Cervicofacial infection of dental origin presenting to maxillofacial surgery units in the United Kingdom: a national audit

Atypical presentation of polymicrobial cervicofacial necrotizing fasciitis: An extraordinary odontogenic infection in a healthy female patient

Cervicofacial necrotizing fasciitis (CNF) can occur as a dental complication in young, healthy individuals. Early diagnosis, treatment, and awareness of severe acute cervicofacial pain, rapid swelling, and radiological gas formation are crucial. Broad molecular profiling is recommended for understanding the organisms involved in such infections in future research.

The association of travel distance and severity of odontogenic infections

BACKGROUND

Odontogenic infections (OI) are a preventable disease commonly managed in a tertiary hospital setting. Prevention of severe infections and hospitalisation relies on timely access to primary dental care. This study outlines the pre-hospital treatment of patients presenting to hospital with OIs and the association between travel distance from the patients' residence to a tertiary hospital oral and maxillofacial surgical (OMS) unit.

METHODS

This study analysed patients who initially presented hospital with an OI. Patient demographics, pre-hospital treatment, and clinical markers of severity were recorded. The travel distance from the patient's residence to the hospital was recorded in kilometers, along with any inter-hospital transfer via road/air ambulance.

RESULTS

Two hundred twenty-seven patients were included in this study, 17.2% required an inter-hospital transfer. Of these patients, 70.3% had prior treatment before hospitalisation, and antibiotics without source control was the most frequent treatment (83.1%). The mean travel distance for patients with more severe markers of infection significantly greater than patients with minor infections (p = < .001). Patients who required an inter-hospital transfer accounted for most cases with airway compromise requiring ICU admission.

CONCLUSION

This study found that most patients presenting to hospital with an OI had received antibiotics alone as treatment before hospitalisation. The travel distance from a tertiary hospital with OMS services had a significant correlation to more severe infections. This has important public health implications for the allocation of preventative dental services, and patient access to OMS services.

Vacuum-Assisted Closure Therapy: A Lifesaver in a Case of Neck Necrotizing Fasciitis

Necrotizing fasciitis (NF) is a severe and rare soft tissue infection with a high potential for mortality, particularly in cases related to odontogenic infections in immunocompromised patients. The conventional treatment for NF includes broad-spectrum antibiotics and aggressive surgical debridement. This report presents a unique case of a 34-year-old healthy male who developed NF following a lower left wisdom tooth extraction. The infection extended into the superior mediastinum, requiring emergency surgical intervention. The therapeutic management included vacuum-assisted closure (VAC), a treatment modality showing promise in managing complex soft tissue infections, in combination with other adjunct treatments. The patient showed a satisfactory healing process and no signs of recurrence during the six-month follow-up period. This case underlines the importance of early diagnosis and the potential benefit of VAC therapy in managing advanced NF, emphasizing the need for further research and clinical application.

Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data

Background: The aim of this systematic review was to analyse the published literature on dental infections leading to hospitalisations in Australia. It was hoped that understanding the patterns and trends would form a basis for improved preventive and management policies. Methods: An electronic search was performed using Web of Science, Medline via Ovid and Google Scholar. Inclusion and exclusion criteria were applied. The included studies were analysed for demographics, aetiology, management, length of hospital stay and outcome of dental infections requiring hospitalisation. Results: Nine retrospective studies were eligible for inclusion. A total of 2196 cases of dental infections leading to hospitalisations were reported, with a male predominance (55–67%). Mental health issues, illicit substance abuse and immunosuppression were the main associated comorbidities (up to 58%). Dental caries (59–90%) and pericoronitis (10–19%) were the leading causes of dental infections. Empirical antibiotics were utilised in up to 75% of cases prior to hospital presentation. Six mortalities were reported. Conclusions: The available published data show that dental infection is a significant public health problem. However, only general conclusions were possible due to the variably small sample size and data collection that was inconsistent and incomplete across studies. Improved data collection is required to develop policies for prevention and management.

