Which services can be billed in the dental emergency service?
§ 14 (1) of the Occupational Code of the Dental Association of Saxony-Anhalt in conjunction with the Emergency Service Regulations shows that every dentist participating in the dental care is in principle obliged to also participate in the emergency service.
Since an emergency treatment is an exceptional service of a dentist, strict conditions are attached to it. Although an emergency care must, in any case, avert further complications, at the same time, however, it must not unnecessarily complicate or even prevent appropriate treatment on the following day. The dental emergency service is not intended to allow patients who are unwilling to attend treatment appointments during regular office hours to seek treatment in times of emergency. For this reason, the dental treatment is limited during emergency care. The German Society of Dental, Oral and Maxillofacial Surgery has already established case groups in the past, which are briefly outlined below.
Prolonged bleeding after dental surgery requires immediate emergency dental intervention (e.g., No. 36). In many cases, even a simple compression may bring the bleeding to a standstill. But also an electrocoagulation or the administration of anticoagulant drugs are conceivable, for example, as a treatment. If hemorrhage does not calm down despite simple measures or the patient has a hemorrhagic diathesis, this indicates that the patient has been referred to the nearest clinic. Similarly, bleeding from the gingival margin in the context of systematic therapies for various forms of leukemia, agranulocytosis, and immunosuppression after organ transplantation. These do not belong to the emergency treatment during a dental emergency service since in this regard a close consultation with an internist is required.
Real emergencies are also all forms of acute febrile, purulent inflammation since an expansion of the infection and a spread to the soft tissues is to be avoided. Emergency services will usually be subperiosteal or submucosal abscesses (e.g., No. 161), which can be incised by local anesthesia. On the other hand, conservative therapies with the prescription of antibiotics or moist-cold compresses are conceivable. Extended soft tissue abscesses, however, speak rather for a hospital admission.
The causes of toothache range from Dolor post extraction, Dentitio difficilis to periodontitis and pulpitis. In most cases, the treatment of pain in the dental emergency service should only include pain elimination measures (for example, numbers 38, 46, 49, 105) and should not prejudge the final treatment on the following day. Exemplary are trepanation of the tooth in pulp angiangles or analgesic inserts in pulpitis (e.g., Nos. 29, 31). If necessary, excavation and temporary closure of a cavity due to discomfort or loss of filling are also required (e.g., No. 11). Further treatments, such as the extraction of a pulpit tooth, which is no longer worth preserving, should be avoided if possible.
Duty to help
During the emergency service, the dentist’s due diligence also requires the symptom-related examination of any patient who seeks help from him at night or at the weekend (for example, No. Ä 1). If a dentist fails to carry out the examination or any necessary consultation and, as a result, there are demonstrable complications or disadvantages for the patient, a dentist may be exposed to allegations of failure to provide assistance or, as the case may be, even bodily injury. As a result, civil law, and in certain situations possibly criminal consequences.
In summary, it can be said that in the context of the emergency service no interference in the therapeutic concept of the actually treating house dentist may be made. The case law has repeatedly confirmed this in the past. In particular, extraction of the endodontic therapy should be preferred on a regular basis.