Where do you go when you have a dental problem on a weekend or holiday?

 Faced with a broken or knocked-out tooth, severe toothache or other serious dental problem, most of us make a beeline for our family dentist.

But that’s not always easy in Delaware. While many dentists set aside time every day to handle emergencies, finding treatment when your dentist’s office is closed -- after hours, weekends or holidays -- can be incredibly difficult. Although walk-in or urgent care clinics for treatment of sprains or similar physical ills are almost everywhere, Delaware’s only 24/7 emergency dental clinic is in New Castle County.

Dr. Joseph Kelly, president of the Delaware State Dental Society, said someone shouldn’t need to immediately head for Wilmington. The best bet is to contact their regular dentist first. Most offices have answering services or recordings to direct patients to after-hours treatment, he said.

Kelly said he put his cell number on his answering machine so patients can contact him any hour of the day.

Dr. Daniel Meara, chair of the Oral and Maxillofacial and Hospital Dentistry Department at Christiana Care Health System, said dentists take being on call and caring for their patients seriously and do have some level of emergency care for their patients.

The Wilmington-based emergency clinic is staffed by residents who work under the direction of licensed, practicing dentists, and they’re equipped to take in round-the-clock patients.

“We get about 20 a week who are emergency cases, who don’t have appointments,” Meara said.

Many of those don’t have a regular dentist. If they do, they haven’t been able to get help quickly enough to deal with their problem, he said.

The pain factor

There’s a subjective difference between what dentists consider a true emergency and conditions that would be classed as urgent care situations.

It’s called pain.

Because most dental problems, such as a broken, chipped or lost tooth are painful, people want relief through an immediate trip to their dentist. But that’s not always something a dentist can figure out during an after-hours phone call.

“Most patients aren’t able to delineate their exact problem,” Meara said. “But pain is one of the things, if not the top thing, dentists take into account, particularly if they don’t have a relationship with a patient.”

Dr. Jane Grover, director of the Council on Advocacy for Access and Prevention at the American Dental Association, said “emergency” is a term that implies an unanticipated event that requires attention to keep a more serious issue from developing.

Kelly said pain alone doesn’t make every case rise to the nature of a true emergency. Unless there’s a factor that puts the patient’s life in danger, such as uncontrolled bleeding or swelling that could close off an airway, when a dentist’s office is closed cases involving pain caused by toothaches or broken or missing teeth can be handled at walk-in clinics or emergency rooms.

There, treatment deals with relieving the immediate discomfort. Fixing the cause of the pain can be dealt with during a dentist’s regular office hours, he said.

“The dental office is very specialized as far as equipment and personnel are concerned,” Kelly said. “An emergency room is not a place where you go to get a crown or filling done or a tooth extracted.”

Root canals at 11 p.m.

All four dentists said it’s important for patients to have a “dental home,” an office where patients make their regular visits for cleaning and routine procedures.

“Establishing that dental home and having a dental office is very important as far as prevention goes,” Kelly said. “It means that if emergencies do happen, you have somebody to reference.”

For patients, it also means they have access to a dentist and staff who are familiar with their history. This makes it much easier when unexpected trouble develops.

Grover said most private practitioners have to provide emergency services.

“Most I know have answering services or answering machines where they can be contacted in case of emergency,” he said.

Talking with a dentist allows them to assess the severity of the problem. They make a decision whether to open the office after hours or to treat the issue over the phone. The dentist can prescribe pain medication or antibiotics that allow the patient to wait and make it in during regular hours.

Grover knows what it’s like to treat a problem after hours.

“I’ve gotten many calls at 1 or 2 o’clock in the morning, and I’ve started root canals at 11 p.m. It goes with the territory.”

Meara said in most cases, you should be able to speak with somebody after hours.

“In most practices as a patient, I’ve found there’s usually a path where I can get hold of someone on-call to figure out what is the next step,” Meara said.

Conte concurs, but said patients should be prepared to pay an after-hours fee to cover the dentist’s time and staff expenses.

