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Over prescribing of antibiotics in dentistry

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Over prescribing of antibiotics in dentistry

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Since the discovery of penicillin, the first antibiotic, by Alexander Fleming in 1928 and its subsequent introduction to clinical practice by Florey in 1940, antibiotics have been used extensively in dentistry. Interestingly from a dental perspective, one of the first reports of the clinical effectiveness of penicillin involved the successful treatment of a patient with cellulitis and angular cheilitis. However, while many bacterial species were initially found to be sensitive to penicillin, there has been a gradual and sustained emergence of resistant strains. Similar patterns of reducing susceptibility have been observed for all types of antibiotic that have subsequently been developed during the past 50 years. We have now entered an era where some bacterial species are resistant to the full range of antibiotics presently available. Perhaps the most widely known example of extensive resistance is methicillin-resistant Staphylococcus aureus (MRSA), also known commonly as a 'superbug'. MRSA is rarely out of the national press due to its association with severe infection and death in hospitalised patients. The impact of the loss of antibiotics as effective agents in the treatment of human infection cannot be over-emphasised and this truly represents a potential medical disaster.

The emergence of antibiotic resistance

It is from the background of the worldwide emergence of antibiotic resistance that the European Centre for Disease Prevention and Control (ECDC) marked Tuesday 18 November 2008 as the first ever European Union Antibiotic Awareness Day in an attempt to improve the use of antibiotic therapy within the community and the healthcare professions. Of the 40 million oral courses of antibiotics dispensed in England each year, a significant proportion (over three million) is prescribed by dentists. Antibiotics account for the vast majority of medicines prescribed by dentists, with analgesics, antifungals and antiviral agents accounting for a small proportion of prescriptions. In 2004, a survey of over 6,000 general dental practitioners in the UK revealed that 40% of dentists were prescribing antibiotics on at least three occasions every week. The research also revealed that 15% of the dentists prescribed antibiotics on a daily basis. However, it is increasingly being accepted that such prescribing habits are often either inappropriate or unnecessary. A study of 500 patients presenting at a secondary care dental emergency unit demonstrated that 57% had been provided with an antibiotic in the absence of a recognised clinical indication for such medication. Furthermore, clinical audits have shown that prescribing an antibiotic makes no difference to the outcome of treatment of acute dental infection if drainage is established. Unfortunately it is well recognised that patients are also routinely provided with one or more antibiotics in these circumstances, despite the availability of range of guidelines advising against this practice.

The spectrum of antibiotics used in dentistry in the United Kingdom is fortunately small, with amoxicillin and phenoxymethylpenicillin having been the two drugs most frequently prescribed during the past 25 years. There is now clear evidence linking the dental prescribing of these antimicrobial agents to the emergence of penicillin resistance in the community. Perhaps of greater concern are the susceptibility surveillance studies that have demonstrated that the incidence of penicillin resistance within the microflora of acute dental infections has risen from a relatively low level of 5% of abscesses to more than 55% of cases in the past decade. Coincidently at the same time, maxillofacial surgery units are reporting an increase in the number of severe cases of dental infection requiring admission for management. The figures for England show that admissions for 'drainage of an abscess related to tooth' has doubled from just under 800 in 1998 to almost 1,600 in 2006. Although it has been postulated that this increase may in part reflect reduced access to primary dental care, it may also reflect the emergence of resistance to first line antibiotic therapy. Unfortunately, culture and sensitivity of pus specimens from dental infections is not routinely undertaken in the vast majority of hospitals and this has severely limited the availability of antimicrobial resistance data. The majority of dental healthcare workers are likely to be unaware that at least one patient a month dies in the United Kingdom due to unsuccessful management of acute dental infection.

Reducing dental prescriptions

Two of the main factors associated with development of resistance are duration of therapy and dose of drug. Individuals within the community can harbour resistant bacterial strains for up to three months following antibiotic usage and as such, represent a high level of resistance within the general population. If the number of prescriptions issued in dentistry could be reduced then the selection of resistant strains should occur less frequently. It has recently been shown that reducing antibiotic prescribing for urinary tract infections at the general medical practice level resulted in a reduced incidence of resistance in the local community. This observation is extremely important since it does demonstrate to individual practitioners that modifying their prescribing habits can influence patterns of resistance. The same beneficial effect would probably be observed for dental practitioners if they reviewed their prescribing for dental conditions.

It is important that not only the dental profession but the general public understand the importance of restricting the use of antibiotics to those true cases of severe infection that require them. Patients have become accustomed to being given an antibiotic for a range of medical complaints. Unfortunately, patients presenting at dental surgeries also routinely expect an antibiotics for the treatment of 'toothache'. It is difficult to explain to the patient, and occasionally their relatives, that dental pain is an inflammatory condition that is appropriately managed by use of analgesics and local measures and not a bacterial infection that requires provision of an antibiotic. The same problematic situation is frequently encountered in general medical practice, where patients with dental pain request the provision of an antibiotic.

