Carter L M, Layton S
British Association of Oral and Maxillofacial Surgeons Clinical Effectiveness Sub-Committee, and Leeds Dental Institute, Oral and Maxillofacial Surgery, Clarendon Way, Leeds.
Br Dent J. 2009 Jan 24;206(2):73-8. doi: 10.1038/sj.bdj.2009.4.
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.
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.
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.
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.
英国的本地研究表明，前往口腔颌面外科就诊的牙源性颌面部感染有所增加。无法获得国民医疗服务体系（NHS）的初级保健牙科服务被认为是一个根本原因。
全国性横断面审计。方法：要求英国的口腔颌面外科单位报告2006年10月和11月出现的严重牙源性颌面部感染的详细情况。收集了以下数据：患者人口统计学信息、转诊来源、初级保健中的管理情况、颌面外科的管理情况以及治疗结果。
在审计期间报告了266例牙源性颌面部感染病例。就诊时，56.4%的患者在普通牙科医生（GDP）处注册。140例（52.6%）患者因颌面部感染事件寻求初级保健牙科服务治疗，只有20例患者未成功获得治疗。47%的患者未寻求初级保健牙科服务治疗。50%的患者由急诊转诊。46%的患者由初级牙科保健服务在未进行手术干预的情况下开具了口服抗生素。81%的患者需要住院治疗，46%的患者需要在全身麻醉下进行外科手术。89%的患者完全康复，3%的患者康复时有并发症。审计期间未报告死亡病例。
本次审计提供了一个基准，可用于未来的比较，但从设计上来说无法证明牙源性颌面部感染的就诊率有所增加。无法获得NHS初级保健牙科服务的影响可能比最初认为的要小。相当一部分患者优先前往初级保健医疗服务机构而非牙科服务机构就诊。初级保健牙科服务治疗的患者中有三分之二仅接受了口服抗生素治疗，这对于牙源性感染来说治疗水平不足。
