoples and those living in high-deprivation areas. Of these, 343 (37%) received an OPG, of which 24% (83) were considered low value. Of patients managed by ED staff who were not referred to specialist dental services, 258 (42%) were prescribed antibiotics, of whom only half had facial swelling, and 71% received a script for analgesia, of which 78% included an opiate. Seventy-three percent of patients presented outside of normal working hours. Fewer than one in five NTDPs received definitive treatment.

Conclusions: NTDPs may receive non-optimal management in EDs. Continuing to care for NTDPs in this environment may add to increased healthcare costs, access block and poor opioid and antimicrobial stewardship.