The management of odontogenic cervicofacial infections presenting to Oral and Maxillofacial Units during the first wave of the COVID-19 pandemic in the United Kingdom

Abstract

On 25th March 2020, the Chief Dental Officer issued national guidance restricting the provision of all routine, non-urgent dental services in response to the spread of COVID-19. We analysed odontogenic cervicofacial infections (CFI) presenting to Oral and Maxillofacial Surgery (OMFS) departments during the first wave of COVID-19 in the United Kingdom.

Materials and methods

From April 1st 2020 until July 31st 2020 a database was used to prospectively collect records for all patients with cervico-facial infection (CFI), presenting to oral and maxillofacial teams. Information gathered included clinical presentation, location/origin of infection and how they were managed. The OMFS units were asked to compare the patient’s care with the treatment which would usually have been given prior to the crisis.

Results

32 OMFS units recorded 1,381 entries presenting with CFI in the UK. Most of the infections were referred via the Emergency Department (74%). Lower first or second molars were the most common origin, contributing 40% of CFI. Collaborators reported that patient's treatment was modified as a response to COVID in 20% of the cases. The most frequently cited reason for the change in treatment was applying COVID-19 hospital policy (85%).

Conclusions

The impact of the first wave of COVID modified the management of a significant number of patients presenting with CFI. There was a proactive move to avoid a general anaesthetic where possible. Some patients who presented to secondary care were given no treatment, suggesting they could have been managed in primary dental care if this care was available. We recommend OMFS units and Urgent Dental Care Centres (UDCCs) build strong communication links to not only provide best possible patient care, but minimise COVID exposure and the strain on emergency departments during the pandemic.