Odontogenic infections presenting to the Emergency Department: which patients are discharged to dental clinics?

Abstract

Abstract Introduction: Odontogenic infections (OI’s) can present with a variable clinical picture to hospital emergency departments (ED). Some require inpatient surgical management due to the risk of airway compromise or systemic signs of infection. Other OIs are minor and can be managed in the primary care setting. This study aimed to evaluate the differences in OI’s requiring inpatient surgical treatment compared to those who can be discharged to their local dental practitioner. Methods: This study analysed the in-hospital assessment of patients with OI’s presenting to ED, and factors which lead to surgical admission and inter-hospital transfers. Results: 228 patients were studied, with 59% admitted for surgery and the remainder discharged to primary care. Smokers, patients treated with antibiotics prior to hospital, mandibular molar teeth, trismus and moderate to severe space involvement were associated with the need for inpatient surgical treatment. Anterior maxillary teeth, vestibular space infections, and low risk infections were likely to be discharged to primary care. Conclusion: There are key features of OI’s which are associated with the requirement for inpatient surgical management. Minor odontogenic infections are often triaged to community dental clinics, and the dental workforce should be prepared to appropriately evaluate and manage these patients. At present there is a concerning trend of overreliance on antibiotics alone to treat odontogenic infections in the community.