Communicating the urgency
Featured Products Promotional FeaturesPosted by: Dental Design 27th January 2021
At present there is a heightened risk that patients are suffering in silence, delaying a practice visit and treatment while their condition deteriorates. It is entirely possible that some patients are avoiding getting treated, even for issues that have progressed to dental emergencies – which can even represent a risk to their wellbeing.
As dental professionals we know well, that while dental care is localised to the orofacial region, oral health is well-established to have wider ranging effects. Poor oral hygiene and health can have a bidirectional relationship with various systemic and psychological health issues.
Unfortunately, some patients may not grasp that delaying treatment for something like a dental abscess or failing implant could cause a cascade of further health problems. Cardiovascular problems remain among the leading causes of death in England and Wales, and a common pathway for infective endocarditis is infection via the oral cavity.[1] Carious and infected teeth and gums can allow oral bacteria to enter the blood stream, and where a pre-existing valve defect is present, this can allow bacteria to colonise and spread, which can lead to heart failure. It is also possible for the bacteria to break off and spread from this site to other organs, including the brain. Over a third of infective endocarditis cases are traceable to dental infection.[2] While rare, infective endocarditis is fatal in around a quarter of cases, and can lead to lifelong complications in survivors. These can include stroke, heart valve replacement and perpetual anticoagulant medication. Half of all infective endocarditis cases occur in individuals without known cardiac valvular lesions.[3]
Odontogenic infections have also been implicated in other serious and life-threatening conditions. Brain abscesses, osteomyelitis, necrotising fasciitis, severe sinus and orbital infections, and, of course, sepsis have all been traced to infections originating in dental tissues. The threat of serious infections arising from untreated odontogenic infections has declined in recent decades as access to dental care and oral hygiene education have improved. However, septicaemia remains to be a challenge to identify and treat in a timely manner. The disruptions of the past year are likely to have set progress back somewhat.[4] Patients may not fully appreciate that an oral complaint can have more far-reaching consequences, and decide to try to tough out or ignore a dental issue as a result. With patients potentially not being seen as regularly as pre-pandemic, right now it is especially important that patients are made aware of when to urgently seek care.
Against the backdrop of the current pandemic, many members of the public may feel an extra responsibility to not tie up resources and services that may be more urgently needed by others. While this self-sacrificing attitude can be commendable, members of the public often lack the experience or knowledge required to properly assess their own medical condition, and can only guess at institutional capacity. While it is difficult to ascertain just how many patients are behaving in this way, there have been reports that even A&E attendance and patients seeking treatment for heart attacks, circulatory system problems, mental health issues, diabetes and other serious conditions have seen huge drops this year – in some cases, the reduction is as much as fifty percent compared to previous years.[5], [6] If people are putting off seeking treatment for issues such as these, it is easy to envisage that they are likely doing the same over dental maladies. In addition, this year has placed vast numbers of people under considerable financial stress and many have either lost jobs or are concerned that they may. This is another factor that may keep patients away from practices.
While immunisation efforts are now well under way, it will still take quite some time to return to some semblance of normalcy. Dental practices have faced exceptional challenges this year, and dental teams have shown great adaptability in continuing to serve patients safely. However, practices across the country are dealing with considerable backlogs for even routine care and there is still the potential for further disruption. It is vital that urgent cases are still handled in a timely manner.
If you are dealing with an urgent or complex oral surgery case, consider referring your patient to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction. Led by Professor Cemal Ucer – Specialist Oral Surgeon – the cutting-edge treatment centre offers a wide variety of oral surgery treatments such as surgical removal of teeth, cystic lesions and pathology as well as advanced dental and oral implantology procedures, major grafting including zygomatic dental implants for the rehabilitation of severely atrophic patients. It features cutting-edge facilities such as a day care operating theatre and recovery suit, in house digital laboratory and digital diagnostic imaging centre and has a clinical team that boasts considerable experience, ensuring they are well equipped to handle demanding, high risk and urgent cases.
It is extremely important that patients understand that urgent care is still available, and under what circumstances they should seek immediate care. When caught and treated early enough, the majority of oral health issues can be resolved without serious complications.
Please contact Professor Ucer at ice@ucer.uk or Mel Hay at mel@mdic.co
01612 371842
[1] Office for National Statistics. Monthly mortality analysis, England and Wales: October 2020. ONS. 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/monthlymortalityanalysisenglandandwales/october2020 December 3, 2020.
[2] Baldin M., Srinivasan B., Sharma S. Dental infection as a cause of bacteraemia in infective endocarditis. Dental Update. 2018; 45(4): 357-358. https://doi.org/10.12968/denu.2018.45.4.357 December 3, 2020.
[3] Robinson A., Tambyah P. Infective endocarditis – an update for dental surgeons. Singapore Dental Journal. 2017; 38: 2-7. https://doi.org/10.1016/j.sdj.2017.09.001 December 3, 2020.
[4] Bali R., Sharma P., Gaba S., Kaur A., Ghanghas P. A review of complications of odontogenic infections. National Journal of Maxillofacial Surgery. 2015; 6(2): 136-143. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922222 December 3, 2020.
[5] Williams R., Jenkins D., Ashcroft D., Brown B., Campbell S., Carr M. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort survey. The Lancet. 2020; 5(10): 543-550. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30201-2/fulltext December 4, 2020.
[6] Bostock N. Millions of patients ‘avoiding calls to GP’ during COVID-19 pandemic. GPOnline. 2020. https://www.gponline.com/millions-patients-avoiding-calls-gp-during-covid-19-pandemic/article/1681384 December 3, 2020.