Evolution of the treatment of severe odontogenic infections over 50 years: A comprehensive review

Objectives

Severe odontogenic infections remain a challenge for maxillofacial surgeons. The aim of this work is to review the literature to provide an update of knowledge on the topic.

Methods

A comprehensive review of articles in PubMed, Web of Science and Africa Journals Online was performed through searching for "severe odontogenic infections." No language restrictions were applied. Only articles pertaining to treatment options were retrieved. Articles from the past 50 years were included.

Results

A total of 84 articles from 39 countries worldwide were included. Severe odontogenic infections are not unique to low- and middle-income countries but also pose challenges in developed countries. Surgical management and antibiotic therapy for this type of infection is discussed. Some immunocompromised patients have high risks of complications and mortality rates. A world map of publications on the topic is provided.

Conclusions

Several important aspects of managing severe odontogenic infections are discussed. Predictors of severity in addition to recommended antibiotic choice have been debated. Diabetes mellitus is a poor predictor of the prognosis of odontogenic infections.

Clinical, CT scan, and laboratory changes of abscess patients with odontogenic origin admitted to Shiraz acute surgical care center, Iran

Introduction

Rapid diagnosis of maxillofacial abscess with the odontogenic origin is effective in the treatment of patients. This study aimed to check the clinical evaluation, head, and neck computed tomography (CT) scan, and microbial sensitivity of hospitalized patients diagnosed with maxillofacial abscess admitted to the Maxillofacial Surgery Ward Shaheed Rajaie Surgical Acute Care Center of Shiraz, Iran from 2019-2021.

Method

A cross-sectional study was conducted. The sample included patients diagnosed with the abscess of odontogenic origin. Data collection tools included personal profile registration form, chief complainant and clinical evaluation, laboratory test results, pus culture, antibiogram results, and head and neck CT scan changes form. Data was reported with descriptive statistics by SPSS-16 software.

Results

The majority of patients were male; infection duration was 10 days; maximum mouth opening size was less than 20 mm in more than half of patients. The scan revealed 41.8% abscess, 36.4% cellulite, and 21.8% mixed abscess and cellulitis. There was 29.1% involvement of salivary glands. The majority of abscesses were unifocal involved in the submandibular space, and the least involvement was in peri mandibular space and carotid sheath. The most common organism causing was staphylococcal abscess coagulase-negative.

Conclusion

In patients with maxillofacial abscess requiring hospitalization, the most common clinical features were trismus, toxic appearance, and dysphagia, and the most common source of abscess in scanning patients with mandibular molars was the most involved submandibular space and pterygomandibular space. Vancomycin, cotrimoxazole, and cefazolin had the greatest effect in the treatment of odontogenic infections in terms of antibiogram results and microbial culture.

Odontogenic Infection Complicated by Cervicofacial Necrotizing Fasciitis in a Healthy Young Female

Necrotizing fasciitis (NF) is a critical and rapidly progressive infection of the skin and soft tissue, and it is associated with a high mortality rate. NF of the cervicofacial region is uncommon due to the rich vascular supply of the head and neck, which promotes an efficient immune response to infection. Patients who are immunocompromised or have comorbidities affecting the vasculature, such as diabetes mellitus or peripheral vascular disease, are at an increased risk of more severe disease and outcome. Cervicofacial necrotizing fasciitis (CNF) is most frequently attributed to mucosal damage, such as those related to dental infections or local trauma including medical procedures. Due to its ability to quickly spread to the neck and mediastinum, CNF must be diagnosed and treated expeditiously. In this report, we present a case of a 28-year-old female with a past medical history significant for obesity and tobacco abuse who presented to the emergency department (ED) with fever, left-sided facial pain, cervical pain, and swelling. She had worsening symptoms despite current treatment with clindamycin for a dental abscess. A CT scan of the head and neck revealed an odontogenic abscess complicated by CNF. Intravenous antibiotics were initiated and she underwent prompt surgical intervention. She remained nasally intubated following her surgery due to concern for postoperative edema leading to airway compromise. Following extubation, she experienced an uncomplicated recovery. This case demonstrates that NF is a complication of dental infection that may occur even in young and relatively healthy patients. Additionally, due to the swiftly destructive nature and high mortality rate of CNF, early diagnosis and aggressive medical and surgical therapy are essential to reduce morbidity and mortality.

Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infection (CFI) is a common presentation to the Oral and Maxillofacial (OMFS) department and accounts for significant emergency activity. The current study aims to understand the aetiology, management, and clinical features of patients hospitalised with CFI. Our study included all patients admitted for management of CFI from May to October 2017 at 25 OMFS units across 17 UK regions. Data were collected prospectively and included age, comorbidities, prior treatment received, markers of sepsis, and presenting clinical features. One thousand and two (1002) admissions were recorded; 546 (54.5%) were male. Median (range) age was 34 (1-94) years. The most common presenting complaints were trismus (46%) and dysphagia (27%). Airway compromise was present in 1.7% of cases. Odontogenic infection accounted for 822/1002 (82%) admissions. Of those with an infection of odontogenic origin, 453/822 (55.1%) had received previous treatment. Two-thirds of those who had received treatment were managed by antibiotics alone (300/453, 66.2%). Patients met criteria for sepsis in 437/1002 (43.6%) of CFI, and in 374/822 (45.5%) of odontogenic infections. This is the largest study worldwide of patients requiring inpatient management for CFI. Infection due to odontogenic origin is the most frequent reason for admission and nearly half do not seek treatment before presentation. Patients with CFI often present late in their disease and frequently meet criteria for sepsis, requiring timely and aggressive treatment to ensure optimum outcomes. Trismus is an emerging dominant feature with all the implications related to the anaesthetic management of these patients. Knowledge of these factors has implications for the referrer, triage, the emergency department, the anaesthetic team, and members of the OMFS team.

Noma and Necrotizing Fasciitis of the Face and Neck

Necrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.

Mapping the microbiological diversity of odontogenic abscess: are we using the right drugs?

OBJECTIVES

The aim of this study was categorizing the microbial flora and susceptibility to antibiotics and to clarify to which degree the empiric administered antibiotics are suitable for therapy.

MATERIALS AND METHODS

A 3.5-year retrospective study evaluated hospital records of 206 patients who suffered from head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage and received intravenous antibiotics and inpatient treatment. The specimens were obtained by performing a swab.

RESULTS

Two hundred six patients were included with 251 strains isolated (1.22 per patient). One hundred eight strains showed antibiotic resistance. Eighty-seven patients showed at least one bacterial strain that showed antibiotic resistance (42.2%). The most frequent isolated bacteria were Streptococcus spp. (n = 116), with a high rate of antibiotic resistance (50.8%). We investigated 205 cases of antibiotic resistance in 87 subjects. Nine bacterial strains showed no susceptibility to unacid (4.3%) and 36 strains to clindamycin (17.5%).

CONCLUSION

Antibiotic resistance against clindamycin was rather high. The distribution of the afflicted spaces and isolated bacteria was alike recent findings. It is mandatory to understand that immediate surgical treatment in terms of incision and drainage is the basis in abscess treatment. Antibiotic treatment is adjunct therapy.

CLINICAL RELEVANCE

Streptococcus species were the most frequently identified bacteria presenting antibiotic resistance in more than 50%. Increased resistant rates for clindamycin require reconsiderations regarding an empiric antibiotic treatment.

