Although most of the health care debate has centered on medical care, many Americans are ending up in emergency rooms with severe tooth abscesses as federal and state governments struggle to expand access to dental care, according to a recent report by the Pew Center.

In 2009, more than 830,000 people visited hospital emergency rooms nationwide due to preventable dental conditions that were the primary diagnosis, the Pew Center reported last week. Children accounted for nearly 50,000 of these ER visits.

“These visits are totally preventable,” said Julie Stitzel, manager for the Pew Children’s Dental Campaign, adding that many of the patients who are on Medicaid or uninsured could have avoided the emergency room if they had affordable, accessible dental care.

In 2009, an estimated 130 million Americans lacked dental coverage, which is about 43 percent of the U.S. population, according to a report by Institute of Medicine.

For low-income families, Medicaid dental benefits are the only option, and they struggle to find dentists who participate in the program. Fewer than half of the dentists in 25 states studied treated any Medicaid patients in 2008, according to a 2010 study by the Government Accountability Office.

“I know how it feels to collect 23 cents on every dollar,” said Dr. Lynn Mouden, chief dental officer of Centers for Medicare and Medicaid Services. Mouden’s also a 20-year practicing dentist in Missouri.

ER visits for dental problems that could have been prevented by access to routine dental care are becoming a burden on many states like Georgia, Iowa and Minnesota, said Stitzel. One of the hardest hit by this epidemic is Florida. That’s because the state had to cover roughly one-third of the $88 million in hospital ER dental visits in 2010 through the Medicaid program, according to the state’s health agency.

Children are among the most vulnerable groups without access to preventive dental care. In Washington state, one in four children use ERs as their first “dental visit.” But such treatment “won’t provide lasting care,” Stitzel said. “They [the hospitals] just prescribe pain medications and antibiotics.”

Under the Affordable Care Act, 5.3 million more of them will be entitled to dental benefits from Medicaid and the Children’s Health Insurance Program by 2014.

But the shortage of dentists persists across certain parts of the country, with the majority of dentists practicing in big cities. About 47.8 million people in the U.S. live in areas where they cannot gain easy access to a dentist, according to the Department of Health and Human Services.

To solve this problem, a new midlevel provider called dental therapist is being considered in some states despite resistance from the American Dental Association. Alaska and Minnesota are licensing the therapists; California, New Hampshire, Oregon and Connecticut have or are developing training programs. The therapists take the same clinical testing through the Central Regional Dental Test as dentists, and can perform preventive care and routine procedures like sealants, fillings and simple extractions.

Dental therapists can provide lower cost dental care as their average wages are $45 per hour compared with $75 for dentists.

Christy Fogarty, one of two people to become a licensed dental therapist in the nation who now practices in Minnesota, insists her profession does not threaten the jobs or the demands of dentists.

“We are only certified to perform six of the 75 pages of procedures that dentists perform,” Fogarty said. “Dentists can do far more expensive procedures.”