(21) Severe Odontogenic Infections and the Impact of Temperature Difference and Early Source Control on Hospitalizations

Abstract: Abstract:

Background:
Hospital stays for odontogenic infections can be both lengthy and costly, and some patients are admitted more than once. The longer the hospital stay, the more likely the patient will require additional care following the surgery due to rehabilitation needs.

Purpose:
The primary aim was to assess the efficacy of early source control in the number of hospitalizations in patients with severe odontogenic infections. The secondary aim was to evaluate whether temperature difference had an impact on hospitalization.
Study design, setting, sample: Retrospective review of inpatients treated with surgery within the M Health Fairview hospital system.
Inclusion criteria: Patients ages 18-85 who had management of a severe odontogenic infection with an incision and drainage procedure. Exclusion criteria: Pregnant patients, minors and elderly > 85 years old, prisoners, those who did not consent to research, exposure to bisphosphonates, septic arthritis, major jaw surgery, cancer, or trauma surgery < 8 weeks prior.

Predictor/exposure/independent variable:
Predictor variables in this study were the number of hospital encounters for the same diagnosis code, environmental temperature change within 14 days of initial encounter, and previous treatment prior to presentation.

Main outcome variable(s): The main outcome variable for this study was whether patients received dental extractions, i.e. source control, affiliated with their initial hospital encounter. The secondary outcome variable was the temperature difference prior to hospitalization.

Covariates: Performance of extraction, ethnicity, prior dental treatment, multiple hospital stays, age, and sex

Analyses: Data analyses performed were binary logistic regression, with a backward conditional method. The statistical software is SPSS 27.0. P-value < .05.

Results: A total of 102 patients met the initial criteria, and when exclusion criteria were applied, a final sample size of 67 subjects was analyzed. Subjects were 22.4% BIPOC or Hispanic, and 77.6% White. Also, 46.2% of subjects were female, and 53.8% were male. Patients without multiple hospital stays were more likely to have their teeth extracted in the first hospitalization/surgery (P = .011, Odds Ratio = 50.044, 95% CI: 2.488, 1006.461). When the temperature range on Day 2 (2 days prior to hospitalization) was greater than 20 degrees, patients were more likely to have their teeth extracted on the day of hospitalization (P = .013, OR=8.145, 95% CI: 1.543, 42.995).

Conclusions and relevance: Patients who received extractions in the first hospitalization were less likely to have multiple hospital stays. When the temperature difference was greater than 20 degrees Fahrenheit two days prior to hospitalization, the patient was more likely to have extraction(s) on the day of hospitalization. Currently, no guidelines exist for tooth extractions in treating patients with severe odontogenic infections. Information indicating that early source control via tooth extraction can minimize length of hospital stays can help guide care and reduce the financial burden and likelihood of requiring additional rehabilitation for patients.
References
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https://pubmed.ncbi.nlm.nih.gov/18603196/
2. Almuqamam M, Gonzalez FJ, Kondamudi NP. Deep Neck Infections [Internet]. Nih.gov.
StatPearls Publishing; 2022 [cited 2023 Jul 13]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK513262/