Convincing patients and professionals

In the United Kingdom, the Advisory Committee for Antimicrobial Resistance and Hospital Associated Infection (ARHAI) is working to help encourage the development of more formal systems to monitor both hospital and community prescribing. Equally important would be the collection of information that demonstrates the successful clinical outcome of the 'no antibiotic prescribing' option. All efforts must be made to convince patients, families, dentists and doctors that it is both appropriate and safe to treat toothache and the majority of acute dental conditions without the use of an antibiotic. This will require investment in auditing systems to show that low prescribing rates are best practice. There is no doubt that achieving low prescribing rates will be a considerable challenge to the profession due to the pressure exhibited by patients expecting antibiotic therapy.

In summary, there is an urgent need to raise public and professional awareness regarding the risks of antibiotic use not only in dentistry but all aspects of medical care. The establishment of an EU Antibiotic Day is an excellent start and it is hoped that this opinion article will inspire dental professionals to think about the necessity to prescribe an antibiotic and also, if they do write a prescription, the implications of their actions. If the profession and public respond responsibly to the issues surrounding antibiotic prescribing now, it may be possible to preserve the usefulness of these drugs for clinical situations where they are truly indicated. Ignoring these problems will undoubtedly result in an increase in incidence of untreatable dental infections and most importantly, death of patients from dental disease in the future.

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Why we must reduce dental prescription of antibiotics: European Union Antibiotic Awareness Day

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The prescription of antibiotics in dentistry is relatively small but nonetheless significant. With the emergence of bacterial species resistant to antibiotics there is a need to become vigilant about their prescription and with this, an urgent requirement for both professional and public understanding of the appropriate use of this life-saving component of treatment.

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Dementia-Friendly Dentistry: Good Practice Guidelines enables dental professionals to understand dementia and its implications for dental practice, and adapt their patient management and clinical decisions accordingly. It is available:
"Dentists have a crucial role to play in the community for people with dementia. These guidelines are an important step to helping more people live well with their condition, and we hope that dentists across the UK will put them into practice." Alzheimer's Society
The number of people living with dementia in the UK is currently estimated at 850,000 - 5% of the population - and Dementia-Friendly Dentistry offers guidance on how to care for this signifiicant patient group, including:

The epidemiology and diagnosis of dementia, and its implications for dental professionals.

Principles of care management, including patient identification, competence and referrals, communication, consent and capacity.

Clinical care, including history taking, treatment planning, care delivery and prescribing.

Site-specific considerations for dental practices, care homes and domiciliary care.

The new book also signposts readers to local support, educational programmes and resources for patients, and contains over 50 recommendations for practitioners, categorised using the Faculty's 'ABC' (Aspirational, Basic, Conditional) grading system.

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Dementia-Friendly Dentistry: Good Practice Guidelines enables dental professionals to understand dementia and its implications for dental practice, and adapt their patient management and clinical decisions accordingly. It is available: "Dentists have a crucial role to play in the community for people with dementia.

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Your health care professional will ask if you have a cough, if you have a lot of sputum and if your breathlessness is brought on by anything. They'll also ask how your daily life is affected and other questions about your general health.

They'll ask if you've smoked and if you've been exposed to dust, fumes or chemicals.

Spirometry

To get an accurate diagnosis, you should have a simple test called spirometry. This involves blowing hard into a machine that measures the total amount of air you can breathe out, called your lung capacity, and also how quickly you can empty your lungs. The measure used is called the forced expiratory volume in one second, often shortened to FEV1. Healthy people can empty at least 70% of the air from their lungs in the first second of a hard blow out.

Spirometry only covers one aspect of your lung function. People with the same spirometry result may be more or less breathless depending on their level of fitness, any other medical problems and the exact way COPD has damaged their lungs.

Chest X-ray and blood test

For the vast majority of people, a firm diagnosis of COPD can only be confirmed by spirometry. It will not be made on a chest X-ray finding on its own. Your health care professional should arrange for you to have a chest X-ray and blood test to rule out other causes of your symptoms.

BMI calculation

Your doctor will calculate your body mass index (BMI) to find out if you're a healthy weight. This is important because you can deal with your COPD better if you're not underweight or overweight.

Your health care professional may want to get a better picture of your condition and how it affects you, including:

You may be referred to see a specialist doctor or a specialist nurse to confirm the diagnosis or to work out the right treatment for you.

You may also see other health care professionals who can help you to manage your condition:

physiotherapists - to help you deal with your sputum, control your breathing and keep active

dieticians - to help you manage your weight

occupational therapists - to help make your daily living easier

counsellors or talking therapists - to help your mental wellbeing

smoking cessation advisors - if you smoke, to help you quit

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How is COPD diagnosed? - British Lung Foundation

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Your health care professional will ask if you have a cough, if you have a lot of sputum and if your breathlessness is brought on by anything. They'll also ask how your daily life is affected and other questions about your general health.

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Association of dental implantology

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The Association of Dental Implantology has a dedicated website, 'Considering Dental Implants' for Patients to be able to find unbiased information about implant treatment.

The Great Debate. Current Dilemmas in Dental Implantology. 5 - 8 May 2021, Manchester Central. Programmes for the whole dental team. Save the Date!

ADI membership is open to all members of the dental team and we offer a range of benefits to suit everyone. Find out more about membership and join online today.

Unfortunately the ADI Study Club meetings planned to the end of June 2020 have been postponed owing to the Coronavirus pandemic.