Increasing frequency and severity of odontogenic infection requiring hospital admission and surgical management

Odontogenic infections can become life-threatening if not managed in a timely manner, and they increase the physical cost of treatment to the patient and the financial cost to the public health system. We investigated the number of admissions to a Queensland tertiary hospital within a decade, and differences in the patients' characteristics, severity at presentation, and clinical outcomes. We compared patients with odontogenic infections who were taken to theatre at the Royal Brisbane & Women's Hospital (RBWH) between January 2003 and December 2004 with those treated between January 2013 and December 2014, a total of 292. Data on demographics, presentation, previous history, antimicrobial treatment, and admissions, were collated and analysed. There were no significant differences in demographics. In the 2013/2014 group there was a two-fold increase in infections related to lower third molars (p=0.001), a 50% increase in trismus (p=0.001), and a 20% increase in submandibular swelling (p=0.010). The percentage of patients admitted to the intensive care unit (ICU) was three and a half times higher in the 2013/2014 group (p=0.001). The presentation of odontogenic infections has increased in the decade from 2003/2004 to 2013/2014. Measures of the severity of disease have increased, while the basic characteristics of the patients have remained constant. Improved primary preventative measures and early interventions are therefore needed to alleviate the burden that these infections place on the public health system.

Cervicofacial Necrotizing Fasciitis in Patients with No Underlying Medical Conditions: A Review of Four Cases Seen in Twelve Months at a Nigerian Tertiary Hospital

Necrotizing fasciitis of the head and neck is a rare but rapidly progressive infection involving the skin, subcutaneous tissue, and fascia. We report 4 cases of cervicofacial necrotizing fasciitis with similar patterns of presentation. All the 4 cases presented with an odontogenic source and no underlying medical condition. All the patients had tooth extraction and serial wound debridement. Three of these patients recovered well, and healing of the wound occurred by secondary intention. One patient had a resultant neck defect, which was repaired with a supraclavicular island flap after the infection had subsided. We advocate the importance of early detection of necrotizing fasciitis with or without an underlying medical condition and an aggressive medical and surgical intervention. Additionally, eradication of the source of infection is highly indicated to reduce the mortality of this disease.

Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai

Purpose

The aim of this study is to comprehensively review and analyse pure odontogenic maxillofacial space infections in a tertiary care hospital in Navi Mumbai over a period of 5 years.

Methods

A retrospective analysis of 315 patients treated at Dr. D. Y. Patil Dental College and Hospital at Nerul, Navi Mumbai, from January 2007 to December 2011 was done. Multiple variables were analysed. Localised infections like dentoalveolar infections without space involvement and infection of non-odontogenic cause were excluded from the study.

Results

Analysis of the records was done. Majority of patients were from lower socioeconomic background and were daily wage workers who had either consulted a general physician or a general dental practitioner or had self-medicated themselves before presenting to us with acute symptoms. Early recognition and prompt treatment involving intravenous antibiotics with extraction of involved tooth/teeth and incision and drainage helped in resolution of infections in a span of 72 h. Medically compromised patients had longer duration of hospital stay as compared to the patients who had no underlying medical condition. Majority of space infections involved multiple spaces and local anaesthesia with sedation was found to be the satisfactory mode of anaesthesia. Complications were very few.

Conclusion

We concurred that any form of odontogenic maxillofacial space infection should be rendered prompt and aggressive treatment and hospitalisation should be recommended wherever required.

The surgical management of severe dentofacial infections (DFI)-a prospective study

Dentofacial infections (DFI) lead to morbidity and rarely, mortality. We hypothesised that certain clinical and laboratory parameter factors may be associated with a more severe course and an increased length of stay. We designed a prospective study that included all patients admitted with a DFI to the Oral and Maxillofacial Department between July 2014 and July 2015. A total of 125 were enrolled. We found that serum concentration of CRP on admission and increasing number of fascial spaces involved by the infection were significant predictors of hospital stay (p = 0.02 and p = 0.01, respectively). The average length of stay for a dentofacial infection requiring admission was 4.5 days. Most patients require surgical intervention in combination with intravenous antibiotics for successful resolution. Improved and timely access to primary dental care is likely to reduce the burden for patients their families and the acute hospital service as a consequence of advanced DFI.

The Use of Antibiotics in Odontogenic Infections: What Is the Best Choice? A Systematic Review

PURPOSE

Odontogenic infections are a common problem in dentistry, and their treatment often requires the use of antibiotics besides the removal of the source of infection, which frequently makes it more difficult for clinicians to make a decision regarding the choice of antibiotic. This study aimed to answer the following questions through the Patient, Intervention, Comparison, Outcome (PICO) format: When should antibiotics be used in dental infections (DIs)? Which are the most effective drugs? How long should antibiotics be administered?

