Sir, the guidance from the Chief Dental Officer dated 25 March 2020 outlined changes in general dental and community practices with cessation of all routine, non-urgent dental care during this COVID-19 pandemic.1 The guidance informs that practices should provide a telephone triage service for advice, analgesia and antimicrobials (where appropriate) or refer patients to their Local Urgent Dental Care System for emergency dental care.
Telephone assessments will add a degree of complexity to patient assessment as visual signs will be lost. We wish to bring to attention the importance of vigilance for sepsis, one of the most common causes of death and disability in adults and children worldwide2 which can arise from a dental infection. Sepsis is defined as a 'life-threatening organ dysfunction caused by a dysregulated host response to infection'.3 Symptoms can vary but some hallmark signs include a core temperature <36°C or >38.5°C, abnormal heart rate (tachycardia or bradycardia) or tachypnea.4,5 Altered mental state is another important red flag sign (such as new onset confusion, sleepiness, lethargy or agitation).
A high degree of vigilance is needed for patients who may have communication challenges such as those with learning disabilities, impaired consciousness and cognitive disorders. Dental practitioners may wish to devise a pro forma to ensure all relevant information is recorded during telephone consultations including a sepsis screen. Questions should include inquiry for local factors such as swelling, trismus, difficulty in breathing or swallowing and wider systemic factors such as hypothermia or fever, reduced urine output and changes in the skin such as cyanosis or non-blanching rashes.
May we please signpost readers to NICE clinical knowledge summaries, which provides useful information on sepsis diagnosis and management for patients seen in primary care?6
References
Hurley S, Neligan M. Preparedness-letter-for-primary-dental-care. United Kingdom: NHS England, 2020. Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/issue-3-preparedness-letter-for-primary-dental-care-25-march-2020.pdf (accessed 25 March 2020).
Wiens M O, Kumbakumba E, Kissoon N, Ansermino J M, Ndamira A, Larson C P. Pediatric sepsis in the develo** world: challenges in defining sepsis and issues in post-discharge mortality. Clin Epidemiol 2012; 4: 319-325.
Singer M, Deutschman C S, Seymour C W et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801-810.
Randolph A G, McCulloh R J. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence 2014; 5: 179-189.
Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6: 2-8.
National Institute for Health and Care Excellence. Sepsis. United Kingdom: NICE, 2019. Available at: https://cks.nice.org.uk/sepsis (accessed 25 March 2020).
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Dave, M., Barry, S. & Patel, N. Telephone triaging and possible sepsis?. Br Dent J 228, 488 (2020). https://doi.org/10.1038/s41415-020-1487-9
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DOI: https://doi.org/10.1038/s41415-020-1487-9
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