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Gender differences in patients with severe dental infections presenting to hospital

Abstract

Introduction Gender differences have been documented in prevalence and morbidity of caries, gingivitis and oral health, but not previously in cervicofacial infection. Identification and minimisation of gender inequalities is a World Health Organisation priority, and there are physiological, behavioural and cultural reasons to suspect that sex and gender differences may be present.

Methods Analysis was carried out of the MTReC National Snapshot audit of cervicofacial infections. This database was created by oral and maxillofacial surgery trainees in 2017 and records over 400 variables in 1,002 individual patients admitted to hospital with severe odontogenic infection.

Results Records were available for 1,002 patients with cervicofacial infection (456 females and 546 males). There were significant differences between recorded gender in those presenting with airway compromise (male 7% vs female 2%, p = 0.001), severe inflammatory response syndrome (male 60% vs female 39%, p = 0.007) and requirement for awake fibre-optic intubation on admission (male 4% vs female 1%, p = 0.014).

Discussion These results suggest that male patients access healthcare later in their disease than female patients, and with more severe systemic compromise. This may be due to prevalent cultural and behavioural norms. As equality of access is the responsibility of the administrator, we discuss methods which might improve timely presentation in males with cervicofacial infections.

Key points

  • Gender and sex differences exist in the presentation and management of severe dental infections, as with other common oral health conditions.

  • Males seem to present to hospital with more severe disease than females and appear more likely to require immediate airway management.

  • Reducing this gender inequality is the responsibility of the healthcare provider and strategies to minimise these effects are discussed.

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Acknowledgements

Frances Gilchrist, NHS Greater Glasgow and Clyde, for her help in setting up the RedCap database. Rory O'Conner and Syca Shaheen for their help with data collection.

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Authors and Affiliations

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Contributions

Dirk Stephanus Brandsma,4 Helen Cashman,10 Aoife Swain,10 Kapil Java,10 Gauri Vithlani,11 Melanie Watson,12 Mark Cairns,12 Susan Murray,13 Gabriele Baniulyte,14 Jamie Grant,12,14,15 Laura Feeney,15 Sam Wareing,16 Alex Kawalec,16 Teresa Ng,16 Nagarjuna Reddy Aculate,17 Milad Tavakoli,18 Charlotte Underwood,18 Siddharth Gowrishankar,19 Tim Collins,19 Rhodri Davies,19 Sharonjeet Uppal,20 Ross Elledge,20 Hudson King,21 Ben Tudor-Green,22 Montey Garg,23 Jonathan Wareing,24 Catherine Wicks,25 Oliver Mitchell,26 Marwa Maarouf,27 Priya Chohan,28 Rachael Otukoya,29 Eiling Wu,28 Saadia Farooq,30 Esther Brewer,31 Samuel King,31 Baljeet Nandra,31 Sam Stevenson,32 Ellis Stiles,33 Laurie Davies,33 Ramachandra Madattigowda34 and Aneesh Mohindra35.

MTReC Collaborative author affiliations

10MTReC, Aintree University Hospital, Liverpool; 11MTReC, Royal Free London NHS Foundation Trust; 12MTReC, St John's Hospital, NHS Lothian; 13MTReC, Victoria Hospital, NHS Fife; 14MTReC, NHS Greater Glasgow and Clyde; 15MTReC, Ninewells Hospital, NHS Tayside; 16MTReC, Hull Royal Infirmary; 17MTReC, Royal Stoke University Hospital; 18MTReC, Manchester Royal Infirmary; 19MTReC, John Radcliffe Hospital, Oxford; 20MTReC, Birmingham Community Healthcare NHS Foundation Trust; 21MTReC, University Hospitals of Derby and Burton NHS Foundation Trust; 22MTReC, Peninsula Medical School; 23MTReC, Kent Surrey Sussex Deanery; 24MTReC, Health Education Yorkshire and Humber; 25MTReC, Severn Deanery; 26MTReC, Health Education Wessex; 27MTReC, The Royal Wolverhampton NHS Trust; 28MTReC, University Hospitals Coventry and Warwickshire NHS Trust; 29MTReC, Shrewsbury and Telford Hospital NHS Trust; 30MTReC, University Hospitals North Midlands NHS Trust; 31MTReC, University Hospital of Wales, Cardiff; 32MTReC, Torbay and South Devon; 33MTReC, Aneurin Bevan Health Board; 34MTReC, Northwick Park Hospital; 35MTReC, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust.

Corresponding author

Correspondence to Samuel Kent.

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Kent, S., Regan, A., McDonald, C. et al. Gender differences in patients with severe dental infections presenting to hospital. Br Dent J (2021). https://doi.org/10.1038/s41415-020-2351-7

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