MATERIALS AND METHODS

This was a systematic review using the PubMed, Scopus, and Cochrane databases without restriction as to the period researched. The variables analyzed in each article were the number of odontogenic infections in each study, type of study, surgical intervention performed, antibiotics administered, statistical differences between groups studied, and patients' evolution after treatment.

RESULTS

The search included 1,109 articles. After the full reading of 46 articles, 16 were included in the final review and 30 were excluded. A sample of 2,197 DI cases was obtained, in which 15 different antibiotics were used, with a 98.2% overall cure rate.

CONCLUSIONS

The studies showed that antibiotics were prescribed only in situations of regional and/or systemic body manifestations. In the case of DIs, once drainage has been performed and/or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local intervention treatment procedure. When the real need for antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.

A case of labio-facial necrotizing fasciitis complicating acne

BACKGROUND

Facial necrotizing fasciitis is extremely rare. Most of the cases reported in literature are related to dental, sinus, tonsillar and salivary glands causes, but rarely as consequence of skin infection. We report a unique case of lower lip cellulitis, which was initially misdiagnosed as angioedema and subsequently progressed into lower lip necrotizing fasciitis.

CASE PRESENTATION

This is a case report of necrotizing fasciitis involving the lower lip as a consequence of infected skin acne in a 19 year old black female. The patient had been diagnosed earlier as a case of angioedema by a physician and treated accordingly. She was mildly anemic, hyponatremic and hypokalemic. Treatment was started immediately by incision, drainage and full debridement of the whole necrotic tissue. Triple antibiotic therapy was administered and daily irrigation and dressing were performed until full recovery. Complete healing occurred within a month by secondary intention.

CONCLUSION

This case demonstrates the misdiagnosis of a lip swelling leading to the development of labiofacial necrotizing fasciitis, a serious and life threatening condition. Lip angioedema is a common condition; however, lip fasciitis is rare. A broad differential diagnosis in case of lower lip swelling is essential to avoid inappropriate treatment delay.

Detecting Gram-positive anaerobic cocci directly from the clinical samples by multiplex polymerase chain reaction in odontogenic infections

PURPOSE

Gram-positive anaerobic cocci (GPAC) can be isolated as pathogens from odontogenic infections. Culturing GPAC is time consuming and labor intensive. The objectives of the present study were to examine the utility of polymerase chain reaction (PCR) in directly detecting the presence of GPAC in clinical samples obtained from patients with odontogenic infections and to compare the distribution of GPAC in infected and healthy tissue.

MATERIALS AND METHODS

In the present case-control study, the infected tissue from patients and oral mucosal swabs from healthy control subjects were subjected to anaerobic culture and direct PCR analysis for the presence of GPAC. The McNemar, chi-square, and Fisher exact tests and kappa analysis were used for the statistical analyses. P < .05 was regarded as significant.

RESULTS

The patient group included 13 men and 14 women, including 9 patients diagnosed with granulation of tooth extraction, 6 with impacted tooth follicles, 4 with peri-implantitis, 3 with abscesses, 2 with epithelial cysts, 2 with infected cysts, and 1 with an oroantral fistula. The control group included 14 men and 12 women. All the patient and control samples contained at least 1 GPAC. The groups did not differ by method of determining GPAC presence, but more microorganisms were detected when clinical samples were directly used for PCR analysis than when cultured bacteria were used (P = .001).

CONCLUSIONS

The presence of GPAC in infected tissue cannot be directly related to the development of odontogenic infections. PCR performed directly on clinical material is a sensitive and specific method that can detect GPAC and save time.

Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.

Patterns of cervicofacial infections: analysis of the use of computed tomography

OBJECTIVE

The aim of this study was to determine which clinical, microbiological and radiological factors contribute to the need for repeated computed tomography (CT) imaging and surgical drainage.

