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Letter to the Editor| Volume 61, ISSUE 1, P120-121, January 2023

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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

Published:December 19, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.12.004
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
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      Sir,
      We would like to support and applaud the review paper by Gray et al that highlighted the increase in emergency department (ED) presentations with odontogenic pain and infection during the COVID-19 pandemic.
      • Gray E.
      • Hardwick C.
      • Gradwell N.
      • et al.
      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.
      Br J Oral Maxillofac Surg. 2022; 60: 1254-1260
      Worryingly, in our experience it did not only increase attendance of these patients, but also significantly affected another vulnerable population, those with suspected oral cancers. During this unprecedented time, with a government-mandated lockdown and lack of access to primary medical and dental services, we saw an increase in patients presenting to the ED with advanced head and neck cancer. GP referrals via the two-week wait pathway were reported to have reduced by up to 84% in this same period.
      • Sud A.
      • Torr B.
      • Jones M.E.
      • et al.
      Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study.
      Lancet Oncol. 2020; 21: 1035-1044
      We performed an extensive review of head and neck cancer presentations to the ED in our North London teaching hospital between March 2020 and October 2021.
      • Stringer H.
      • Mohammad N.
      • Mumtaz S.
      • et al.
      Head and neck cancer presentations in the emergency department during the COVID-19 pandemic.
      Br Dent J. 2022; (Online ahead of print)https://doi.org/10.1038/s41415-022-4505-2
      Of 34 patients presenting to the ED with suspicious oral lesions, nine were subsequently diagnosed with oral cancer. Unfortunately, all of them were graded as stage IV cancers and only one was suitable for ablative surgery. When we came to analyse and interpret our data, two of these patients sadly had already passed away due to their disease, and a further three were experiencing cancer recurrence or progression despite active treatment.
      Even though non-urgent dental care services gradually resumed in England on 8 June 2020, we are still not at pre-pandemic levels of NHS dental activity. In the 24 months up to 30 June 2022, 16.4 million adults were seen by an NHS dentist compared to 21 million in the 24 months up to 30 June 2020.

      NHS Digital. NHS dental statistics for England, 2021-22, annual report. 25 August 2022. Available from URL: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2021-22-annual-report#:~:text=Key%20Facts&text=26.4m%20courses%20of%20treatment,compared%20to%20the%20previous%20year (last accessed 20 December 2022).

      This is particularly concerning considering how oral cancer screenings are opportunistically performed during routine dental examinations.
      Additionally, as we are currently enduring a cost-of-living crisis, for many of those unable to access NHS dental care, private dentistry is not an economically viable option. The Office for National Statistics reported that in the 12 months up to October 2022, the Consumer Price Index, including owner occupiers’ housing costs (CPIH), rose by 9.6%.

      Office for National Statistics (ONS). Consumer price inflation, UK: October 2022. ONS 16 November 2022: 1-27. Available from URL: https://www.ons.gov.uk/economy/inflationandpriceindices/bulletins/consumerpriceinflation/october2022 (last accessed 20 December 2022).

      To avoid future catastrophe, more needs to be done by the government to ensure access to NHS primary care medical and dental services. This access is a long-standing issue pre-dating the pandemic, but the collateral damage exacerbated by COVID-19 has highlighted the unforgivable results of this apathetic system, the price of which is being borne more heavily by those who are more vulnerable.

      Conflict of interest

      None.

      Ethics approval

      N/A.

      Patients’ permission/consent

      N/A.

      References

        • Gray E.
        • Hardwick C.
        • Gradwell N.
        • et al.
        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.
        Br J Oral Maxillofac Surg. 2022; 60: 1254-1260
        View in Article
        • Sud A.
        • Torr B.
        • Jones M.E.
        • et al.
        Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study.
        Lancet Oncol. 2020; 21: 1035-1044
        View in Article
        • Stringer H.
        • Mohammad N.
        • Mumtaz S.
        • et al.
        Head and neck cancer presentations in the emergency department during the COVID-19 pandemic.
        Br Dent J. 2022; (Online ahead of print)https://doi.org/10.1038/s41415-022-4505-2
        View in Article

      4. NHS Digital. NHS dental statistics for England, 2021-22, annual report. 25 August 2022. Available from URL: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2021-22-annual-report#:~:text=Key%20Facts&text=26.4m%20courses%20of%20treatment,compared%20to%20the%20previous%20year (last accessed 20 December 2022).

        View in Article

      5. Office for National Statistics (ONS). Consumer price inflation, UK: October 2022. ONS 16 November 2022: 1-27. Available from URL: https://www.ons.gov.uk/economy/inflationandpriceindices/bulletins/consumerpriceinflation/october2022 (last accessed 20 December 2022).

        View in Article

      Article info

      Publication history

      Published online: December 19, 2022
      Accepted: December 10, 2022
      Received: November 28, 2022

      Identification

      DOI: https://doi.org/10.1016/j.bjoms.2022.12.004

      Copyright

      Crown Copyright © 2022 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons. All rights reserved.

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