COVID-19 and Limited Dental Resources. The Impact of Odontogenic Infections on Emergency Room and Intensive Care Unit Admissions: The Wexner Medical Center at The Ohio State University Experience

Abstract

Many dental procedures generate a significant number of droplets and aerosols, thus posing a potential risk of transmission of the COVID-19 virus and forcing many dental offices to close in an attempt to protect their providers, staff, and patients. The purpose of this study is to assess whether the barrier to dental care in Ohio during the height of the COVID-19 pandemic contributed to an increase in hospital admissions, length of stay, and severity of odontogenic infections extending to the deep neck spaces. This retrospective study included all patients admitted to the Wexner Medical Center at the Ohio State University (OSUWMC) for management of a deep space neck abscess of odontogenic origin requiring an extraoral incision and drainage +/- dental extraction between the timeframe of March 2017 and January 2021. Data, such as age and sex of patient, length of hospital stay, number of deep neck spaces involved, ASA status, subsequent need for a surgical washout, and need for ICU transfer, were collected from a chart review of 212 patients (Image 1). We used a Fisher exact test to look for differences in categorical variables both before and after the start of the COVID-19 pandemic. We used a Wilcox signed rank test to look for differences in continuous variables both before and after the COVID-19 pandemic. Based on these tests, we see that there is a marginally significant difference in the total number of spaces before/after COVID-19 (P value = 0.0784 < 0.1). We also see marginally significant difference in whether there were complications before/after COVID-19 (P value = 0.0973 < 0.1). While these results are not significant under the usual significance level of α = 0.05, they are marginally significant. The P values are greater than 0.05, however, not by much. We did not see additional significant differences in variables before/after COVID-19 (Image 2). The authors proposed that the barrier to dental care during the global COVID-19 pandemic would lead to a significant increase in the number of odontogenic infections seen, treated, and admitted to OSUWMC. While the data show only marginal significance, the fact remains that, at a baseline, an endemic exists in patients with odontogenic disease leading to severe cervicofacial infections requiring invasive surgical treatment and lengthy hospital stays.Tabled 1Summary TableSummary statistics of dataXLevelOveralln211Sex (%)F102 (48.3)M109 (51.7)Washout needed? (%)No188 (89.1)Yes23 (10.9)ICU TransferNo192 (91)Yes19 (9)Complications?No171 (81)Yes40 (19)ASA (mean (SD))2.36 (0.75)Age (mean (SD))41.10 (17.4)Length of Stay (Days) (mean (SD))6.64 (7.29)Total # of Spaces (mean (SD))2.39 (1.34)during covid (%)No139 (65.9)Yes72 (34.1) Open table in a new tab Tabled 1Stratified by before/during covidSummary statistics of data stratified by before and after covidVariableLevelBefore COVID-19After COVID-19P valuen13972Sex (%)F62 (44.6)40 (55.6)0.1476M77 (55.4)32 (44.4)Washout needed? (%)No124 (89.2)64 (88.9)1.0000Yes15 (10.8)8 (11.1)ICU Transfer? (%)No124 (89.2)68 (94.4)0.3103Yes15 (10.8)4 (5.6)Complications? (%)No108 (77.7)63 (87.5)0.0973Yes31 (22.3)9 (12.5)ASA (mean (SD))2.33 (0.79)2.42 (0.64)0.2796Age (mean (SD))42.20 (18.39)38.99 (15.2)0.3329Length of Stay (Days) (mean (SD))6.99 (8.64)5.96 (3.27)0.5646Total # of Spaces (mean (SD))2.28 (1.33)2.59 (1.34)0.0784We used a Fisher exact test to test for differences in categorical variables between before/after COVID-19 (sex, washout needed, etc.). We used a Wilcox signed mak test to test for differences in continuous variables between before/after COVID (ASA, Age. etc). Based on the test, we see that there is a marginally significant difference in total number of spaces before/after COVID (P value = 0.0784 < 0.1). We also see marginally significant difference in whether there are complications before/after COVID-19 (P value = 0.0973 < 0.1). These results are not significant under the usual significance level of α = 0.05 but they are marginally significant. The P values are greater than 0.05 but not by much.We do not see additional significant differences in variables before/after COVID-19. Open table in a new tab