METHODS

In this retrospective study, medical records of all patients who underwent surgical drainage of cervicofacial infections between January 2006 and August 2010 at a London tertiary referral centre were analysed. Patients who underwent CT due to a clinical suspicion of deep cervicofacial infection were divided into two groups: (1) single CT only and (2) repeated CT imaging. These groups were then compared using Fisher's exact test. Patients requiring return to theatre for additional exploration and drainage of collection were also analysed.

RESULTS

Four hundred and forty-five patients were admitted with cervicofacial infections, of whom 78 patients had a CT scan. The most frequent site of infection was the submandibular space, involving 54 % of patients. Among the patients who underwent repeated imaging compared to those who underwent a single CT scan, the parapharyngeal space was involved significantly more frequently (5/24 vs 2/54, p = 0.03), as was the presence of multiple-space infections (13/24 vs 15/54, p = 0.04) and osteomyelitis (4/24 vs 0/54, p = 0.007). Multiple-space infection was also more frequent in the group who required repeat visits to theatre as compared to those who had a single drainage (7/9 vs 23/69, p = 0.02).

CONCLUSIONS

The majority of cervicofacial infections are managed without the need for CT scanning. Presence of infection in multiple cervicofacial spaces and in the parapharyngeal space and presence of osteomyelitis result in persistent sepsis necessitating repeat imaging and drainage.

Acute cervico-facial infection in Scotland 2010: patterns of presentation, patient demographics and recording of systemic involvement

Acute bacterial cervicofacial infection is a common problem that is most often secondary to dental infection. Most cases present as localised abscesses but some may be associated with serious morbidity including scarring, embarrassment of the airway, SIRS (systemic inflammatory response syndrome), and sepsis syndrome. Fourteen oral surgery or maxillofacial surgery units in Scotland took part in a clinical audit of acute infection during two four-week cycles (August and November) in 2010. Information regarding the patients, signs and symptoms, and management was recorded. Training material was distributed between cycles with information on SIRS, sepsis, and the prescription of antibiotics. Overall, 140 patients presented with acute infection. There was an equal sex distribution and ages ranged from 5 to 87 years. There was an association with deprivation and 36% of patients were from the lowest socioeconomic quintile. Most infections were dental (n=120, 86%), and patients presented with pain and swelling (n=120, 86% and n=134, 96%, respectively) Twenty-three patients (16%) met the criteria for SIRS. A further 23 (16%) had at least one positive SIRS marker with incomplete recording of the remaining markers. Twenty-six patients (19%) had no recorded SIRS markers. Cervicofacial infection can be associated with serious morbidity and mortality, which may be better managed if the systemic signs and symptoms of sepsis are recognised and recorded at presentation. This study showed that the recording of signs of sepsis was variable even with training. Further training of junior staff to recognise severe acute bacterial infection may improve management.

Oral cancer teaching of medical students in the UK: time for a new approach?

Many patients with oral lesions present to general medical practitioners (GMPs). GMPs are also more likely to see patients with higher oral cancer risk. Therefore, GMPs play an important role in the early detection and prevention of oral cancer but is this reflected in undergraduate medical teaching. A questionnaire regarding oral cancer teaching was delivered to the curriculum directors of all UK medical schools. A response rate of 66% was achieved. There was wide variation in teaching time, teaching methods employed, and specialties involved. Sixty percent of schools provided clinical examination of patients with oral lesions. Up to 55% of medical schools included oral cancer in student assessment. There is wide variation in oral cancer teaching in UK medical schools. There is a need to develop a curriculum that addresses the important aspects of oral cancer from an evidence-based consensus approach.

Changes in admission rates for spreading odontogenic infection resulting from changes in government policy about the dental schedule and remunerations

The government changed the system of payment to general dental practitioners on 1 April 2005 from a fee/item to a banding system. The figures collected have shown that there has been a 62% increase in the number of patients who require admission for surgical treatment of spreading odontogenic infections compared with the 3-year period before this date.