Prevalence and Risk Factors for Severe Complications of Odontogenic Infections

Odontogenic infections can spread beyond the oral cavity into potential spaces of the head, neck, and thorax. Identifying predictors for these severe complications can improve early risk stratification and guide timely intervention.

This study aimed to estimate the frequency and identify risk factors for severe extraoral complications among patients with odontogenic infections.

This retrospective cohort study utilized the 2022 Nationwide Emergency Department Sample. Subjects diagnosed with odontogenic infections (ICD-10-CM K12.2, K04) were included.

Predictor variables included demographics, medical comorbidities, and social history.

The primary outcome was the presence or absence of a severe complication. Secondary outcomes included the type of severe complication (intracranial abscess, cavernous sinus thrombosis, orbital cellulitis, Lemierre's syndrome, descending mediastinitis, and necrotizing fasciitis), inpatient admission, and mortality.

Not applicable.

Descriptive statistics were calculated for all variables. Bivariate analyses were performed using t test and χ² test. A logistic regression model was used to identify independent predictors of a severe complication. A P value of <.05 was considered statistically significant.

The final sample included 2,530 subjects with a mean age of 43 years (SD = 20), and 1,386 (55%) were male. The frequency of severe complications was 248 (9.8%), which included 31 (1.2%) intracranial abscess, 16 (0.6%) cavernous sinus thrombosis, 78 (3.1%) orbital cellulitis, 42 (1.7%) Lemierre's syndrome, 30 (1.2%) mediastinitis, and 70 (2.8%) necrotizing fasciitis. Overall, 1,756 (69%) subjects required inpatient admission and mortality was 15 (0.6%). Independent predictors of severe complications were male sex (odds ratio [OR]: 1.51; 95% CI: 1.15 to 2.01; P < .01), immunodeficiency (OR: 2.91; 95% CI: 1.32 to 6.41; P < .01), obesity (OR: 1.88; 95% CI: 1.11 to 3.19; P = .02), and alcohol use (OR: 1.88; 95% CI: 1.11 to 3.19; P = .02). Severe complications were associated with inpatient admission (relative risk: 1.35; 95% CI: 1.28 to 1.41; P < .01) and mortality (relative risk: 10.52; 95% CI: 3.85 to 28.75; P < .01).

Patients with immune dysfunction, metabolic disorders, or substance use disorders may benefit from early recognition and aggressive management to prevent severe complications of odontogenic infections.