How often do Deep Fascial Space Infections Occur After Wisdom Teeth Extraction?

An interesting article titled “Incidence of deep fascial space infections following lower third molar removal” written by O’Connor et al. appears in the 2018 edition of Oral Surgery (vol. 11, pp. 17-21). The article seeks to explore how many infections of the deep fascial spaces occur after wisdom teeth removal.

The authors say that while an infection is commonly disclosed as a complication following wisdom teeth surgery many patients may not be familiar with the fact that when an infection occurs they may have to be hospitalized, given intravenous antibiotics, and require surgery under general anesthesia which could lead to scarring. These systemic infections can involve deep fascial spaces of the neck, which can lead to endotracheal airway protection, systemic sepsis, and death. In the article a study is conducted using 723 patients who had lower wisdom teeth extracted in Edinburgh in the UK to attempt to determine the number of deep fascial space infections experienced after wisdom teeth surgery. The patients had wisdom teeth surgery performed between June 2012 and June 2013 while under local anesthesia, conscious sedation, or general anesthesia. Patients were identified as having developed a deep fascial space infections if there was a need for drainage after the wisdom teeth surgery.

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It was found that a total of 4 of the 723 (0.5%) patients were admitted to a hospital after wisdom teeth surgery because of deep fascial space infections. The average age of these patients was 46 and there were no significant differences noted in gender. Further there were no significant underlying predisposing medical problems in any of these four patients. After extraction it took anywhere from 2 to 8 days before these 4 patients were admitted to the hospital for an average stay of 3 nights. All patients required incision and drainage to treat the infections, with an intraoral and extraoral approach occurring in three and one case respectively. These patients were given intravenous co-amoxiclav while at the hospital and a 5 day oral course after being discharged. Two of the four patients experienced reduced mouth opening for at least two weeks after discharge. The authors state

“…this audit has served a valuable purpose in heightening our awareness of deep fascial space infections following mandibular third molar [lower wisdom teeth] removal. It will change our practice with immediate effect, and prior to wisdom tooth removal, our patients will be aware that hospitalisation, treatment with intravenous antibiotics and further surgery are potential post-operative complications.”

The authors do point out that it is possible that their study underestimated the true rate of deep fascial space infections after wisdom teeth removal. This is because some of the patients may have returned to a permanent place of residence after surgery in another geographic area then where the wisdom teeth surgery took place. The authors suggest that in the future it would be valuable to conduct another study with a telephone follow-up 2 to 3 weeks after the initial surgery with all patients to ensure all patients requiring admission to a hospital were taken into account. The authors also mention a 2001 Japanese study that reported a deep fascial space infection rate of 0.8% following lower wisdom tooth removal but point out that their patients were given prophylactic antibiotics for 3 to 4 days after surgery and none of these patients required surgical drainage. Thus the authors believe their results are not directly comparable to this study as they did not give any antibiotics prophylacticly and required surgical drainage to be considered as having a deep fascial space infection.

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