Having dental insurance will help cover that. When starting a dental plan, it’s important to do some research into the local dental practices. Find out whether a prospective office has extended weekday or weekend hours and what they can do if after-hours help is needed.

Still, getting in touch after hours can be challenging.

The Dover Post called several dental offices on a Saturday afternoon and reached an answering machine at all but one. The recordings asked for information so a doctor could make a return call. In the other, the answering service did offer to contact an on-call dentist.

Calls made to these and other offices during normal business hours for information about emergency procedures told the same story. They all had phone numbers patients could call and either talk to an answering service or leave a message for a dentist or office manager. For regular patients, responding dentists can prescribe pain medication or antibiotics as needed over the phone, with instructions to go to an urgent care clinic or hospital if needed.

All of the offices contacted said they work to schedule immediate appointments for emergencies on their next open day.

Many don’t have dental insurance

Although anyone can find themselves needing emergency or urgent dental care, in general, many dental problems can be prevented. A regular dentist has a good idea of their patients’ health, encourage good dental hygiene and perform pre-emptive care.

Office manager Diana Bennett at Rehoboth Beach Dental said when you’re a new patient, the doctor does a comprehensive exam and a full-mouth series of X-rays.

“That gives him a pretty good picture of what’s going on and if you have a situation getting ready to come to the surface,” she said. “We try to go from the standpoint that we want to avoid your emergency.”

Most insurance plans cover regular checkups and cleanings, but premiums, even on basic policies, can put them out of reach of low-income families.

It’s worse for the homeless or families whose income levels don’t permit them to buy into any kind of health or dental insurance.

Statistics from 2016 provided by the National Association of Dental Plans show that 74 million Americans had no dental coverage. While virtually all Americans over 65 have health coverage, the statistics showed only about 53 percent of seniors have dental coverage.

Advocates for government-assisted dental care for children often point to the case of 12-year-old Marylander Deamonte Driver, who died in 2007 from complications of an abscessed tooth. Poverty, lack of access to care and problems getting financial help led to delays that killed him through a brain infection.

Conte said consistent care is key for dental health.

“The best way is to emphasize preventative services and to get at problems before they occur,” he said.

Conte said it’s a question of paying for care now to keep teeth in good condition, or paying later for much more expensive procedures -- including emergencies.

Free care through DPH

The Centers for Disease Control and Prevention lists tooth decay as the most common chronic disease for American children aged 6 to 19. Nine out of 10 Americans older than 20 have some degree of dental rot.

Delawareans have access to information about low-cost dental services through the state’s Oral Health Program, administered by the Department of Health and Social Service.

These are free to Medicaid-eligible children under age 21 and to those under 19 eligible for the Children’s Health Insurance Program. The DHSS lists more than 300 dentists offering services to children, and a number can see patients speaking languages including Spanish, Tagalog and Korean. Several provide signers for the deaf.

Around the state, there are 15 community dental clinics for affordable oral health services for children and adults, including seven in New Castle County, five in Kent and three in Sussex.

Federally-sponsored clinics such as the Henrietta Johnson Medical Center in Wilmington and Claymont, Westside Family Healthcare (in four locations including Dover) and the La Red Health Center in Georgetown offer sliding scale fees to patients without health or dental insurance, or reduced fees based on income.

For children who cannot come to a clinic, the care has been coming to them since 2004. The DPH employs a 40-foot mobile dental office that travels to schools offering free oral exams. During the 2016-2017 school year, the staff screened 304 students at 17 schools. Almost 39 percent were diagnosed with untreated cavities, and of those, 21 percent were referred to a DPH clinic for problems needing immediate attention. For many children, this was their first professional dental care.

The DPH has programs where children are bused from schools to dental clinics and back to the classroom. It has the Smile Check program, begun in 2017, where dental hygienists go into schools for checkups. To date, more than 1,000 Delaware schoolchildren have been screened by this program and more than 3,000 have been taught the importance of good dental hygiene.