New research from the University of Bristol shows that admissions for the surgical treatment of dental abscess in the UK have doubled in the last ten years despite the fact that these serious infections are preventable with regular dental care. The findings could reflect a decline of oral health, changes in access to dental treatment or changes in attitudes to dental care.
The analysis was conducted by Dr Steve Thomas and colleagues from the Division of Maxillofacial Surgery and Department of Oral and Dental Science using routine NHS data on hospital admissions and was prompted by three complex cases of dental abscess that presented over a six-month period in 2006. The case studies, provided in full below, highlight the serious and potentially life-threatening consequences of dental abscesses. In two of the cases the patients needed to be admitted to a hospital critical-care unit; none of the three was registered with a dentist.
Recent surveys report improvements in oral health, so an explanation for the increase in hospital admissions is required. The paper suggests it could be linked to changes to dentists’ remuneration in the 1990s, which led many to reduce their National Health Service (NHS) workload, and a corresponding decline in the number of adults in England registered with an NHS dentist from 23 million in 1994 to approximately 17 million in 2003/04. These changes may have resulted in reductions in the provision of routine dental care and reduced access to emergency dental care and may explain the rise in surgical admissions.
An alternative explanation is that the problem lies with people not seeking dental care but a recent survey of 5,200 members of the public and 750 dentists, conducted by the Commission for Patient and Public Involvement in Health, found that 22% of people had declined treatment because of high cost, and 84% of dentists felt that their new contract had failed to improve access to NHS services.
The authors recommend that access to routine and emergency dental care be reviewed and formal and robust systems of referral established to ensure that GPs can be confident that patients presenting to them with acute dental sepsis will receive appropriate dental treatment.
Speaking about the findings, Dr Thomas said: ‘Dental abscess is a serious problem and can be life threatening. In the past ten years the incidence of dental abscesses requiring surgical drainage in hospital has doubled. The reasons for this increase need to be identified and robust measures taken to ensure the epidemic is controlled.’
Case study 1
In March 2006 a 48-year-old woman was referred by her GP to the A&E department of Bristol Royal Infirmary with a swelling beneath the jaw bone in her neck that was diagnosed as an abscess. She was prescribed antibiotics and the abscess drained. Two days later she was breathing rapidly, had low blood pressure and low urine output. A scan showed she had fluid from the neck to the diaphragm. She underwent surgery and pus was drained from around her trachea and heart. She was transferred to the Critical Care Unit for treatment and was diagnosed as having Adult Respiratory Distress Syndrome. She spent 22 days on the Critical Care Unit and a further 22 days on the surgical ward. She was not registered with a dentist.
Case study 2
In May 2006 a 48-year-old-man presented to the A&E Department at Frenchay Hospital, Bristol with a swelling beneath the jaw bone in his neck that was diagnosed as a dental abscess. He was not registered with a dentist. He was advised to find a dentist and request treatment. He was unable to find a dentist and returned to the same A&E department three days later. He was given antibiotics and again advised to seek dental treatment. A day later his partner found him in a coma. He was admitted to the Critical Care Unit where he was diagnosed with diabetic keto-acidosis (a diabetic condition which can lead to coma) and the neck abscess drained. He was ventilated and dialysed and spent three weeks in the Critical Care Unit.
Case study 3
In July 2006 a 41-year-old woman saw her GP because of swelling on the left side of her face. It was diagnosed as mumps. One week later she presented to the A&E department of Bristol Royal Infirmary with an abscess. The wound was cleaned and drained and antibiotics were prescribed. The patient was not registered with a dentist.
- Steven J. Thomas, Charlotte Atkinson, Ceri Hughes, Andrew R. Ness. Is there an epidemic of admissions for surgical treatment of dental abscesses in the UK? British Medical Journal, May 30, 2008
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