Advertisement

Did the March 2020 Lockdown cause an increase in patients presenting to the Emergency Department with Odontogenic pain and infection? A Single Centre, Retrospective Analysis

  • Author Footnotes
    1 Joint first authors
    Emily Gray
    Correspondence
    Corresponding author at: Oral and Maxillofacial Department, Bristol Dental Hospital, Lower Maudlin Street, BS1 2LY. 0117 342 4422.
    Footnotes
    1 Joint first authors
    Affiliations
    Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street, Bristol BS1 2LY
    Search for articles by this author
  • Author Footnotes
    1 Joint first authors
    Constance Hardwick
    Footnotes
    1 Joint first authors
    Affiliations
    Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street, Bristol BS1 2LY

    Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY
    Search for articles by this author
  • Nicola Gradwell
    Affiliations
    Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street, Bristol BS1 2LY
    Search for articles by this author
  • Annie Pellatt
    Affiliations
    Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street, Bristol BS1 2LY
    Search for articles by this author
  • Naomi Cassells
    Affiliations
    Dept. of Anaesthesia, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street Bristol BS1 2LY
    Search for articles by this author
  • Rachael Craven
    Affiliations
    Dept. of Anaesthesia, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street Bristol BS1 2LY
    Search for articles by this author
  • Author Footnotes
    2 Joint last authors
    Jacqueline Cox
    Footnotes
    2 Joint last authors
    Affiliations
    Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street, Bristol BS1 2LY
    Search for articles by this author
  • Author Footnotes
    2 Joint last authors
    Tom Dudding
    Footnotes
    2 Joint last authors
    Affiliations
    Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Lower Maudlin Street, Bristol BS1 2LY

    Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY

    MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN
    Search for articles by this author
  • Author Footnotes
    1 Joint first authors
    2 Joint last authors

      Abstract

      On the 25thMarch 2020 the Chief Dental Officer (CDO) published guidance to restrict the provision of routine dental care in England due to the rapid spread of the severe acute respiratory syndrome coronavirus 2 (COVID-19). We analysed the impact of the pandemic on the number of patients presenting with odontogenic pain and infection to the emergency department (ED) an urban based teaching hospital, the Bristol Royal Infirmary (BRI). Furthermore, we investigated the severity of infection at first presentation to ED. The study period encompassed three phases representing the stages of pandemic restrictions: phase 1 prior to lockdown measures, with no restrictions to dental practice; phase 2 during the government lockdown, with the severest restrictions on dental practices; and phase 3 following the ease of lockdown measures, with return to limited dental services. Data was collected retrospectively from electronic patient records (EPR) regarding adult patients presenting to the ED with dental pain. The rate of presentations (per week) was calculated for each timepoint and compared. A severity score was assigned to each patient using a grading system based on signs of clinical infection and treatment modality. Patients' presentations were analysed at each phase of the pandemic.
      There was a 42.8% attendance increase in presentation of oral facial pain and infection to ED from phase 1 to 3. The COVID-19 pandemic resulted in restrictions to routine primary dental care services which were deemed necessary to reduce the spread of the virus. However, this increased demand on secondary care services as patients increasingly struggled to access primary dental care to manage dental pain.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Health Organisation. Director-General's opening remarks at the media briefing on COVID-19 11 March 2020. 2020. Available From URL: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 (Last accessed: 22/04/22)

      2. UK Government. Prime Minister's statement on coronavirus (COVID-19): 23 March 2020. Available from URL: https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23-march-2020#:∼:text=Prime%20Minister%20Boris%20Johnson%20addressed%20the%20nation%20on%20coronavirus.&text=Good%20Evening%2C,this%20country%20is%20not%20alone (Last accessed: 22/04/22)

      3. Hurley S, Rooney E, Reece C. Issue 2 preparedness letter for primary dental care 20 March 2020. Available from URL: https://www.gdc-uk.org/docs/default-source/covid-19/issue-2-prepardness-letter-for-primary-dental-care-20-march-2020.pdf?sfvrsn=69d46d90_2 (Last accessed: 22/04/22)

        • Shah S.
        • Wordley V.
        • Thompson W.
        How did COVID-19 impact on dental antibiotic prescribing across England.
        Br Dent J. 2020; 229: 601-604
      4. Office of Chief Dental Officer England. Standard operating procedure: transition to recovery. 28th August 2020. Available from URL: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0575-dental-transition-to-recovery-SOP-4June.pdf (Last accessed: 22/04/22)

      5. NHS Business Services Authority. Guidance to support dental contract management arrangements for the 2020/21 – year-end reconciliation. Available from URL: https://www.nhsbsa.nhs.uk/sites/default/files/2020-12/2021%20YE%20CM%20guidance.v15.3_0.pdf (Last accessed: 22/04/22)

      6. Faculty of Dental Surgery. A resumption of dental services - one year on. September 2020. Available from URL: https://www.rcseng.ac.uk/-/media/files/rcs/coronavirus/fds-report-resumption-of-dental-services-2-oct-2020.pdf (Last accessed: 22/04/22)

        • Long L.
        • Corsar K.
        The COVID-19 effect: number of patients presenting to The Mid Yorkshire Hospitals OMFS team with dental infections before and during the COVID-19 outbreak.
        Br J Oral Maxillofac Surg. 2020; 58: 713-714
        • Puglia F.A.
        • Ubhi H.
        • Dawoud B.
        • et al.
        Management of odontogenic cervicofacial infections presenting to oral and maxillofacial units during the first wave of the COVID-19 pandemic in the United Kingdom.
        Br J Oral Maxillofac Surg. 2021; 59: 875-880
      7. NHS. NHS Dental Statistics for England – 2020-21 Annual Report. 26th August 2021. Available from URL: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2020-21-annual-report# (Last accessed: 22/04/22)

        • Cope A.L.
        • Chestnutt I.G.
        • Wood F.
        • et al.
        Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study.
        Br J Gen Pract. 2016; 66: e329-e336