Dental Navigator Program helps patients transition from Emergency Department visits to long-term dental care

Image

Ann Arbor, Mich., Aug. 12, 2025 – Severe dental pain drives many people to hospital emergency departments, usually because they don’t have a family dentist or can’t afford dental insurance. Most emergency departments aren’t equipped for dentistry, so often the only treatment available is medication to control pain or infection. That means the underlying dental problem remains unresolved and the patient likely will suffer from it again in the near future.

Linking those patients with prompt and effective dental care – and helping them maintain long-term dental care moving forward – is the goal of a program at the University of Michigan School of Dentistry that is in its early stages and growing.

The Dental Navigator Program (DNP) was developed as a resource to connect emergency room (ER) patients with treatment at the dental school.  DNP’s initial collaboration was with the Michigan Medicine Adult Emergency Services staff, who have begun making referrals to the dental school. Organizers have since added collaboration with Trinity Health Ann Arbor Hospital and anticipate the program will grow to also help people who take their dentistry needs to other southeast Michigan hospital ERs and urgent care facilities.

At the dental school, a team of faculty, dental and dental hygiene students, and social work staff and students help the patients connect with the proper dental school clinic to solve the immediate care problem. Once that is completed, the dental school team provides the patients with any additional assistance they may need, for example, in applying for dental insurance; support with transportation to the dental school for appointments; and information on community resources, such as food pantries, shelters, addiction and recovery services, and other healthcare and mental health providers. The goal is to knock down any barriers the patients have to setting up regular dental check-ups so that their long-term dental health and overall health can be improved and maintained.

Two grants from the Delta Dental Foundation have boosted the program early on, providing vouchers to help pay for the treatment. The program is limited to ER patients who:
• Are referred by a participating emergency department or urgent care provider.
• Are age 18 or older.
• Do not have a primary dental care provider.
• Do not have insurance or are insured through Medicaid.
• Agree to attend all appointments at the dental school and to complete three questionnaires at different points during their treatment plan.

Image

Dental Hygiene faculty member Martha McComas, a Clinical Associate Professor of Dentistry who manages the program, said the program’s scope goes beyond fixing the immediate dental emergency. The program recognizes that patients who go to the ER for dental care are often part of the population who are underserved by the larger healthcare system for a variety of reasons. Such patients may not be able to afford health or dental insurance if they also struggle to provide food, housing, childcare and transportation for their families.

“What makes this program unique is that we provide wider services than just dental care,” said McComas, who is also the school’s Director of Interprofessional Education.  “This population of patients who have gone to the emergency room for dental care often have wider issues in their lives than whatever dental problem flared up. They come to us with a lot of hoops they’ve had to jump through just to do life. Having to navigate through a big institution like a university or healthcare facility can be challenging. So our ultimate goal is to get them into a place where they can be taken care of, where they don’t feel anxious, where their needs are being met here at the dental school instead of once in a while at the emergency room.”

Regular dental care instead of emergency visits to the hospital improves the person’s overall health and also reduces the burden on ERs, which are designed to provide critical care to patients needing immediate medical attention, often for life-threatening injuries and illness, including accident trauma, heart attacks and strokes.

Around the country, ER visits for what are commonly called “non-traumatic dental conditions” have grown into the hundreds of thousands annually in recent years, according to studies by the American Dental Association and the American Medical Association. The trend has grown locally as well over the last several years, according to Dr. David Somand, an Associate Professor of Emergency Medicine at U-M. Somand is one of the team members from the hospital and dental school who meet regularly to review and refine the Dental Navigator Program.

Somand said the Dental Navigator Program is an innovative approach involving interprofessional collaboration. “It is an important step forward to help educate patients and call attention to the importance of regular visits to a dentist,” Somand said. “While emergency departments are prepared to treat a wide range of patients for many types of trauma and illness, when we prescribe pain meds or infection control for someone with tooth pain, that doesn’t get to the heart of the problem, which is what a dentist will do.”

McComas and Dr. Elizabeth Hatfield, also a dental school faculty member, first considered the idea for Dental Navigator while they were fellows in the University of Michigan Interprofessional Leadership Program in 2020. Hatfield is experienced in the hospital setting as a Clinical Assistant Professor of Dentistry in the Department of Oral and Maxillofacial Surgery/Hospital Dentistry, and she previously completed a General Practice Residency at the U-M hospital. Her hospital experience has provided insight into the variety of reasons that patients choose to utilize the ER for many health issues, including dental needs.

McComas and Hatfield brainstormed how the dental school could contribute to a solution that would help dental patients navigate through both the medical and dental healthcare systems to reach an improved level of care. They created a pilot program, collaborating with hospital ER staff, dental school faculty, the school’s social worker and dental students to test various best practices for the new process. As the program came together, McComas assumed the role of manager with Hatfield and dental school social worker Karen Burnett serving as co-managers.

A core group of dental students joined the initiative as part of the school’s Pathways curriculum, which allows students to pursue campus courses, programs and research that interest them beyond the standard dental school curriculum. The first group of students who helped with the program start-up have since graduated, but students from following classes have joined the program, also as their Pathways project. Students on the DNP team contact the ER patients to screen for eligibility, then follow up from the patient’s initial appointment to assist with future appointments and surveys to determine if DNP is meeting the patient’s needs. Third- and fourth-year students provide the dental care in school clinics under the supervision of faculty.

