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Nontraumatic dental-related emergency department visits has resulted in a financial burden to hospitals across the United States. This study investigated whether there is a relationship between adult preventive dental care and emergency department visits for nontraumatic dental conditions by comparing specific states. Guided by Andersen's behavioral model of health services utilization, this retrospective quantitative study also investigated associations between state-specific community water fluoridation and dental-related emergency department visits. The population of interest was adult Medicaid enrollees who visited the emergency department for non-trauma-related dental conditions in the top 5 most populous states as identified in the 2012 NHAMCS survey. These top 5 states represented 52% of emergency department visits. Among these visits, 2.4% were for adults with nontraumatic dental conditions. Two binary regression models were constructed, and statistically significant relationships were found between emergency department visits and age, gender, race/ethnicity, and Medicaid as a payment source (n=18,112). State-specific community water fluoridation did not emerge as a statistically significant predictor of emergency department visits. Social change implication may allow taxpayers and public health policy leaders to identify new strategies in promoting oral health. New approaches include reeducating the public on policies in support of community water fluoridation as a preventive strategy and understanding how to encourage adult Medicaid enrollees to use preventive dental care in their community and avoid the emergency department for dental care.