Sepsis is a critical condition that arises when the body's immune system reacts excessively to an infection. This extreme response can cause damage to the body’s own systems, potentially leading to shock and multiple organ failure. If not identified and treated quickly, sepsis can result in death. Early recognition and prompt treatment are essential for improving outcomes.
Sepsis is usually the result of a bacterial infection, but can also be caused by viruses, parasites or fungi. Sufferers will generally require hospital treatment, and depending on the cause, may be treated with antibiotics, fluids, oxygen, medications and where needed to remove a source of infection, surgery.
Although deaths from sepsis due to odontogenic infection are rare it remains a possibility. Cases of sepsis are on the rise globally, and there is always a potential risk in any healthcare setting which should be mitigated carefully. As sepsis can arise from a range of infections, excellent dental infection control is vital to safeguard patients. Cross contamination is possible through poorly maintained/sterilised instruments as well as improper disinfection of shared surfaces and furniture.
As important, is maintaining an awareness of the signs and symptoms. Early recognition and timely intervention can significantly improve the chances of recovery and reduce the risk of severe complications.
Prevalence of sepsis
In the UK, there are estimated to be around 245,000 cases of sepsis, and approximately 48,000 deaths due to the condition every year. In 2017, 48.9m cases of sepsis and 11m sepsis-related deaths were reported globally– about 19.7 per cent of all recorded deaths.
While the incidence of sepsis has dramatically increased over the past several decades, mortality rates have fallen. The rise in cases has been attributed to an aging population with a higher prevalence of predisposing health conditions, more frequent use of immunosuppressants, a greater frequency of invasive surgical procedures, and the spread of drug-resistant pathogens. The decline in mortality rates is attributed to an improved recognition of symptoms, and faster treatment.
Sepsis can affect anyone but tends to pose a greater risk to vulnerable people, including those with a weakened immune system, who are immunosuppressed, and very young, old or frail people.
Sepsis within the dental setting
An odontogenic infection is an infection that originates from a tooth or from its supporting structures. Though rarely the case due to improvements in infection control, odontogenic infections can lead to sepsis. Patients presenting with an infection should be routinely checked for sepsis, however, patients with non-odontogenic-related infection can present with sepsis at a dental practice, so it is important to recognise the signs.
Symptoms can include mottled skin, cyanosis, changes to blood pressure and body temperature, tachycardia, rapid breathing, mental confusion, slurred speech, nausea and vomiting, diarrhoea, urine cessation, severe muscle pain and a non-blanching rash. It is important to stay abreast of current specific guidelines according to the different ages and vulnerabilities presented by patients, and to be aware of when emergency protocols should be observed.
When treating odontogenic infections, clinicians must exercise caution to prevent the spread of infection. For example, when conducting root canal treatment (RCT), dentists should eliminate the source of infection; make incisions on healthy skin or mucosa; not damage vital structures during exploratory dissection; irrigate copiously; and provide adequate drainage to keep the abscess cavity open. The use of a rubber dam is also highly recommended to further reduce the risk of infection during endodontic treatment.
Decontamination procedures
Committing to best practice in all decontamination protocols helps to prevent the spread of infection and can reduce the risk of sepsis. To prevent cross-contamination, dental practices should ensure all policies and procedures are effective and up to date, complying with the Health Technical Memorandum 01-05: decontamination in primary care dental practices. When reprocessing handpieces, for example, clinicians are advised to use a validated steriliser suitable for the instrument according to manufacturer’s instructions.
W&H offers a range of high-end, easy-to-use sterilisers that facilitate best practice in meeting infection control guidelines for the safe and effective reprocessing of instruments. The Lisa Mini 5L vacuum pump autoclave from W&H is an excellent choice for rapid reprocessing. This incredibly quick type B and S steriliser can process wrapped instruments in 23 minutes, and unwrapped loads can be ready for use in 10 minutes.
Maintaining a current awareness of the signs and symptoms of sepsis is vital in ensuring patients gain access to care as quickly as possible. Implementing preventive measures against infections, including proper hygiene practices and other best practices for infection prevention and control in the dental setting, is also essential for decreasing the incidence of sepsis.
References available on request.
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