Details of rearranged meetings will be posted on the website at a later date.

View Events & Courses Calendar

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The Association of Dental Implantology has a dedicated website, 'Considering Dental Implants' for Patients to be able to find unbiased information about implant treatment. The Great Debate. Current Dilemmas in Dental Implantology. 5 - 8 May 2021, Manchester Central. Programmes for the whole dental team. Save the Date!

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Smoking and respiratory disease

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Dentures are removable dental appliances designed to replace some or all of the teeth in a dental arch. When an individual loses their teeth, their jawbone remodels and shrinks over time. This can make it difficult for their denture to fit snugly and comfortably. Dentists found that by attaching the denture to either the remaining teeth in the mouth or to dental implants, they could better stabilize it. This appliance is called an overdenture.

Benefits of Overdentures

An overdenture is a complete or partial denture that sits on top of or is attached to underlying tooth structures or dental implants. According to a study in the Journal of Oral Research and Review, overdentures can reduce shrinkage of the jawbone and redirect forces and pressure in the mouth, helping the dentures stay stable. For patients with dental-related conditions, such as cleft palate, oligodontia (absence of more than six teeth in primary, permanent or both types of teeth), cleidocranial dysostosis (abnormal development of bones in the skull and clavicle area) and Class III occlusion, overdentures may be especially useful.

In general, overdentures provide improved function and retention when compared to conventional dentures, which may become unstable over time or require refitting. Overdentures, which are made from acrylic, can help preserve the surrounding bone and ensure that the patient has an appliance that will last. Like other dentures, overdentures are removable.

Tooth-Supported Overdentures

Overdentures can be placed over retained teeth or dental implants. If the patient has teeth present, overdentures may be a good option because the appliances may not require teeth extraction, a procedure that can make some patients anxious. With this treatment, they can rest assured that they are retaining some of their natural teeth.

Most commonly, overdentures are supported by the canine teeth. The teeth undergo root canal treatment, after which they are connected with a metal bar or kept individually with an attachment placed on them that fits into the base of the overdenture. This can be done for both the upper and lower jaws.

Implant-Supported Overdentures

Some dentists consider it more predictable and cost-effective to use two dental implants to support overdentures instead of two natural teeth. Keep in mind that upper or lower dentures - if still in good condition - can be converted to overdentures supported by dental implants. The dentist will place implants in the area where the canines used to be. Then the implants can be connected with a metal bar or be individually restored with an attachment that fits into the overdenture.

Overdenture Care

To avoid developing cavities and gum disease, patients with overdentures must maintain a thorough oral hygiene routine, reports the Journal of Oral Research and Review study. They should remove the dentures at night and clean around all the attachments in the mouth. It's best to follow the advice of your dentist and see them for regular checkups and professional hygiene appointments to ensure your gums remain healthy and your appliance fits well.

If you will be getting your first set of dentures, discuss the option of overdentures with your dentist. Your dentist will help ensure that you are making the best decisions for your oral health and guide you on how to best care for your new smile.

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What Is an Overdenture? | Colgate® Oral Care

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Dentures are removable dental appliances designed to replace some or all of the teeth in a dental arch. When an individual loses their teeth, their jawbone remodels and shrinks over time. This can make it difficult for their denture to fit snugly and comfortably.

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Welcome to the BACD | The British Academy of Cosmetic Dentistry

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The BACD's mission is to make a difference to people's lives by providing exceptional, ethical cosmetic dentistry.

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The Straumann® Dental Implant System designed for simplicity and freedom of choice.

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The Dental Defence Union (DDU) is warning members to be cautious when considering accepting gifts from a patient or professional contact this festive season. Although it can be touching to receive a token of appreciation from a patient or a treat from a professional contact, it is important that dental professionals make sure that this does not impact their impartiality or affect their professional judgement.

Leo Briggs, dento-legal adviser at the DDU says,

'Dental professionals are always pleased to hear positive feedback and thanks from a happy patient and at Christmas time this may come in the form of a gift. However it is important to remember that accepting a gift from a patient could be misconstrued. While a box of biscuits or a bottle of wine is unlikely to be looked upon as anything more than a kind gesture, accepting something more substantial may be considered inappropriate and the dental professional's motives could be called into question.

'At the same time, even small gifts could ring alarm bells in the context of other behaviour, for example, if the dental professional suspects that the patient has romantic feelings and in such circumstances, the gift may be best declined.

'GDC guidance states that you must refuse any gifts, payment or hospitality if accepting them could affect, or could appear to affect, your professional judgment. With this in mind, dental professionals should weigh up the impact of accepting a gift from a patient and may wish to consider declining the gift if they feel that their reasons for accepting could be misconstrued or if the patient is likely to think that the gift will have an impact on their clinical care.'

While patients may wish to express their gratitude to a member of the dental team by giving a gift, professional contacts, such as pharmaceutical suppliers may want to treat dental professionals to hospitality such as meals out, hampers or even theatre tickets. This can be particularly problematic as it could be perceived as a bribe in exchange for prescribing certain medicines or using a particular supplier.

'Section 300 (4) of the Human Medicines Regulations Act 2012 states that a person qualified to prescribe or supply medicinal products may not solicit or accept any gift, pecuniary advantage, benefit or hospitality, unless it is inexpensive and relevant to medical practice. This includes sponsorship of attendance at a meeting or event and the payment of travel or accommodation expenses.'

