Third Molar Extractions in Patients With Developmental Disabilities

Abstract

Background: Patients with developmental disabilities may exhibit behavioral problems or be unable to maintain proper hygiene, potentially placing them at greater risk for infection following the extraction of third molars.

Purpose: The purpose of this study was to estimate and compare the risk for surgical site infection after third molar removal between patients with and without developmental disabilities.

Study design, setting, sample: This was a retrospective cohort study of patients who underwent extraction of all four-third molars at Boston Children's Hospital from August 1, 2021, to July 31, 2023. Patients were excluded if all four-third molars were not present or if all four-third molars were not extracted during one visit.

Predictor variable: The primary predictor variable was developmental disability status. Subjects were grouped by developmental disability, coded as present or absent.

Main outcome variable: The primary outcome variable was diagnosis of a postoperative surgical site infection. Secondary outcomes included time to follow-up and infection treatment.

Covariates: Covariates included age, sex, race, ethnicity, procedure setting, anesthesia type, and impaction status.

Analyses: Independent Samples T-tests, χ² tests, and Fisher's Exact tests were used for analysis.

Results: A total of 1,896 subjects were evaluated. There were 236 subjects in the developmental disability group (72.5% male [n = 171] mean age of 19.3 ± 2.7 years) and 1,660 in the nondevelopmental disability group (53.4% female [n = 887] mean age of 19.0 ± 2.3 years). Subjects in the developmental disability group more frequently underwent their extractions in the operating room under general anesthesia (57.6% [n = 136] P < .001). The overall postoperative infection rate was 2.7% (n = 52). There was no statistically significant difference in the rate of infection between the developmental disability group (0.8% [n = 2]) and the nondevelopmental disability group (3.0% [n = 50]) (P = .057). There was no significant difference in time to follow-up between subjects who were and were not diagnosed with an infection (6.26 ± 9.39 weeks vs 4.69 ± 10.95 weeks, P = .434) or for subjects in the developmental disability and nondevelopmental disability group who had an infection (2.64 ± 0.30 weeks vs 6.43 ± 9.76 weeks, P = .588).

Conclusion and relevance: Patients with a developmental disability do not exhibit higher rates of postoperative infections following third molar extractions when compared to patients without developmental disabilities.