Analysis

Is there an epidemic of admissions for surgical treatment of dental abscesses in the UK?

BMJ 2008; 336 doi: 10.1136/bmj.39549.605602.BE (Published 29 May 2008)
Cite this as: BMJ 2008;336:1219

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  1. Steven J Thomas, consultant maxillofacial surgeon and senior lecturer1,
  2. Charlotte Atkinson, lecturer in nutrition2,
  3. Ceri Hughes, consultant maxillofacial surgeon1,
  4. Peter Revington, consultant maxillofacial surgeon3,
  5. Andrew R Ness, professor of epidemiology2
  1. 1Division of Oral and Maxillofacial Surgery, University of Bristol, Bristol BS1 2LY
  2. 2Department of Oral and Dental Science, University of Bristol, Bristol BS1 2LY
  3. 3North Bristol NHS Trust, Bristol BS16 1LE
  1. Correspondence to: S J Thomas Steve.Thomas{at}bristol.ac.uk
  • Accepted 8 March 2008

Steven J Thomas and colleagues think that recent changes in dental care provision have led to increased numbers of hospital admissions for dental abscess, and they suggest that access to routine and emergency dental care needs to be reviewed

Three complicated cases of dental abscess that presented in Bristol over a six month period in 2006 prompted us to investigate the frequency of admission for surgical treatment of dental abscess. Analysis of routine data on hospital admissions indicates that the number of admissions for surgical drainage of dental abscess has increased since the turn of the century.

Summary points

  • Dental sepsis is preventable

  • Dental sepsis can have serious local and systemic consequences

  • Dental abscess may present to both medical and dental practitioners

  • Hospital admissions for drainage of dental abscess have doubled in the past 10 years

  • Access to routine and emergency dental care needs to be reviewed

Three complicated cases of dental abscess

Case 1

In March 2006, a 48 year old woman was referred by her general practitioner to the accident and emergency department with a submandibular swelling, which had been present for a week. She was diagnosed as having a right submandibular abscess secondary to a carious infected tooth. She was started on antibiotics and the abscess was drained. After two days she became increasingly unwell. She was tachypnoeic, hypotensive, and oliguric. Computed tomography showed that she had a fluid collection extending from the neck to the aortic arch (fig 1)⇓. She underwent a left thoracotomy and pus was drained from around the trachea and aortic arch. She was transferred to the critical care unit for ventilation and haemofiltration. Chest radiographs were consistent with a diagnosis of adult respiratory distress syndrome. Her lung and renal function improved gradually. She spent 22 days on the critical care unit and a further 22 days on the surgical ward. …

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