Leo concludes,

'No dental professional wants to appear ungrateful or offend a patient or professional contact by declining a kind offer of a gift but it is important that they think carefully before accepting and make sure that their intentions cannot be misunderstood.'

This page was correct at publication on 14/12/2015. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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Be cautious when accepting gifts this Christmas

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The Dental Defence Union (DDU) is warning members to be cautious when considering accepting gifts from a patient or professional contact this festive season. Although it can be touching to receive a token of appreciation from a patient or a treat from a professional contact, it is important that dental professionals make sure that this does not impact their impartiality or affect their professional judgement.

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BDDF – Body Dysmorphic Disorder Foundation

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Together, we can relieve suffering for people with BDD, while advancing research, treatments and awareness of the condition.

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Flu is an unpredictable virus that can be unpleasant, but if you're otherwise healthy it'll usually clear up on its own within a week.

It can cause severe illness and even death among vulnerable groups, including older people, pregnant women and people with an underlying health condition.

Certain people are more likely to develop potentially serious complications of flu, such as bronchitis and pneumonia.

These people are advised to have a flu vaccine each year.

Flu can be very unpleasant for otherwise healthy people, but most people will recover from flu within a week or 2.

People who should have a flu vaccine

The injected flu vaccine is offered free of charge on the NHS to people who are at risk.

This is to help protect them against catching flu and developing serious complications.

You should have the flu vaccine if you:

are 65 years old or over

are pregnant

have certain medical conditions

are living in a long-stay residential care home or another long-stay care facility

receive a carer's allowance, or you're the main carer for an elderly or disabled person whose welfare may be at risk if you fall ill

Frontline health and social care workers are also eligible to receive the flu vaccine. It's your employer's responsibility to arrange and pay for this vaccine.

You may also be able to have the flu vaccine at your GP surgery or a local pharmacy offering the service if you're a frontline health or social care worker employed by a:

registered residential care or nursing home

registered homecare organisation

hospice

Flu vaccine for children

The flu vaccine is free on the NHS for:

children over the age of 6 months with a long-term health condition

children aged 2 and 3 years on 31 August 2019 (that is, born between 1 September 2015 and 31 August 2017)

children in primary school

Children aged between 6 months and 2 years who are eligible for the flu vaccine will receive an injected flu vaccine.

Children eligible for the flu vaccine aged between 2 and 17 will usually have the flu vaccine nasal spray.

65s and over and the flu vaccine

You're eligible for the flu vaccine this year (2019-20) if you're aged 65 and over on 31 March 2020 - that is, you were born on or before 31 March 1955.

So if you're currently 64 but will be 65 on 31 March 2020, you do qualify.

It's important that you benefit from having the most effective vaccine.

For those aged 65 and over this is either the adjuvanted trivalent vaccine or the cell-grown quadrivalent vaccine.

Pregnant women and the flu vaccine

If you're pregnant, you're advised to have the injectable flu vaccine, regardless of the stage of pregnancy you have reached.

That's because there's strong evidence to suggest pregnant women have an increased risk of developing complications if they get flu.

If you're pregnant, you'll benefit from the flu vaccine because:

it reduces your chance of getting serious complications of flu, such as pneumonia, particularly in the later stages of pregnancy

it reduces your risk of having a miscarriage, or your baby being born prematurely or with a low birthweight, because of flu

it'll help protect your baby, as they'll continue to have some immunity to flu for the first few months of their life

It's safe to have the flu vaccine at any stage of pregnancy from conception onwards.

Talk to a GP, midwife or pharmacist if you want more information.
Find out more about the flu vaccine in pregnancy
Flu vaccine for people with medical conditions

The injected flu vaccine is offered free of charge on the NHS to anyone with a serious long-term health condition, including:

chronic (long-term) respiratory diseases, such as asthma (that requires an inhaled or tablet steroid treatment, or has led to hospital admission in the past), chronic obstructive pulmonary disease (COPD), emphysema or bronchitis

chronic heart disease, such as heart failure

chronic kidney disease

chronic liver disease, such as hepatitis

chronic neurological conditions, such as Parkinson's disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy

problems with your spleen - for example, sickle cell disease or if you have had your spleen removed

a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy

being seriously overweight (a BMI of 40 or above)

This list of conditions is not definitive. It's always an issue of clinical judgement.

A GP can assess you to take into account the risk of flu making any underlying illness you may have worse, as well as your risk of serious illness from flu itself.

The vaccine should always be offered in such cases, even if you're not technically in 1 of the risk groups.

If you live with someone who has a weakened immune system, you may also be advised to have a flu vaccine.

Speak to a GP or pharmacist about this.

GOV.UK also provide Easy Read guides to flu vaccination for people with a learning disability.

Flu vaccine for health and social care workers

Outbreaks of flu can occur in health and social care settings, and because flu is so contagious, staff, patients and residents are all at risk of infection.

If you're a frontline health and social care worker, you're eligible for an NHS flu vaccine.

It's your employer's responsibility to arrange vaccination for you. Find out what arrangements have been made at your workplace for providing flu vaccination.

