Alcohol or illicit drug use are implicated in more than 90 per cent of patients treated for human bite injuries, doctors at St James's Hospital, Dublin, have found. And 70 per cent of human bite wounds occur over the weekend or on a public holiday, while men are 12 times more likely than women to be injured in this way.
The research, published this morning in the Emergency Medicine Journal, also found that the majority of human bite injuries occur between 11pm and 4am. One of the study's authors, Dr Patricia Eadie, consultant plastic surgeon at St James's, told The Irish Times: "Many of these injuries occur during late night, alcohol-fuelled aggression with 82 per cent occurring between 11pm and 4am, with a median [ average] of 3am. This may be related to the closure of many bars at 2am discharging many inebriated people onto the streets at the same time. Fights break out and bites occur."
Dr Eadie, and her colleagues Dr Francis Henry and Dr Elizabeth Purcell, reviewed 92 patients who were treated for human bite wounds by the plastic surgery service at the hospital in 2003-2005. Some 85 of these patients were men. Their ages ranged from 16-57 years with an average age of 22 years. All of the injuries were the result of an assault.
Some seven out of 10 bites were to the face, with the remainder to the upper limb. Of the facial wounds, two-thirds were to the ear while 20 per cent involved a bite to the nose. The tip of the nose was most likely to be bitten, while most of the ear injuries were to the upper part of the ear.
There are two main types of human bite wounds: an occlusive bite injury which occurs when the teeth close over with sufficient force to break the skin and, in some cases, remove tissue; and a closed fist injury, when the fist strikes a tooth with sufficient force for the tooth to pierce the flesh. Both types are associated with late night alcohol-fuelled aggression.
The study found that bites become infected in one in five patients and infection was most likely when patients waited longer than 12 hours to seek medical attention. Just 14 per cent of patients either have had or plan to undergo reconstructive surgery for the damage caused by the bite.
"While cosmetic factors tend to be a primary concern [ for patients] on initial assessment of facial injuries, we have noted a poor compliance with follow-up care," the authors state. Complex bite injuries with tissue loss require specialist plastic surgery.
At present there are plastic surgery units in Dublin, Cork and Galway. Dr Eadie said there may be a case for having units in some of the smaller cities such as Limerick and Waterford. "But they should only be established with adequate resources, both in terms of manpower and infrastructure."
Asked what can be done to minimise bite injuries, Dr Eadie said she would like to see the closing times of bars on a phased basis. "And we need to educate young men in particular about control of alcohol intake and about anger management," she said.