Sir, the oral health of 102 patients (age 14–88) admitted for 24 hours of intravenous antibiotics for odontogenic infections was considered over 12 months in a Surrey district general hospital. Orthopantomograms were used to assess dental disease and restorative status. Three patients required ITU admission.
The average number of carious teeth (over two thirds into dentine) was 3.1; endodontically treated teeth was 0.9 and 2.3 teeth had radiographic evidence of apical pathology. The most common infected source tooth was the mandibular first molar and 10.7% of infected source teeth were root filled. No significant radiographic bone loss patterns were identified. The average number of restored (non-root filled) teeth was 5.0.
Whilst assessment of oral health using radiographic examination alone is insufficient, it nevertheless provides a general overview of the dentition in a secondary care setting. Full oral health screenings are seen as irrelevant, time consuming and often intolerable when patients are systemically unwell from odontogenic infection. The data show that patients admitted tend to have untreated decay in multiple teeth which may be a source of future odontogenic infection, and very few source teeth have had endodontic therapy.
Patients are usually treated solely for the infected source tooth and discharged with the hope that the rest of the dentition will be managed by primary care services. However, on questioning, the overwhelming majority of such patients have no primary care dentist due to financial, social and psychological reasons; these patients may thus return with similar episodes of infection and morbidity which presents a cost burden on public health care facilities.1,2 There has been a 62% increase in the number of patients who require admission for surgical treatment of spreading odontogenic infections.3 The number of admissions and bed days as a result of drainage of a dental abscess almost doubled between 1998-99 and 2005-06.4
Whilst referrals to maxillofacial departments for routine dentoalveolar services from primary care are common, a reverse pathway should also be firmly established to ensure patients presenting in secondary care are followed up by primary care or community dental services on discharge.
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Jamil, F. Oral health: Reverse referral. Br Dent J 218, 265 (2015). https://doi.org/10.1038/sj.bdj.2015.153
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DOI: https://doi.org/10.1038/sj.bdj.2015.153