Sir, following the recent media coverage and public awareness campaigns regarding sepsis, we feel it is vitally important to raise awareness of the potential for sepsis to arise in the general dental practice setting. Sepsis occurs when the body's immune system responds to infection (such as an odontogenic infection) in an exaggerated way. This can cause a cascade of reactions from shock to organ failure and even death.1 There may often be the presence of an underlying systemic disease. NHS England published a wide-ranging sepsis action plan at the end of last year2 and the health secretary Jeremy Hunt has revealed plans to develop further tools to help diagnose and raise awareness.3 We would like to discuss the warning signs or 'red flags' that can emerge, which include:
Altered mental state (ie slurred speech or confusion); malaise, shivering (rigors) and muscle pain; failure to pass urine in the previous 18 hours; breathlessness and an increased breathing rate (over 20 respirations per minute); derangement of blood pressure and body temperature; tachycardia; non-blanching rash; cyanosis of the skin, lips or tongue.
In the case of younger children and babies these signs may present differently. A high index of suspicion should be adopted in certain groups of patients, including those over 75 years of age, the immunocompromised, the pregnant and those with recent surgical interventions. Patients exhibiting signs of sepsis should be urgently referred to the local emergency department, where further investigations can be carried out and acted upon. Immediate treatment can include high flow oxygen, intravenous fluids and antibiotics.2 Spotting a deterioration in these signs can help stop sepsis, a condition which claims an estimated 44,000 lives each year,4 from progressing. Publication of the final specific guidance for clinicians from NICE on sepsis is expected in July of this year.2
References
Carter L, Lowis E . Death from overwelling odontogenic sepsis: a case report. Br Dent J 2007; 203: 241–242
NICE. 2016. Sepsis: guidance and guidelines. Available at: https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0686/documents (accessed 28 January 2016).
Department of Health. New action to reduce sepsis. 5 January 2015. Available at: https://www.gov.uk/government/news/new-action-to-reduce-sepsis (accessed 28 January 2016).
The UK Sepsis Trust. 2016. Available at: http://sepsistrust.org (accessed 28 January 2016).
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Gilway, D., Brown, S. Medical emergencies: Sepsis in primary dental care. Br Dent J 220, 278 (2016). https://doi.org/10.1038/sj.bdj.2016.202
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DOI: https://doi.org/10.1038/sj.bdj.2016.202
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