November JADA examines clinical, economic burdens caused by orofacial infection complications

Other articles discuss opioid prescribing, pediatric dental sedation

Severe complications caused by distant spread of orofacial infections are associated with increased mortality, hospital length of stay and hospital charges, according to a study published in The Journal of the American Dental Association.

The November cover story, “Complications from Distant Spread of Orofacial Infections: Frequency and Effects on Clinical and Economic Burden in the United States,” found that severe complications — defined as cavernous sinus thrombosis, intracranial abscess or mediastinitis — from distant spread occur in 1.1% of orofacial infections in the United States.

The authors used 2020-22 data from the National Inpatient Sample database to analyze the following patient- and hospital-level contributors and outcomes related to severe complications: age, sex, insurance status, infection etiology, comorbidities, in-hospital mortality, hospital length of stay, hospital charges and hospital settings, such as their location and teaching status.

They found there were 207,750 cases of orofacial infections and 2,265 instances of severe complications caused by distant spread, of which mediastinitis was the most common, followed by intracranial abscess and cavernous sinus thrombosis.

The mean hospital length of stay was 5.8 days for orofacial infections and 19.7 days for severe complications caused by distant spread, and the mean charges were $72,823 per hospitalization, according to the study. The mortality rate was 1.2% for orofacial infections and 4.9% for severe complications.

The regression analysis indicated the presence of severe complications and nonendodontic etiology were the strongest predictors of mortality, hospital length of stay and hospital charges.

“The clear role of [severe complications from distant spread] on the clinical and economic burdens and their interplay with other sociodemographic and clinical factors accentuate the importance of developing broad-based strategies targeting the reduction of [orofacial infections], particularly those with greater potential for distant spread, with the goal of reducing hospitalizations and improving oral health,” the authors said in the study.

Other articles in the November issue of JADA discuss opioid prescribing after nonsurgical root canal therapy, the association between dental care and low birthweight and preterm birth, and adverse outcomes associated with pediatric dental sedation.

Every month, JADA articles are published online at JADA.ADA.org. ADA members can access JADA content with their ADA username and password.