GP4c - Mortality and Associated Variables of Full-mouth Extractions

Abstract: Full-mouth extractions (FMEs) are common procedures that are classically performed electively due to caries and periodontal disease. Up to 17% of adults over the age of 65 and 2% of adults aged 20-64 in the United States are edentulous. At the University of Cincinnati Medical Center, approximately 250 FMEs are performed annually with nearly half performed on adults over the age of 50. There is currently an absence of data on this patient population and their overall outcomes. The authors hypothesize that FMEs are often performed on socioeconomically and medically vulnerable populations, thereby further compromising their conditions and potentially contributing to their demise. The authors aim to describe patient-related characteristics and document post-FME time to death.

The authors performed a single-center retrospective chart review from July 1, 2012, to January 1, 2020. Inclusion criteria included all patients who underwent FME at the institution due to caries, periodontal disease, and non-restorable dentition. Patients were excluded if there were insufficient data or identifiers. Recorded data included demographics, medical insurance, medical history, and social history. The primary outcome variable was post-FME time to death. Patient mortality was identified through chart review and inquiry of the National Death Index, a database of the National Center for Health Statistics. Statistical analysis was performed with SASv9.4 and included simple descriptive statistics and multivariate survival analysis.

A total of 1829 patients were included in the study; 976 were female. Median age was 49 (IQR 38-58); 65% identified as Caucasian and the remaining African-American. Insurance coverage included Medicaid (59%), Medicare (30%), and private insurance (10%). In total, 1709 patients were diagnosed with more than 1 comorbidity at the time of FME. The most prevalent were psychiatric illness (50%), diabetes mellitus (20%), coronary artery disease or congestive heart failure (16%), and chronic obstructive pulmonary disease or emphysema (14%). Overall, 1072 patients (59%) were identified as current smokers, 690 (38%) as alcohol users, and 394 (22%) had a history of illicit drug use; 85 (5%) patients were nursing home residents. As of December 31, 2019, a total of 170 patients (9.3%) were identified as dead; 51% of deaths occurred within the first 2 years of the procedure, and 87% occurred within 5 years. Median time to death was 2.0 years (IQR 0.9-3.8) at a median age of 56 (IQR 46-63). Mortality rate was higher in nursing home residents at 29%. Post-FME predictors of mortality included male gender (P-value < .02), ASA score > 3 (P-value < .0001), liver disease (P-value < .05), and oncologic disease (P-value < .0003), collectively estimating a median time to death of 4.2 years.

FME patients are typically medically disadvantaged and likely to be on Medicaid or Medicare. Approximately 1 in 10 FME patients died within 5 years of the procedure at the center. This may suggest that FME exposure can lead to serious deterioration, comorbidities or death. Further studies are currently underway at the institution to assess FME-related complication rates and quality of life improvement. The authors recommend thoughtful consideration to the overall implications of such a procedure on the well-being of patients rather than strict adherence to traditional indications.

References:

1. Centers for Disease Control and Prevention. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999-2004 to 2011-2016. Atlanta, GA. Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2019

2. Kochanek KD, Murphy SL, Xu J, Arias E: Deaths: final data for 2017. Natl Vital Stat Rep 68(9):1-77, 2019. PMID: 32501199