(42) Is Socioeconomic Status a Predictor for Odontogenic Infection Severity?

Abstract: Severe odontogenic infections that require surgical drainage in an operating room can pose significant risk to patients and burden to the tertiary referral centers that often treat them. Although modern antibiotics and surgical care have improved outcomes for these patients over the past eighty years, these infections can still progress to cause airway obstruction, necrotizing mediastinitis, cavernous sinus thrombosis, cerebral abscess, sepsis, Lemierre’s syndrome, and death1. Severe odontogenic infections are also largely preventable with timely care that can be accessed by those at risk. Previous studies have demonstrated that low socioeconomic status (SES) and physical distance from place of residence to a tertiary referral center are associated with more severe odontogenic infections2. This study seeks to determine what socioeconomic factors increase the risk for odontogenic infection requiring surgical drainage in an operating theater rather than with bedside incision and drainage or antibiotics.

A retrospective cohort study of subjects at the University of Tennessee Medical Center (UTMC) diagnosed with odontogenic infection requiring consultation by the Department of Oral & Maxillofacial Surgery (OMS) from January 1st, 2021 to December 31st, 2022 was performed after Institutional Review Board approval (#4817). 276 subjects met inclusion criteria. Subject data related to age, gender, county of residence, insurance carrier, and treatment rendered was then collected. Subjects were then grouped by insurance status into commercial (for private, private) insurance or disadvantaged (Medicaid, Medicare disability, or uninsured). Subject county population density, average county per capita income, and availability of a county-sponsored health department dental clinic were used as additional surrogates for subject SES. The main outcome variable is severity of infection; whether the subject required drainage in an operating theater was used as a clinical marker for this.

Tests for continuous and categorical variables were performed using a Welch two sample t-test or Pearson’s Chi-squared test, respectively. Statistical significance was assumed at p-value < 0.05.

The average age of the 276 subjects was 41.1 years old at the time of initial presentation. The cohort was split evenly by sex with 138 males and 138 females. 51.1% required treatment in an operating theater while 48.9% were treated in the emergency department. Decreasing population density was positively correlated with increased risk for requiring intervention in the operating theater (p=0.03). County average income per capita was approaching statistical significance (p=0.08) and may meet significance with review of a larger subject population. No statistically significant difference in operating theater requirements were found when comparing subjects living in a county with a health department dental clinic versus those living in counties without these facilities (p=0.83).

The association of low county population density with severe odontogenic infections while no association was found with other predictor variables points to the complexity of social factors that impact healthcare outcomes. This may be the result of barriers that physical separation can pose to accessing care that are not directly related to economic privation. It is remarkable that subjects from higher income counties and counties with publicly funded dental clinics were found to require surgical care just as frequently as those from lower income counties and those without publicly funded dental clinics. This suggests that public resources allotted to improve dental health may not be reaching those at highest risk for severe odontogenic infections.

1) Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. Biology. 2022; 11(12):1784. https://doi.org/10.3390/biology11121784

2) Sklavos A, Lee K, Masood M. The association of travel distance and severity of odontogenic infections. Oral and Maxillofacial Surgery. 2022. https://doi.org/10.1007/s10006-022-01135-1