I recently came across a news story in the national media whereby a young man developed sepsis after he was unable to see a dentist in 2021.[i] For him, this led to a six-week hospital stay, but the outcome could have been so much worse. Whenever a dental infection is identified in the mouth, sepsis is always a potential concern. As dental professionals, we are able to educate patients on the warning signs and help them get the help they need before the disease takes hold.

Sepsis stats

In the UK, there are approximately 245,000 cases of sepsis diagnosed every year. Sadly, this leads to an estimated 48,000 deaths annually, making it a bigger killer than breast, bowel and prostate cancer combined.[ii]

Improved awareness is the first step to reducing these statistics. When people know what they’re looking for, it is easier to identify potential cases. Early detection and treatment can dramatically enhance treatment outcomes and recovery rates. In fact, it has been reported that mortality increases by 8% for every hour that sepsis treatment is delayed.[iii] In contrast, a sepsis diagnosis and treatment within the first hour are associated with up to an 80% survival rate.[iv]

Cause and effect

So, what is sepsis? It is a life-threatening condition that occurs when the immune system goes into overdrive when responding to an injury or infection and starts to damage its own tissues and organs.[v] Among the challenges of a rapid diagnosis are the broad range of potential causes. These are most commonly bacterial infections, but can also be viral or fungal infections, or non-infectious insults such as traumatic injuries.[vi] It is believed that inadequately regulated chemical or protein immune mediators trigger widespread inflammation, blood clots and leaky blood vessels, which impair blood flow and deprive tissues of nutrients.

Key risk factors associated with the development of sepsis include age, gender and comorbidities.[vii] In particular, the National Institute for Health and Care Excellence (NICE) reported those most at risk to:[viii]

Be under 1-year-old or over 75-years-old
Have impaired immune systems due to cancer treatment, long-term steroid use or immunosuppressant drug therapy
Have undergone recent surgery
Experience breach of skin integrity, with cuts, burns or blisters
Be pregnant or within six weeks post-birth, termination of pregnancy or miscarriage

Health inequalities have also been linked to sepsis, with lower socioeconomic status, unemployment and lower education levels.[ix]

Sepsis and dentistry

Though not common, it is possible for sepsis to develop as a result of dental infections. One study[x] found that approximately 3.3% of patients with severe odontogenic infections developed sepsis. Despite the low figures, it is crucial that dental professionals remain vigilant in order to prevent any patients from developing the life-threatening condition.

The CQC[xi] outlines the major signs of sepsis that dental professionals should be aware of – malaise; shivering; muscle pain; failure to urinate; non-blanching rash of the skin, lips or tongue’ reduced blood pressure; increased heart and respiratory rates; and altered mental state.

Guidance set out by the UK Sepsis Trust requires all healthcare professionals to assess any patient with a fever, symptoms presenting with a source of orofacial/dental infection and those who have clinical observations beyond expected limits.[xii] This GDP sepsis decision support tool for primary dental care should be available to all dental professionals to refer to whenever a patient presents with suspicious symptoms.

Know the flags

Different documents are on offer to support professional decision-making for adults and children. They each classify symptoms according to amber or red flags to visually represent the urgency of any signs identified in a patient. Should the latter be recorded, emergency care steps should be taken, including calling 999 to arrange a blue light transfer to an accident and emergency facility. In the presence of amber flags, a clinical judgement is necessary to evaluate the likely danger, with a second assessment or further testing indicated for clarity.

The acronym SEPSIS can also be useful for detecting symptoms – Slurred speech, Extreme shivering, Passing no urine, Severe breathlessness, I feel I might die, and Skin mottled, ashen or blue.

In addition to these tools that can be placed around the practice as useful reminders, there are many training courses that the dental team may find helpful. At the end of the day, sepsis is a dangerous condition that we must all be ready to fight as quickly and efficiently as possible.

[i]

[[1] STV News. News. North East & Tayside. ‘I’m left scarred by sepsis because I couldn’t get a dentist appointment’ https://news.stv.tv/north/students-toothache-turned-into-deadly-blood-poisoning-after-struggle-to-get-dental-appointment [Accessed March 2025]

ii] The UK Sepsis Trust. References & sources. https://sepsistrust.org/about-sepsis/references-sources/ [Accessed March 2025]

[iii] Sepsis Alliance. Sepsis awareness reaches 65%, few know the signs. September 2018. https://www.sepsis.org/news/sepsis-awareness-reaches-65-few-know-the-signs/ [Accessed March 2025]

[iv] Abionic: international pivotal study successfully demonstrates diagnosis of sepsis within 5 minutes. September 2019. https://www.swissbiotech.org/listing/abionic-international-pivotal-study-successfully-demonstrates-diagnosis-of-sepsis-within-5-minutes/ [Accessed March 2025]

[v] The UK Sepsis Trust. What is sepsis? https://sepsistrust.org/about-sepsis/?gad_source=1 [Accessed March 2025]

[vi] National Institute of General Medical Sciences. Sepsis. https://www.nigms.nih.gov/education/fact-sheets/Pages/sepsis.aspx [Accessed March 2025]

[vii] Fathi M, Markazi-Moghaddam N, Ramezankhani A. A systematic review on risk factors associated with sepsis in patients admitted to intensive care units. Aust Crit Care. 2019 Mar;32(2):155-164. doi: 10.1016/j.aucc.2018.02.005. Epub 2018 Mar 21. PMID: 29574007.

[viii] NICE. Sepsis: recognition, diagnosis and early managementNICE guideline. 2017. Available at https://www.nice.org.uk/guidance/ng51/resources/sepsis-recognition-diagnosis-and-early-management-1837508256709 (Accessed March 2025)

[ix] Bladon, S., Ashiru-Oredope, D., Cunningham, N. et al. Rapid systematic review on risks and outcomes of sepsis: the influence of risk factors associated with health inequalities. Int J Equity Health 23, 34 (2024). https://doi.org/10.1186/s12939-024-02114-6

[x] Weise, H., Naros, A., Weise, C. et al. Severe odontogenic infections with septic progress – a constant and increasing challenge: a retrospective analysis. BMC Oral Health 19, 173 (2019). https://doi.org/10.1186/s12903-019-0866-6

[xi] CQC. Dental mythbuster 25: Sepsis. Updated May 2024. https://www.cqc.org.uk/guidance-providers/dentists/dental-mythbuster-25-sepsis [Accessed March 2025]

[xii] The UK Sepsis Trust. Clinical Tools. 2020. https://sepsistrust.org/professional-resources/clinical-tools/ [Accessed March 2025]