We need a new treatment approach for severe dental infection

Tooth decay is a major cause of hospital admissions in children, with literature showing more than 26,000 children under the age of 15 are hospitalised each year as a result of dental caries.

Severe dental infections can develop rapidly and spread from the original site of tooth decay to surrounding bone and soft tissues. If left untreated, it can impact a child’s airways and their ability to breath normally and lead to sepsis.

The first line of treatment when a child presents to a hospital Emergency Department is for a dental and medical team to assess the cause of the swelling and, if it is due to dental decay, the tooth is removed under general anaesthetic. The child then receives antibiotics, usually through a drip in the arm.

Dr Rachelle Welti.

Dr Rachelle Welti is currently completing her PhD on antibiotics and the management of paediatric dental infections at the University of Melbourne, Murdoch Children’s Research Institute and the Royal Children’s Hospital Melbourne. Dr Welti graduated from the University of Melbourne with a Bachelor of Biomedicine and Doctor of Dental Surgery.

The focus of Dr Welti’s research is looking at whether oral antibiotics are an effective and more convenient alternative to antibiotics delivered via a drip.

“Studies show that intravenous antibiotics are as effective as oral antibiotics in many infections. If this is the case for severe dental infections, the child can go home after surgery. Tey don’t need to have a needle in their arm and stay in a hospital bed, and a nursing team aren’t required to administer and monitor the drip,” says Dr Welti.

Dr Welti says that more research also needs to be done to identify the ideal antibiotic regimen for young patients with severe dental infection. Currently, there are no consistent national or international guidelines.

“As well as looking at the benefits of IV versus oral antibiotics, we need to investigate different types and ideal dosages of antibiotics. At the moment we base decisions on data from the adult population or on information from other types of swellings not caused by dental infections,” she says.

Dr Welti is in the first year of her PhD and she hopes to combine her research with speciality training in paediatric dentistry. Eventually she would like to work as a clinician researcher.

“I have a long road of study and work ahead but I am enjoying the journey,” she says.

“When I initially worked in private practice, I found managing children to be challenging so I deliberately sought to get more experience working with young patient and I developed a love for it. Children can be unpredictable but you can make such an impact on them – an impact that has lifelong effects on their dental health. That is something I am passionate about.”