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It is not uncommon for patients with odontogenic and non-odontogenic infection to present in general dental practice. Untreated infection can lead to life-threatening sepsis. This article aims to advise general dental practitioners on the relevance of sepsis and highlight the recent published NICE guidelines for interpretation in the dental setting. Sepsis is defined as a life-threatening organ dysfunction due to a deregulated host response to infection. It is paramount for dental professionals to understand head and neck infection, underlying systemic infection and concepts of fascial space infection. It is also essential to know the warning signs or ‘red flags’ of emerging sepsis.
CPD/Clinical Relevance: Following the recent published NICE guidelines and public awareness campaigns regarding sepsis, it is vitally important to raise awareness of the potential for sepsis to be identified in the general dental practice setting.
Article
Sepsis has recently been defined by international consensus as a life-threatening organ dysfunction due to a deregulated host response to infection.1 This is associated with a high rate of mortality and has been reported to claim an estimated 44,000 lives each year.2
The infection may have started anywhere in a patient's body and can be widespread. Although sepsis may be secondary to odontogenic, mucosal or salivary gland infections,3 sepsis can also occur following chest or urinary tract infections, or simple skin injuries like cuts and bites. A high index of suspicion should therefore be adopted in certain groups of patients, including those over 75 years of age, the immunocompromised, the pregnant and those with recent surgical interventions (Table 1).
Undiagnosed and untreated sepsis can lead to septic shock which is defined as a subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock are associated with hospital mortality rates of greater than 40%. Adult patients with suspected infection can be identified as being more likely to have poor outcomes typical of sepsis if they have at least two of the following clinical criteria:
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