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Gender differences in patients with severe dental infections presenting to hospital


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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  1. Payne S. How can Gender Equity be Addressed Through Health Systems? 2009. Available at (accessed October 2020).

  2. Franconi F, Campesi I, Colombo D, Antonini P. Sex-Gender Variable: Methodological Recommendations for Increasing Scientific Value of Clinical Studies. Cells 2019; 8: 476.

  3. Wilkins D, Payne S, Granville G, Branney P. The gender and access to health services study: final report. 2008. Available at (accessed October 2020).

  4. Doyal L, Naidoo S. Why dentists should take a greater interest in sex and gender. Br Dent J 2010; 209: 335-337.

  5. Ferraro M, Vieira A R. Explaining gender differences in caries: a multifactorial approach to a multifactorial disease. Int J Dent 2010; 649: 643.

  6. Branch-Elliman D. A Gender-Based Approach to Oral Health Changes Across the Lifespan. 2012. Available at (accessed May 2020).

  7. World Health Organisation. Female Life Expectancy. Available at (accessed May 2020).

  8. Wang H, Dwyer-Lindgren L, Lofgren K T et al. Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2071-2094.

  9. Baker P, Dworkin S L, Tong S, Banks I, Shand T, Yamey G. The men's health gap: men must be included in the global health equity agenda. Bull World Health Organ 2014; 92: 618-620.

  10. Deeley K, Letra A, Rose E K et al. Possible association of amelogenin to high caries experience in a Guatemalan-Mayan population. Caries Res 2008; 42: 8-13.

  11. McDonald C, Henndegie A, Henry A et al. Management of cervicofacial infections: A survey of current practice in maxillofacial surgery units in the UK. Br J Oral Maxillofac Surg 2017; 55: 940-945.

  12. Broadbent J M, Thomson W M, Poulton R. Oral Health Beliefs in Adolescence and Oral Health in Young Adulthood. J Dent Res 2006; 85: 339-343.

  13. Firmino R T, Martins V M, Sousa R et al. Comparative Analysis of Gender: A Population-Based Study on Dental Trauma. Acta Stomatol Croat 2013; 47: 147-153.

  14. Sakalauskienė Ž, Vehkalahti M, Murtomaa H, Mačiulskienė V. Factors Related to Gender Differences in Toothbrushing Among Lithuanian Middle-Aged University Employees. Medicina (Kaunas) 2011; 47: 180-186.

  15. Clarkson J E, Worthington H V. Association between untreated caries and age, gender and dental attendance in adults. Community Dent Oral Epidemiol 1993; 21: 126-128.

  16. Christensen L B, Petersen P E, Steding-Jessen M. Consumption of dental services among adults in Denmark 1994-2003. Eur J Oral Sci 2007; 115: 174-179.

  17. Bertakis K D, Azari R, Helms L J, Callahan E J, Robbins J A. Gender differences in the utilization of health care services. J Fam Pract 2000; 49: 147-152.

  18. Singh A K, Cydulka R K, Stahmer S A, Woodruff P G, Camargo CA, for the Multicentre Asthma Research Collaboration Investigators. Sex Differences Among Adults Presenting to the Emergency Department with Acute Asthma. Arch Intern Med 1999; 159: 1237-1243.

  19. Brott A, Dougherty A, Williams S T, Matope J H, Fadich A, Taddelle M. The Economic Burden Shouldered by Public and Private Entities as a Consequence of Health Disparities Between Men and Women. Am J Mens Health 2011; 5: 528-539.

  20. Kent S, McDonald C, Henndegie A et al. Steroid use in cervicofacial infection. A Maxillofacial Surgery Trainee Research Collaborative (MTReC) project. Br J Oral Maxillofac Surg 2019; DOI: 10.1016/j.bjoms.2019.10.268.

  21. Casimir G J, Heldenbergh F, Hanssens L et al. Gender differences and inflammation: an in vitro model of blood cells stimulation in prepubescent children. J Inflamm (Lond) 2010; 7: 28.

  22. Cawson R A, Odell E W. Cawson's essentials of oral pathology and oral medicine. Edinburgh: Churchill Livingstone, 2008.

  23. White A K, Johnson M. Men Making Sense of their Chest Pain: Niggles, Doubts and Denials. J Clin Nurs 2000; 9: 534-541.

  24. Kent S J, Hennedige A, McDonald C et al. Systematic review of the role of corticosteroids in cervicofacial infections. Br J Oral Maxillofac Surg 2019; 57: 196-206.

  25. Jiang X, Jiang X, Wang Y, Huang R. Correlation between tobacco smoking and dental caries: A systematic review and meta-analysis. Tob Induc Dis 2019; 17: 34.

  26. Banks I. No Man's Land: Men, Illness and the NHS. BMJ 2001; 323: 1058-1060.

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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




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.

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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).

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