Sepsis: A Recent Dental Case
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- Published: Thursday, 22 May 2025 09:14
- Written by Peter Ingle
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GDPs and their teams are expected to be able to detect, and in some cases provide immediate care, for a variety of life threatening conditions. Annual training in basic life support is intended to keep it fresh in everyone‘s mind. Sepsis may be seen as a less likely issue, particularly to those seeing stable lists of well maintained patients, but a recent case provides a reminder of its occurrence in dentistry and potentially devastating consequences.
Offered as a shared learning case by an ICB for their primary care providers, it relates to a patient who initially contacted 111 on a Sunday morning. The patient who was in their 30’s complained of a dental abscess, neck pain and phlegm in the mouth. They were directed to the dental team and an out of hours appointment was offered. Initially the patient was unsure if they could attend, due to the location offered, and as a result were advised to contact their own dentist the following morning.
The patient called again an hour later, and this time an appointment was arranged for them to attend the out of hours service, later that afternoon. The patient arrived and was seen early at the dental service, and antibiotics prescribed for infection. They were advised to see their own dentist as soon as possible.
About one hour later, the patient submitted an online 111 consultation and reported that they had a cough. They were referred to the out of hours GP service for review. The GP called the patient, with the conclusion that the patient needed to be seen in person for a physical examination. The GP advised the patient that they would receive a phone call to organise an appointment.
The service attempted to contact the patient on four separate times over the next five hours to arrange the appointment but there was no response. In line with the protocol for failed contact, the case was sent to a clinical navigator [a health professional who helps patients find the right care for their issue] and closed. Later that evening, the patient’s body was found. The cause of death was recorded as: Sepsis, BETA Haemolytic Streptococcus Group A infection, Non-alcoholic Steatohepatitis, Cardiomegaly, Obesity.
There were a number of key issues and conclusions. Audit of calls to the 111 service identified that further probing and clarification questions were needed. It was noted that the patient had mentioned that they were experiencing difficulty swallowing. The patient had not shared any current medical conditions with the dental service. The dentist had not taken the patient’s temperature because they did not appear unwell, and were not showing any signs of fever, nor were they hot to the touch. However the patient had been advised to take paracetamol and ibuprofen by the 111 service. The dentist had not taken any other observations outlined in the assessment for sepsis. While the dentist noted that trismus was not severe, an x-ray could not to be taken due to the patient being unable to open their mouth and difficulty swallowing.
Actions identified are:
- For the 111 service, call handling improvements, including ensuring all relevant questions are asked and answered in full to ensure the correct pathway is chosen when multiple symptoms are present. Also, that all relevant symptoms and information are provided when escalating and transferring calls within the service.
- For GPs they are that specific questions are asked in relation to difficulty in swallowing; previous medical history is taken; and social history is explored and documented.
- For the Out of Hours Dental Service they include, adherence to the UK Sepsis Trust Guidance for Primary Dental Care, including use of the decision support tool for all those over 12 presenting with fever (or recent fever) symptoms, with dental infection.
https://publishing.rcseng.ac.uk/doi/pdf/10.1308/rcsfdj.2019.142
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