GP4b - Third Molar Extractions in Patients With Autism Spectrum Disorder (ASD) and Other Developmental Delays and Disorders

Abstract: Statement of the Problem:
Concerns have been raised that patients with developmental delay, such as autism spectrum disorder, may exhibit a variety of issues such as behavioral problems or the inability to achieve proper hygiene which may place them at greater risk for infection following the extraction of their third molars.1,2 The purpose of this study was to determine how developmental delay may influence the incidence of postoperative infections in third molar extractions.

Materials and methods:
This is a retrospective cohort study evaluating whether patients with and without a developmental delay experience different rates of post-operative infection following the extraction of all four third molars (Tooth #1, #16, #17, and #32). Patients with all four third molars extracted at Boston Children’s Hospital in Boston, Massachusetts, from August 1, 2021, to July 31, 2023, were included. Hospital medical records were queried using Current Dental Terminology (CDT) codes D7140, D7210, D7220, D7230, and D7240 to identify our patient cohort. The primary predictor variable was whether or not a patient was diagnosed with a developmental delay using the International Classification of Diseases (ICD-10) F84.0-84.9 and F81.9 codes. The primary outcome variable was infection. Covariates included age, sex, race, ethnicity, procedure setting, anesthesia type, and impaction. Our secondary outcome measures included follow-up time and infection treatment method.

Methods of data analysis:
Descriptive statistics were calculated. Independent samples t-tests, chi-squared tests, and Fisher’s exact tests were used to analyze associations between variables and outcomes. Results were considered statistically significant when P ≤ .05.

Results and outcomes data:
A total of 1,897 subjects were evaluated. There were 236 subjects in the developmental delay group (72.5% male, mean age of 19.3 ± 2.7 years) and 1,661 in the non-developmental delay group (53.5% female, mean age of 19.0 ± 2.3 years). Subjects in the developmental delay group more frequently underwent their extractions in the operating room and under general anesthesia (136 subjects, 57.6%, P < .001). Subjects in the non-developmental delay group more frequently underwent their extractions in the clinic (1,548 subjects, 93.2%, P < .001) with 90.8% undergoing IV conscious sedation (P < .001).
The overall postoperative infection rate was 2.7%. There was no statistically significant difference in the rate of infection between the developmental delay group (0.8%) and the non-developmental delay group (3.0%) (P = .057). There was no significant difference in infection treatment rendered between groups (P = .812) or follow-up time (P = .419). Females were more likely to have a postoperative infection compared to males (3.8% vs. 1.7%, P = .005) with 69.2% of infections being female. The average follow-up time was longer for subjects who had an infection compared to those without an infection (0.12 ± 0.20 years vs. 0.03 ± 0.17 years, P < .001). Of subjects with infections, subjects with a developmental delay did not have a significantly longer follow-up time compared to subjects without a developmental delay (0.05 ± 0.01 years vs. 0.13 ± 0.20 years, P = .594).

Conclusions:
Patients with a developmental delay are not more likely to experience a postoperative infection following third molar extraction when compared to patients without a developmental delay.

References
1. Mangione F, Bdeoui F, Monnier-Da Costa A, Dursun E. Autistic patients: a retrospective study on their dental needs and the behavioural approach. Clin. Oral Invest. 2020. 24:1677–1685. https://doi.org/10.1007/s00784-019-03023-7.
2. Azimi S, Wong K, Lai YYL, Bourke J, Junaid M, Jones J, Pritchard D, Calache H, Winters J, Slack-Smith L, Leonard H. Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting. Aust. Dent. J. 2022. 67:328-339. https://doi.org/10.1111/adj.12927.