Periapical abscess is sequelae of the death of the dental pulp often as a result of dental caries or trauma.  It is normally managed in dental practice with root canal treatment or extraction. However, if left untreated it can lead in some circumstances lead to the destruction of bone and the spread of infection to soft tissue and muscle spaces, resulting in a severe, life-threatening infection

The aim of this study was to assess trends in hospitalisation as a result of periapical abscess and to assess any associations between patient characteristics (including age, sex, race, presence of comorbid conditions, and insurance status) and hospitalisation outcomes (including hospital charges, length of stay, in- hospital mortality, discharge status, and the occurrence of complications)

The study used the US National Inpatient sample data set for 2000-2008, the largest publically available all-payer in-hospital data set. All cases with a diagnosis code for a periapical abscess and a periapical abscess with sinus involvement were selected for analysis in the current study.  The primary outcome of interest was hospital charges and length of stay.

• Between 2000-8 there were 61,439 hospitalisations primarily attributed to periapical abscesses.
• 89.1% of all hospitalisations occurred on an emergency/urgent basis
• The average age was 37; women accounted for 51.1% of all hospitalisations
• 66 patients died in hospitals from periapical abscesses.
• The mean length of stay in the hospital was 2.96 days,
• Total hospitalization days during the study period were 2.3 million days.
• Each 1-year increase in the patient’s age was associated with an increase in the length of hospital stay
• The number of patients hospitalized for periapical abscesses increased from 5757 in 2000 to 8141 in 2008, a 41.4% increase overall or an average annual increase of 4.6%.
• The ratio between emergency/urgent and elective hospital admission status steadily increased from 7:1 in 2002 to 11:1 in 2008.
• Medicare, Medicaid, and private insurance plans paid for 18.7%, 25.2%, and 33.4% of hospitalizations, respectively.
• Patients whose primary insurance was Medicare or Medicaid had a longer length of stays than those with private insurance
• Uninsured patients accounted for 18.5% of hospitalisations.

The authors concluded

The current study highlights the increasing burden of hospitalisation of patients with periapical abscesses over a 9-year study period from 2000 to 2008. The high-risk groups likely to seek a hospital setting for the treatment of periapical abscesses were identified as were groups associated with higher hospital charges and a longer length of stay

Comment

This is an interesting retrospective study based on routinely collected data  and the potential for inaccurate coding, as noted by the authors, needs to be considered .  While the overall number of hospitalisations for periapical abscess has increased over the 9 year period the US population has also increased.  However, as regular preventive dental care and access to dental services should enable either the prevention or the routine management of periodontal abscess before it becomes an acute problem requiring hospital admission, it is salutary to remember that small numbers of people are still dying as a result of dental abscesses.

Links

Shah AC, Leong KK, Lee MK, Allareddy V. Outcomes of hospitalizations attributed to periapical abscess from 2000 to 2008: a longitudinal trend analysis. J Endod. 2013 Sep;39(9):1104-10. doi: 10.1016/j.joen.2013.04.042. Epub  2013 Jul 11. PubMed PMID: 23953280