If you're an NHS-employed frontline healthcare worker, the NHS will pay for your vaccination.

You may be able to have the flu vaccine at your GP surgery or a local pharmacy offering the service if your employer does not offer a flu vaccination programme and you're a frontline health or social care worker employed by a:

registered residential care or nursing home

registered homecare organisation

hospice

The flu vaccine will help protect you, your colleagues and the patients and residents you care for.

Flu vaccine for carers

If you're the main carer for someone who's elderly or disabled, speak to a GP or pharmacist about having a flu vaccine along with the person you care for.

Read more about the flu vaccine for carers on the Carers UK website.

Types of flu vaccine available

There are several types of flu vaccine.

You'll be offered 1 that's most effective for you, depending on your age:

children aged 2 to 17 in an eligible group are offered a live attenuated quadrivalent vaccine (LAIV), given as a nasal spray

adults aged 18 to 64 who are pregnant, at increased risk from flu because of a long-term health condition, or a frontline health or social care worker are offered a quadrivalent injected vaccine - the vaccine offered will have been grown either in eggs or cells (QIVe or QIVc), both of which are considered to be equally suitable

adults aged 65 and over will be offered either an adjuvanted trivalent injected vaccine grown in eggs (aTIV) or a cell-grown quadrivalent injected vaccine (QIVc) - both vaccines are considered to be equally suitable

If your child is aged between 6 months and 2 years and is in a high-risk group for flu, they'll be offered an injected flu vaccine as the nasal spray is not licensed for children under 2.

Talk to a GP, practice nurse or pharmacist for more information about these vaccines.

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Flu is an unpredictable virus that can be unpleasant, but if you're otherwise healthy it'll usually clear up on its own within a week. It can cause severe illness and even death among vulnerable groups, including older people, pregnant women and people with an underlying health condition.

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Sepsis is the body's overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. Medically, sepsis is your body's immune system overresponding to an infection.

Spot the symptoms

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The UK Sepsis Trust Home Page | What is Sepsis? | Sepsis Symptoms

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Our goal is to end preventable deaths from sepsis and improve outcomes for sepsis survivors. We believe that earlier diagnosis and treatment across the UK would save several thousand lives a year.

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Pneumonia is a type of chest infection. It affects the tiny air sacs in your lungs, called alveoli. When you have pneumonia, these air sacs get inflamed and fill with fluid. This makes it harder for you to breathe.

More people get pneumonia in winter. This is because respiratory viral infections that spread easily from person to person, such as flu, are more common in the winter, and these increase your risk of developing pneumonia.

If you have a long-term lung condition, or care for someone who does, it's a good idea to have a flu jab every year. Flu can be very serious, and cause complications such as pneumonia.

The flu vaccine is usually free for people at risk and is available from your GP and many high street chemists. It's best to have your vaccine before the flu virus starts to circulate, which is usually mid-December.

Most people with pneumonia can be completely cured. But it can be life-threatening, and you should take it seriously even if you're young and fit.

This page includes:

What causes pneumonia?

Many kinds of bacteria and viruses can cause pneumonia.

The most common type of pneumonia is community-acquired pneumonia, which is when pneumonia affects somebody who is not already in hospital. The most common cause of community-acquired pneumonia is a bacterium called Streptococcus pneumoniae but there are many other causes. Community-acquired pneumonia is much less contagious than flu or a cold, because most people's immune systems can kill the bacteria that causes it before they can cause an infection. Most people with community-acquired pneumonia are unlikely to give the disease to another person.

As well as community-acquired pneumonia, other types include:

Hospital-acquired pneumonia: this is when pneumonia develops while you're in hospital being treated for another condition or having an operation. People in intensive care on breathing machines are at most risk.

Viral pneumonia: common causes include the flu in adults and respiratory syncytial virus, particularly in children; this form of pneumonia is often contagious and can spread to affect others

Aspiration pneumonia: this is when pneumonia is caused by food going down the wrong way, or inhaling vomit, a foreign object or harmful substance. It's fairly common in the elderly, or people who have conditions that cause swallowing difficulties or reduced level of consciousness

Fungal pneumonia: this is when pneumonia is caused by fungi. It's rare in the UK and more likely to affect people with a weakened immune system

You might also hear the term ' double pneumonia '. This means when you get pneumonia in both lungs. It's a term used in America.

Can you catch pneumonia more than once?

Yes. Pneumonia is caused by many different microbes, and so getting it once does not protect you from getting it again. If you get pneumonia more than once you may need to have more investigations to understand why this has happened. It could be due to a problem in your chest or your immune system, and you may be referred to a specialist.

What are the symptoms of pneumonia?

If you have pneumonia, you'll have symptoms that are similar to having flu or a chest infection. Symptoms may develop gradually over a few days but can progress much faster.

The main symptom is coughing. You may feel generally unwell, weak and tired, and you'll probably have at least one of these symptoms too:

coughing up mucus that may become yellow or green

a high temperature - you might also sweat and shiver

difficulty breathing or getting out of breath quicker than normal

chest pain or discomfort

loss of appetite

Even if you have pneumonia, you may not have all these symptoms.