Image

Hatfield points to multiple benefits of Dental Navigator. “First and foremost, it’s providing an avenue for patient care for individuals who have not had access to it previously. Many patients don’t know that they have dental benefits that they can utilize for their dental care. And so I think the number one thing is that patients are getting treated,” she said. “Secondly, it aims to better understand the various barriers and challenges that patients face within their lives and existing systems that make accessing dental care difficult. I have found that often these individuals are stigmatized as not caring about their dental health, which you can imagine makes them feel more ostracized from the very thing they need the most. By meeting people with compassion and empathy, DNP creates an environment free from judgment to be treated kindly and respectfully for their needs.”

Burnett and U-M School of Social Work students who assist the program help patients with a wide variety of life needs at any point in their contact with the dental school. “It is not uncommon for an unmet need to be identified prior to the first appointment, or a need develops during treatment,” Burnett said. “For example, social work was able to identify a transportation benefit and resources for a patient from the Upper Peninsula to attend an early-morning appointment here.” Other resources they’ve helped with so far include applying for benefits, legal assistance, food, utility payments, career training and smoking cessation.

“Planning to go to the dentist can be uncomfortable or overwhelming for many people,” Burnett said. “Social Work can provide ideas and practice for relaxation strategies, and can assist patients in communicating their needs to their provider. It’s empowering and comforting to patients to know that they can ask their provider for what will be helpful to them during the appointment, and see that their provider listens and appreciates this information. Dental Navigator is a great program available to people who might otherwise struggle to find the care they need in the community.”

Aurora Manitiu is one of about 30 patients currently on a treatment schedule at the dental school as a result of the Dental Navigator Program. She didn’t have a regular dentist and over time a painful condition developed that was related to her teeth and gums. A visit to a dentist didn’t solve the problem, the pain worsened and her family took her to the U-M emergency room to seek relief. She qualified for the Dental Navigator Program and started with an appointment at the dental school’s graduate periodontics clinic, which provided the first step in effectively treating the source of the pain. Now she has started a series of appointments that will further improve her overall oral health.

On a recent afternoon during an appointment with fourth-year dental student Anna Cheong, Aurora said her teeth had caused her pain for a long time and now eating is easier and she feels much better. “I am so thankful for everything everyone here is doing for me,” she said.

Those are the sort of results that are rewarding for the dental students treating the Dental Navigator patients as part of their overall clinical education and experience. Third-year student Sydney Mosteller, who has worked with the program over the last two years, said it is addressing the important connection between oral and systemic health. “Growing up with a dad in emergency medicine, I often heard stories about patients coming in with dental pain that couldn’t be fully addressed. Later, when I worked in a pediatric specialty clinic, I saw how many families struggled to find accessible dental care. Helping connect them to providers made me realize how critical it is to bridge those gaps in our healthcare system.”

“What’s impressed me most is that the Dental Navigator focuses on treating the whole person, not just their teeth,” Mosteller said. “We’re showing patients that we genuinely care about their overall well-being. We want what’s best for them, and that naturally extends to improving their oral health. Being part of this program is a great reminder of why we’re here: to make a real difference in people’s lives.”

Image

Fourth-year dental student Kate Ptashnik has worked with the DNP for three years in various roles, including as a treatment provider this year. It has provided new insights into dentistry as she prepares for her career after she graduates next spring.

“I think the program has shown me the value in taking a few extra minutes to talk with your patient about their life and what else they have going on,” she said. “All day I think about teeth, which is just a risk of the trade. But most people only notice their teeth if there is a problem. Many of the patients we see are aware of a dental problem for a while, but other factors, such as a lack of reliable transportation, financial constraints, or uncertainty about where to go, often get in the way of seeking care. Being able to take a couple of more minutes with these patients has allowed me to connect with our social work team and help offer some solutions or alleviate some of the barriers to care that these patients face.”

Hatfield said the evolution of healthcare needs to move toward better-coordinated interprofessional collaboration that provides effective, comprehensive care more widely to the general population. “DNP begins to think about where are some of the challenges or gaps that exist for our patients, and how do we create a solution for this,” she said. “I think this kind of creative and innovative thinking is how we need to work within healthcare as we move forward. Creating solutions that are patient-oriented will be critical to where dentistry is going in the next 10 to 20 years.”

###

The University of Michigan School of Dentistry is one of the nation’s leading dental schools engaged in oral healthcare education, research, patient care and community service.  General dental care clinics and specialty clinics providing advanced treatment enable the school to offer dental services and programs to patients throughout Michigan.  Classroom and clinic instruction prepare future dentists, dental specialists and dental hygienists for practice in private offices, hospitals, academia and public agencies.  Research seeks to discover and apply new knowledge that can help patients worldwide.  For more information about the School of Dentistry, visit us on the Web at: www.dent.umich.edu.  Email: dentistry.communications@umich.edu, or (734) 615-1971.