Sir, I am writing to report an alarming increase in the number of patients presenting to oral and maxillofacial surgery services with dental sepsis requiring admission for incision and drainage under general anaesthesia. Anecdotally the numbers appeared to be increasing, therefore the numbers presenting to Hull Royal Infirmary in 1999 and in 2004 were audited.
The number of patients presenting with dental sepsis on an emergency basis increased from 17 in 1999 to 25 in 2004 (patients from Hull postcode area only). Patients treated under local anaesthesia or with cellulitis were excluded from the audit. While the figures may not seem large, in percentage terms this represents a 47% increase. The trend continues in the projected figures for 2005, and the severity of infections now seen is considerable. More than 60% were not registered with a GDP in either 1999 or 2004, and the vast majority of referrals were from the Accident and Emergency department at Hull Royal Infirmary.
Death from dental sepsis is rare in the United Kingdom.1,2 However as this is a possibility, every dental abscess must be considered potentially life threatening. The rise in numbers of patients with acute dental sepsis has increased the workload of Accident and Emergency staff, who are not primarily trained to deal with dental problems. It has also increased unplanned activity in emergency theatre resulting in the cancellation of elective cases at times of low emergency theatre availability. The forced unpredictable availability of operating time has a deleterious effect on future planning of services.
For those patients not registered with a GDP, attempts to seek treatment from an NHS GDP or Dental Access Centre prior to presentation were not recorded in the audit. Thus it cannot be concluded with certainty that lack of availability of NHS General Dental Practitioners is the main contributing factor to the increase in presentation of acute dental sepsis directly to the hospital setting.
The creation of Emergency Dental Access Centres within the former Hull & East Riding Health Authority area over the last five years has not resulted in a reduction in presentation of dental sepsis to the hospital setting. It would appear, therefore, that patients are preferentially continuing to attend Accident and Emergency departments with later, more severe presentations of potentially life threatening dental sepsis, which is wholly preventable. This is a trend that should cause concern within Dental Public Health and poses difficulties in planning services within the secondary care setting in the face of strict NHS targets.
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Carter, L., Starr, D. Alarming increase in dental sepsis. Br Dent J 200, 243 (2006). https://doi.org/10.1038/sj.bdj.4813368
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