More severe cases may also cause:

quick breathing

confusion

low blood pressure

coughing up blood

rapid heartbeat

nausea and vomiting

Some people get a sharp pain in their chest when they breathe in and out. This may be because the thin lining between the lung and ribcage, called the pleura, is infected and inflamed. This inflammation, called pleurisy, stops your lungs moving smoothly as you breathe.

The symptoms of pneumonia are often very similar to those of other chest infections, such as bronchitis, COPD flare-ups or bronchiectasis flare-ups. To get a proper diagnosis you'll need to visit your GP.

If you feel unwell with these symptoms, see your GP or call 111. If you have chest pain, a rapid heartbeat, quick breathing, shivers or confusion, get urgent advice from your GP or call 999. Take extra care if you're over 65.

Who is most at risk of pneumonia?

You can get pneumonia at any age. Each year in the UK, about 5-11 adults out of every 1,000 get pneumonia.

Some groups of people are at higher risk from pneumonia. If you're in one of these groups, you should take extra care to reduce your chances of catching pneumonia.

People in these at-risk groups include:

babies and young children

people over 65

people with long-term heart, lung, brain, liver or kidney diseases, or diabetes

people with cancer, especially those having chemotherapy

people who smoke or drink alcohol to excess

people on drugs that suppress the immune system, and those with HIV

People in hospital for other problems sometimes develop pneumonia while they're there. This can be for several reasons including the use of mechanical ventilators, recent antibiotic use or because their resistance to infection has been weakened by other medical problems.

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What is pneumonia? - British Lung Foundation

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Pneumonia is a type of chest infection. It affects the tiny air sacs in your lungs, called alveoli. When you have pneumonia, these air sacs get inflamed and fill with fluid. This makes it harder for you to breathe. More people get pneumonia in winter.

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Long-term physical conditions such as diabetes, arthritis or asthma can have a significant impact on your mental health.
*Last updated: 22 July 2021
Our physical and mental health are closely linked. Those of us who have a long-term physical health condition are also likely to experience mental health problems such as depression and anxiety.

This doesn't mean mental ill-health is inevitable though, or that you have to put up with it. There is support available as well as things you can do to help yourself.

What do we mean by long-term physical conditions?

Long-term physical conditions are those which can't currently be cured but can be managed with medication or other treatment. They are also known as chronic conditions. Examples include diabetes, asthma, arthritis, epilepsy, chronic fatigue syndrome and high blood pressure.

More than 15 million people in England have one or more long-term physical conditions. They're more common in older people (58% of people over 60 compared to 14% of people under 40) and in more deprived groups, but anyone can be affected.

You may find having a long-term physical condition affects many areas of your life, including your relationships, your ability to work, your finances and your mental health.

How can a long-term physical condition affect my mental health?

Having a long-term physical condition can lead to social isolation, low self-esteem, stigma and discrimination. You may feel tired, frustrated, worried or stressed, especially when dealing with pain, tests, treatments or flare ups.

All of these things can make you more likely to develop a mental health problem such as depression or anxiety. In fact, research shows that people with a long-term physical condition are more than twice as likely to develop mental ill-health. Mental health problems can then make it harder for you to cope with your physical health condition.

You don't have to put up with mental health problems or think they're just part of having a long-term condition. Speak to your GP about how you're feeling and ask about different treatments to find one that's right for you.

Getting support

Our page on physical health and mental health has ideas on how you might be able to help yourself, although some of these things might feel more difficult if you're physically unwell. You may also find the following helpful when dealing with a long-term health condition.

Talk to friends and family

Some symptoms of a long-term condition such as tiredness and pain aren't always visible. Other people might not realise what you're going through. If you can, talk to someone you trust about how you're feeling and what support you need.

Find a support group

Support groups let you connect with other people who have the same long-term condition. You can share experiences, problems, tips and support. The Befriending Directory lets you search for support groups for specific health conditions.

Try talking therapy

Talking to a counsellor or therapist may help you manage your symptoms better or acknowledge the reality of your condition if you're finding it hard to accept, for example. Ask your GP if they can refer you for counselling.

Cognitive behavioural therapy for pain management

If you're in pain, cognitive behavioural therapy (CBT) may help you change how you think, feel and behave about it. It can help you manage your pain better and feel more in control, even if your level of pain doesn't change. Ask your GP if they can refer you. NHS Inform has an online self-help guide for chronic pain.

Contact an organisation that supports people with your health condition

Having reliable information about your condition, treatment and management can help you feel more positive and in control. Some organisations may also offer practical, financial or emotional support. Some examples include:

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Long-term physical conditions and mental health

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Long-term physical conditions such as diabetes, arthritis or asthma can have a significant impact on your mental health. *Last updated: 22 July 2021 Our physical and mental health are closely linked. Those of us who have a long-term physical health condition are also likely to experience mental health problems such as depression and anxiety.

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Dental anxiety in relation to aggressive behaviour

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Dental anxiety in relation to aggressive behaviour

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Visit Lancashire's Biggest Mobility Store

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Mobility Smart - Be Smart and Save money on Mobility Aids

Now in our 15th year, at Mobility Smart, you can trust us to bring you the best mobility deals, at the lowest prices. We're committed to making your shopping easy and enjoyable. We only select products rigorously tested for quality, so you're getting the best deal, on the very best products.

