6 - Pediatric Odontogenic Infections: Comparing Untreated Caries, Restored, and Traumatized Teeth

Abstract:

Purpose: To characterize odontogenic infections in pediatric patients presenting to Boston Children’s Hospital Emergency Room and to determine the association between number of fascial spaces involved and likelihood of undergoing general anesthesia by tooth status.

Methods: This retrospective chart review included children < 14 years who presented between 2013-2024 with an odontogenic infection from a primary tooth. Tooth status was categorized as untreated caries, intracoronal restorations, extracoronal restorations, or trauma history. Clinical variables included presence of facial cellulitis, number of facial spaces involved, and sedation modality used for extraction. Ordinal and logistic regression with backward stepwise selection was used to obtain final models with considerations for age, arch, and tooth location.

Results: The study included 323 subjects. Most infection sources were posterior teeth (81%) and untreated caries due to pulpal necrosis (58%). Teeth with extracoronal restorations had over twice the odds of having more fascial space involvement compared with untreated caries (adjOR=2.26;95% CI 1.05,4.99;P=.04). In contrast, traumatized teeth had a 62% reduction in odds compared to untreated caries (adjOR=0.38;95% CI 0.17,0.84;P=.02). In a separate multivariable logistic regression model, subjects < six years were twice as likely to undergo general anesthesia (adjOR=2.13,95% CI 1.17,3.94;P=.014).

Conclusions: Teeth with extracoronal restorations were associated with the most severe infections involving multiple fascial spaces, while traumatized teeth were less likely to result in cellulitis. Younger patients face higher risks of cellulitis requiring extraction under general anesthesia. Dental providers should carefully consider the increased risk of facial cellulitis when treating carious primary teeth with extracoronal restorations.

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