Abstract
Keywords
Introduction
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].
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].
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].
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].
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].
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].
Faculty of Dental Surgery. A resumption of dental services? Dental surgeons’ experiences of delivering care since 8 June 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].
Material and methods
Variable | Parameter |
---|---|
Anonymous identifier | |
Age | |
Sex | Male/Female |
Referral source | Emergency department/Bristol Dental Hospital |
Regular dental attender | Yes/No/Unknown |
Previous general dental practitioner visit prior to emergency department attendance | Yes/No |
Previous general medical practitioner visit prior to emergency department attendance | Yes/No |
Previous antibiotic prescription | Yes/No Oral/IV |
Comorbidities | Diabetes, smoking, immunocompromised |
Medication | Steroids, anticoagulants, immunosuppressants, other, none |
Allergies | Yes/No |
Systemic involvement | None, lymphadenopathy, neck swelling, trismus, dysphonia/dysphagia, bilateral neck swelling/Ludwig’s angina |
Infection site | |
Ludwig’s angina | Yes/No |
Return to theatre | Yes/No |
ITU admission | Yes/No |
Previous analgesic use | Paracetamol, ibuprofen, paracetamol and ibuprofen, codeine, codeine and paracetamol, other, none |
Previous dental treatment | None, extirpation, temporary restoration, incision and drainage, extraction under local anaesthesia |
Sepsis six trigger | Yes/No |
Route of antibiotic prescribed in secondary care | Oral and discharge from emergency department, IV in emergency department and discharge, IV and admit |
Treatment | No treatment, analgesic advice, discharge and dentist to treat, extraction under local anaesthesia, incision and drainage under local anaesthesia, treatment under general anaesthesia |
Phase | Number of presentations seen at BRI | Number of days in phase | Number of weeks in phase | Average number of presentations/weeks | Mean difference pre and post COVID-19 restrictions |
---|---|---|---|---|---|
Phase 1 Pre COVID-19 restrictions 1 January to 24 March 2020 | 101 | 84 | 11.8 | 8.5 | |
Phase 2 25 March to 7 June 2020 | 117 | 75 | 10.7 | 10.9 | |
Phase 3 8 June 2020 to 1 January 2021 | 364 | 208 | 29.8 | 12.2 | |
After COVID-19 restrictions Phases 2 and 3 combined | 481 | 283 | 40.5 | 11.8 | 3.07 (0.35, 5.78) p=0.005 |
Variables | Phase 1 | Phase 2 | Phase 3 | Post COVID-19 restrictions (phases 2 and 3) | Total |
---|---|---|---|---|---|
Systemic score: | |||||
No sign of systemic involvement (score = 0) | 82 (81.2) | 100 (85.5) | 298 (81.9) | 398 (82.7) | 480 (82.5) |
Lymphadenopathy (score = 1) | 0 | 3 (2.6) | 4 (1.1) | 7 (1.5) | 7 (1.2) |
Trismus (score = 2) | 12 (11.9) | 7 (5.9) | 44 (12.1) | 51 (10.6) | 63 (10.8) |
Major neck swelling (score = 3) | 0 | 0 | 0 | 0 | 0 |
Dysphagia/dysphonia (score = 4) | 7 (6.9) | 7 (5.9) | 15 (4.1) | 22 (4.6) | 29 (4.9) |
Bilateral neck swelling/Ludwig’s angina (score = 5) | 0 | 0 | 3(0.8) | 3 (0.6) | 3 (0.5) |
Total | 101 | 117 | 364 | 481 | 582 |
Mean score | 0.51 | 0.38 | 0.46 | 0.44 | 0.45 |
Treatment score: | |||||
No treatment (score = 0) | 18 (17.8) | 8 (6.8) | 41 (11.2) | 49 (10.2) | 67 (11.5) |
Analgesic advice/GDP to treat/referral to BDH (score = 1) | 53 (52.5) | 79 (67.5) | 237 (65.1) | 316 (65.7) | 369 (63.4) |
Extraction with LA (score = 2) | 0 | 1 (0.9) | 0 | 1 (0.2 | 1 (0.2 |
Incision and drainage LA (score = 3) | 15 (14.9) | 19 (16.2) | 52 (14.3) | 71 (14.8) | 86 (14.8) |
Treatment under GA (score = 4) | 15 (14.9) | 10 (8.6) | 34 (9.3) | 44 (9.1) | 59 (10.1) |
Total | 101 | 117 | 364 | 481 | 582 |
Mean score | 1.56 | 1.52 | 1.45 | 1.47 | 1.49 |
Antibiotic score: | |||||
No antibiotics (score = 0) | 40 (39.6) | 50 (42.7) | 138 (37.9) | 188 (39.1) | 228 (39.2) |
Oral antibiotics and discharged (score = 1) | 33 (32.7) | 51 (43.6) | 149 (40.9) | 200 (41.6) | 233 (40.0) |
IV antibiotics and discharged (score = 2) | 7 (6.9) | 4 (3.4) | 34 (9.3) | 38 (7.9) | 45 (7.7) |
Admitted for IV antibiotics (score = 3) | 21 (20.8) | 12 (10.3) | 43 (11.8) | 55 (11.4) | 76 (13.1) |
Total | 101 | 117 | 364 | 481‘ | 582 |
Mean score | 1.09 | 0.81 | 0.95 | 0.92 | 0.95 |
Sepsis six pathway: | |||||
No (score = 0) | 98 (97.0) | 115 (98.3) | 354 (97.3) | 469 (97.5) | 567 (97.4) |
Yes (score = 4) | 3 (2.9) | 2 (1.7) | 10 (2.8) | 12 (2.5) | 15 (2.6) |
Total | 101 | 117 | 364 | 481 | 582 |
Mean score | 0.12 | 0.07 | 0.11 | 0.10 | 0.1 |
ITU admittance: | |||||
No admittance to ITU (score = 0) | 100 (99.0) | 116 (99.2) | 359 (98.6) | 475 (98.8) | 575 (98.8) |
Admitted to ITU (score = 5) | 1 (0.9) | 1 (0.9) | 5 (1.4) | 6 (1.2) | 7 (1.2) |
Total | 101 | 117 | 364 | 481 | 582 |
Mean score | 0.05 | 0.04 | 0.07 | 0.06 | 0.06 |
Total mean score | 3.34 | 2.82 | 3.04 | 2.99 | 3.05 |
Low severity score total (0–4) | 76 (75.2) | 99 (84.6) | 295 (81.0) | 394 (81.9) | 470 (80.8) |
Moderate-severe severity score total (5–21) | 25 (24.8) | 18 (15.4) | 69 (19.0) | 87 (18.1) | 112 (19.2) |
Total | 101 | 117 | 364 | 481 | 582 |
Results
Change in attendance
Severity of infections across time



Discussion
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].
Conclusion
Conflict of interest
Acknowledgements
Funding
Ethics statement/confirmation of patients’ permission
References
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].
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].
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].
- How did COVID-19 impact on dental antibiotic prescribing across England.British Dental J. 2020; 229: 601-604
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].
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].
Faculty of Dental Surgery. A resumption of dental services? Dental surgeons’ experiences of delivering care since 8 June 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].
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