Risk factors for oral infection and dry socket post-tooth extraction in medically complex patients in the absence of antibiotic prophylaxis: A case-control study.

Abstract

Dry socket and infection are complications of tooth extractions. The objective was to determine risk factors for post-extraction complications in patients without antibiotic prophylaxis stratified by early- and late-complications and complication type (oral infection and dry socket). Retrospective, case (with complications)-control (without complications) study of patients (n=708) who had≥1 extraction performed at any Veterans Health Administration facility between 2015-2019 and were not prescribed an antibiotic 30 days pre-extraction. Early complication cases (n=109) were more likely to be female [odds ratio (OR)=2.06; 95% confidence interval (CI):1.05-4.01], younger (OR=0.29; 95% CI:0.09-0.94 patients ≥ 80 years old, reference:18-44 years), Native American/Alaska Native (OR=21.11; 95% CI:2.33-191.41) and have fewer teeth extracted (OR=0.53 3+ teeth extracted; 95% CI:0.31-0.88, reference:1 tooth extracted). Late complication cases (n=67) were more likely to have a bipolar diagnosis (OR=2.98; 95% CI:1.04-8.57), history of implant placement (OR=8.27; 95% CI:1.63-41.82), and history of past smoking (OR=2.23; 95% CI:1.28-3.88). Predictors for post-extraction complications among patients who did not receive antibiotic prophylaxis were similar to prior work in cohorts who received prophylaxis. Unique factors identified in a medically complex population included being younger, Native American/Alaska Native, having mental health conditions, history of a dental implant, and fewer teeth extracted.