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Mobility Aids, Equipment, Scooters from Mobility Smart UK Mobility Smart

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JavaScript seems to be disabled in your browser. For the best experience on our site, be sure to turn on Javascript in your browser. Unlike many online only stores, at Mobility Smart, we have a fully stocked mobility discount warehouse you can visit and try out thousands of products for yourself.

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Therapy Dogs Nationwide is a national Charity where visiting volunteers take their own dogs into establishments to give comfort, distraction, and stimulation.

Our volunteers have the unique privilege of volunteering with their own temperament tested Therapy Dogs; some with over 10 years experience and always focused on benefiting people in the community.

The use of animals especially Dogs as therapy is not a new idea. Dogs have been used in the care sector for over 40 years. Many of our volunteers have their roots with Lesley Scott-Ordish who was a pioneer in visiting by taking your own pet dog to nursing homes.

The benefits of Animal Assisted Therapies (AAT) have been extensively studied and the results range from improvement in general health and wellbeing to increased confidence levels, improved and controlled movement to improved communication skills.

Volunteers and Therapy Dogs work with a wide group of people within the community. Our work in residential care homes had improved communication in residents and patients by evoking memories and stimulating conversation.

Therapy Dogs Nationwide dogs have also shown to help with special needs and autistic children and adults by giving focus and providing a calming environment.

We regularly visit local hospitals and hospices where patients and staff interact with our dogs and look forward to their visits

We are proud to be part of the Kennel Club Bark and Read Programme . Many of our dogs visit schools to help children develop their reading skills and build confidence.

Our volunteers also find their visits very rewarding. More of our work can be seen on our Establishments page.

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Therapy Dogs Nationwide is a national Charity where visiting volunteers take their own dogs into establishments to give comfort, distraction, and stimulation. Our volunteers have the unique privilege of volunteering with their own temperament tested Therapy Dogs; some with over 10 years experience and always focused on benefiting people in the community.

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Most of us who own horses talk about their "therapeutic" value. Being in the barn grooming, feeding, and otherwise caring for our horses reduces stress, lowers blood pressure, and improves overall health. Yet, it is the companionship with our equine partners that is the foundation of our growth in relationship to these animals. Being with our horses is "therapy."

The power of this relationship has not been lost on medical professionals. "Equine therapy" is a popular tool to use with a variety of populations. But what is equine therapy, and how is it used?
Equine Therapy Defined
According to PATH International, the Professional Association of Therapeutic Horsemanship, there are many different types of "equine-assisted activities." In its broadest sense, any interaction between a person and a horse is an equine-assisted activity.

Equine-Assisted Therapy has a more specific goal. It is a treatment which uses horses to reach rehabilitative goals that are bounded by a medical professional's scope of practice. Equine-Assisted Therapy is not an activity run by local horse clubs, church groups, or trainers. Instead, it is overseen by a medical professional, usually a licensed psychotherapist or physical therapist. Equine-Facilitated Psychotherapy, which is used by addiction treatment facilities, veterans' groups, and trauma centers, is always overseen by a licensed mental health professional. These types of therapies rarely involve riding the horse.
Benefits of Equine-Facilitated Psychotherapy
Especially for those who are unfamiliar with horses, working with horses can be an intimidating experience. Addicts, the population I work with, often exclaim, "They're so big!" Indeed, as all horse-people know, trying to get a thousand-pound animal to do what you want is no easy task. If you are unaccustomed to being honest and communicating clearly, the task becomes more difficult.

Horses can be an emotional mirror for humans. They respond to the feeling state we show. They are herd and prey animals, which means that they have a strong emotional sense and use this sense as a survival tool; they feed off of and respond to other horses in the herd. If one horse in a herd is scared, the others will become frightened. They respond similarly to humans. If a person approaches a horse with anger, the horse will respond by shying away or becoming stubborn. Horses never hide their emotions.

Because of these qualities, horses can be used to help people heal from a variety of psychological issues.
Identifying and Processing Feelings
First and foremost, horses can help individuals identify their feelings. Addicts, in particular, are known for numbing their feelings through the use of drugs and alcohol. When they get clean, they don't know what to do with, or often how to identify, their feelings. This is a confusing and frustrating period for addicts. The horse, however, provides information to the client. If one walks angrily toward a horse, snatching its halter or lead, the horse will yank its head back and pull away. The therapist might ask the person, "What are you angry about?" Most of the time, the client will deny being angry and need to be shown the evidence of the horse's behavior to identify the feeling. Addicts and other trauma survivors have to learn how to identify their emotions in order to work through them. Horses are a good tool for therapists to help clients do just that.

Horses can also open the door to re-visioning past traumatic events. Perhaps a plastic bag blows into the arena during a session, startling the horses. A client who has experienced child or domestic abuse might break down in tears upon seeing the horses frightened. It might remind him/her of experiences of powerlessness or helplessness, of being frightened, but having no-one to turn to. Any of these kinds of reactions is rich material for talk therapy and can be worked through immediately or in future sessions.
Work Ethic
Horses require us to work. We get up early to feed and water them. We clean stalls. We earn wages to buy feed and tack and maintain horse properties. Domestic horses have to be groomed, exercised, and attended to.

