Cervicofacial infection of dental origin presenting to maxillofacial surgery units in the United Kingdom: a national audit.
BACKGROUND
Local studies have shown an increase in cervicofacial infections of dental origin presenting to oral and maxillofacial surgery units in the UK. A lack of access to National Health Service (NHS) primary care dental services has been implicated as a root cause.


METHODS
Cross-sectional national audit.Method Oral and maxillofacial surgery units in the UK were asked to report details of severe cervicofacial infection of dental origin presenting in October and November 2006. Data were collected regarding: patient demographics, referral source, management in primary care, management by maxillofacial surgery, and outcome.


RESULTS
Two hundred and sixty-six episodes of cervicofacial infection of dental origin were reported during the audit period. At the time of presentation, 56.4% of patients were registered with a general dental practitioner (GDP). One hundred and forty (52.6%) patients sought treatment from primary care dental services for their episode of cervicofacial infection and only 20 patients were unsuccessful in obtaining treatment. Forty-seven percent of patients did not seek treatment from primary care dental services. Fifty percent of patients were referred by accident and emergency. Sixty-six percent of patients were prescribed oral antibiotics without operative intervention by primary dental care services. Eighty-one percent of patients required hospital admission and 46% of patients required a surgical procedure under general anaesthesia. Eighty-nine percent of patients made a full recovery and 3% recovered with complications. There were no deaths reported during the audit period.


CONCLUSIONS
This audit provides a benchmark from which future comparisons can be made and by design cannot prove an increase in the presentation of cervicofacial infection of dental origin. Lack of access to NHS primary care dental services may be less significant than originally thought. A significant proportion of patients preferentially present to primary care medical services rather than dental services. Two thirds of patients treated by primary care dental services received oral antibiotics only which represents an inadequate level of treatment for odontogenic infection.
Carter
L M
LM
British Association of Oral and Maxillofacial Surgeons Clinical Effectiveness Sub-Committee, and Leeds Dental Institute, Oral and Maxillofacial Surgery, Clarendon Way, Leeds. lachlan_carter@hotmail.com
Layton
S
S
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019230:Dental Audit; D003790:Dental Pulp Necrosis / Q000150:complications*; D004636:Emergency Service, Hospital; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005491:Focal Infection, Dental; D005792:General Practice, Dental; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D006113:United Kingdom; D055815:Young Adult
D000900:Anti-Bacterial Agents