Secondary care burden

Here’s a letter from the current BDJ regarding the rise in hospital admissions for the treatment of dental abscesses. Could it be any coincidence that the “new” dental contract started on April 1st 2006? Step forward the honoured CDO who has just been given the confidence of a grateful government.

British Dental Journal 213, 491 (2012)
Published online: 23 November 2012 | doi:10.1038/sj.bdj.2012.1048

Secondary care burden
S. King(1), A. Kanatas(1) & L. M. Carter(1)

Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS e-mail:
Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.
Readers may now comment on letters via the BDJ website ( A ‘Readers’ Comments’ section appears at the end of the full text of each letter online.

Sir, we are writing with concern regarding the continued increase in the number of odontogenic abscesses presenting to secondary care.

Local and national audits have shown a marked increase in patients presenting to secondary care with odontogenic infection since 1999.1, 2

Patient admissions for odontogenic abscesses at Leeds General Infirmary have continued to increase in number since 2006; the number of admissions has increased four fold from 48 in 2006 to 198 in 2011 (Fig. 1).

Figure 1: Odontogenic abscess admissions over time

The distribution of those presenting with odontogenic abscesses pre and post the introduction of the 2006 NHS dental contract is statistically significant, χ2 = 85.86, df = 5, p <0.0001, with this trend continuing to rise.

This rise will only result in more pressure on the already stretched secondary care system, with an increasing workload for Accident and Emergency departments and on emergency theatre facilities.1

Explanations for the continuing increase in admissions are varied and complex. Further work is clearly required to identify the main reasons but difficulty of access to NHS or emergency dental care is still widely described. Reduction in initial operative intervention for dental abscesses in primary dental care is also implicated. These issues are potentially due to changes in remuneration upon introduction of the new contract in 2006 causing a reduction in the amount of NHS treatment carried out by GDPs.3

In this time of austerity and reduction in hospital bed numbers, the avoidable increase in admissions for odontogenic abscesses is causing an ever-increasing demand on already limited resources. This trend shows the importance of enhanced communication between the primary and secondary care settings, and an increase in emergency funding for our GDP colleagues to reduce the burden on secondary care.


  1. Carter L, Starr D. Alarming increase in dental sepsis. Br Dent J 2006; 200: 243. | Article | PubMed |
  2. Thomas S J, Atkinson C, Revington P. Is there an epidemic of admissions for surgical treatment of dental abscesses in the UK? BMJ 2008; 336: 1219–1220. | Article | PubMed |
  3. Carter L M, Layton S. Cervicofacial infection of dental origin presenting to maxillofacial surgery units in the United Kingdom: a national audit. Br Dent J 2009; 206: 73–78. | Article | PubMed | CAS |

1. Leeds


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