Article
The Success of Urgent Dental Centres and ‘Advice, Analgesia and Antibiotics’
In March 2020, the UK entered its first national lockdown in response to the COVID-19 pandemic. Most hospitals,1 including the Oral and Maxillofacial Surgery (OMFS) unit in Norwich, paused their elective procedures and outpatient clinics. Dental practices closed their doors leading to the rapid establishment of Urgent Dental Centres (UDCs).2
In Norwich, we anticipated a rise in severe odontogenic infections presenting to OMFS resulting from this loss of primary care. On the contrary, however, we found that our emergency admissions had decreased during lockdown, and so we conducted a retrospective analysis. We collected data for 3 months before the lockdown (December 2019–February 2020) and compared this with a 3-month period during lockdown (April–June 2020; Table 1).
| Pre-lockdown | During lockdown | |
|---|---|---|
| Total admissions | 78 | 50 |
| Cervicofacial infections | 34 (44%) | 26 (52%) |
| Maxillofacial trauma | 28 (36%) | 12 (24%) |
| Orofacial lacerations | 5 (6%) | 7 (14%) |
| Dental trauma | 4 (5%) | 1 (2%) |
| Miscellaneous | 7 (9%) | 4 (8%) |
Our analysis revealed that before lockdown we had 34 admissions for cervicofacial infections compared with only 26 during lockdown. This is a notable decrease, but these account for more of our overall admissions during lockdown as there was a significant drop in maxillofacial trauma at the same time.
As the pandemic continued to worsen throughout early 2020, hospitals had to preserve beds for a surge in COVID-19 related admissions.1 Healthcare workers also aimed to reduce in-hospital viral transmission as much as possible. This led to a higher level of our treatment being carried out under local anaesthetic (LA). Avoiding general anaesthetic (GA) reduces a patient's length of stay and eliminates associated risks, such as aerosol generation from intubation and extubation.
Surgical management of odontogenic infections is primarily dental extraction or incision and drainage. Around 30% of our emergency treatment of infections was performed under LA during the lockdown compared with only 3% before. The proportion of patients who underwent extra-oral incision and drainage also dropped in this period, which suggests that infections that did require treatment under GA were less severe.
As a result of the March 2020 lockdown, admissions for odontogenic infections did increase as a proportion, although the total number of admissions decreased. More treatment was carried out under LA in an effort to reduce COVID-19 transmission. Infections that did require GA surgical management were less severe, and we believe this highlights the success of UDCs and the Chief Dental Officer's policy of ‘advice, analgesia and antibiotics’.2