It is the same in the human world. Most of us have to work. Whether it is raising children or going to an office, factory, or running a business, we get up early and show up on time. We participate in tasks that are not always easy or pleasant. We attend to our daily needs and those of others. We pay bills, clean the house, and keep the car in working order. We work hard and enjoy our moments of respite.

We also have to work to maintain our relationships. We listen to our friends, show up for our families, and provide service to our communities. Working hard and showing up in a healthy way are skills that can be learned by engaging with horses.
Trust
Horses are majestic animals that are wonderful simply to be with. Horses are gentle and honest; they do not have the ability to manipulate or lie. One common treatment technique for those who were abused as children is to put the (now adult) individual in with a large horse and allow them to interact. Very often, the person will break down in tears and say something like, "I've never been treated this kindly by anything so big." This is an experience the client can then take into the human world.
Conclusions
Equine-Assisted Therapy, particularly Equine-Facilitated Psychotherapy, can have positive results for those who are recovering from substance abuse, trauma, depression, or a number of other psychological issues. It can help individuals develop a work ethic, identify and process feelings, and learn how to trust. However, to be safe and effective, Equine-Facilitated Psychotherapy must be provided by a licensed medical professional. As problematic feelings and memories arise, someone with experience helping people process those feelings must be present. The professionalism of those engaged with equine therapies is what makes them both effective and safe.

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Most of us who own horses talk about their "therapeutic" value. Being in the barn grooming, feeding, and otherwise caring for our horses reduces stress, lowers blood pressure, and improves overall health. Yet, it is the companionship with our equine partners that is the foundation of our growth in relationship to these animals.

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That was a news article from May 2021 of an elderly patient with pre-existing conditions labelled as 'generally fragile' that suffered swollen legs and heart palpitations. Although not recorded as a death from sepsis but rather recorded as natural causes. It was identified that she had contracted sepsis and due to her pre-existing conditions and fragility was unable to recover.

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(Image: Google Maps)

A woman's tragic death in a Derby hospital was caused by a dental abscess, an inquest has heard.

Gillian Yates had become unwell after experiencing heart palpitations and swollen legs, something that saw her admitted to Burton's Queen's Hospital.

Doctors at the site subsequently found she had contracted sepsis, a potentially life-threatening reaction from the body when it detects an infection.

Staffordshire Live reports this had been caused by an abscess on the left side of her face and lower jaw, where two teeth in her mouth had become infection.

The 87-year-old was subsequently moved to Royal Derby Hospital where staff operated on her to remove the teeth and drain the abscess.

Sadly, she did not recover and her condition declined in the weeks that followed.

As a result she was moved to London Road Community Hospital for end-of-life care, where she died on July 28, last year.

Evidence from medics who had treated Ms Yates, who was born in Burton but later moved to Westmead Road, Barton under Needwood, revealed she had a host of underlying health issues. They included kidney disease, rheumatoid arthritis and an irregular heartbeat.

Giving a verdict of death by natural causes, Charlotte Crangle, assistant coroner for the Derby and Derbyshire area, said: "Gillian Yates was 87 when she died.

"She was initially admitted to hospital on July 11, 2020, with leg swelling and heart palpitations.

"In the following days, she was noted to be suffering from sepsis, which brought on confusion and delirium.

"The cause of the sepsis was discovered on July 13 to be an abscess to the left side of the face and lower jaw.

"An operation to drain the abscess and remove teeth took place to try to ease the infection on July 16.

"It was uneventful and did not contribute to her death; there were no immediate issues following the surgery.

"Her condition continued to deteriorate and she was recognised to be coming towards (the stage where she needed) end-of-life care.

"She was transferred to London Road Community Hospital, in Derby, on July 27 and died the following afternoon.

"It was the abscess, not the procedure, that led to her death, contributed to by pre-existing health conditions and her general frailty."

A secondary cause of death was recorded as acute and chronic renal - or kidney - failure.

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Woman's tragic death in Derby hospital caused by dental abscess

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A woman's tragic death in a Derby hospital was caused by a dental abscess, an inquest has heard. Gillian Yates had become unwell after experiencing heart palpitations and swollen legs, something that saw her admitted to Burton's Queen's Hospital. Doctors at the site subsequently found she had contracted sepsis, a potentially life-threatening reaction from the body when it detects an infection.

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This is a case report and a review of a 23 year old male who contracted sepsis as a result of a dental abscess and gives a time line of events and his vital signs.

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A useful article from Dentist.co.uk for dental students to recognise symptoms of Sepsis.

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Good resource to contextualise sepsis in the uk and offers some guidelines on the topic.

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Smoking to be banned outside schools and hospitals in England, but pubs get reprieve

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Legislation also includes ban on advertising of vapes and restrictions on flavours, packaging and marketing

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Delivering smoking cessation interventions in NHS primary dental care - lessons from the ENHANCE-D trial - British Dental Journal

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British Dental Journal - Delivering smoking cessation interventions in NHS primary dental care - lessons from the ENHANCE-D trial

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Drug prescribing | Scottish Dental Clinical Effectiveness Pr

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The Drug prescribing page of the Scottish Dental Clinical Effectiveness Programme - SDCEP website.