Study: Patients With Dental Infections Receive Excessive CT Scans

The results of a study indicate that emergency settings overorder computed tomography (CT) scans for dental infections.

Published in the Journal of Oral and Maxillofacial Surgery, the study examined 470 adult patients who presented through an emergency department for odontogenic infection evaluation, of which 389 received CT scans.

Researchers set out to determine how many of these scans were unnecessary when considering the effectiveness of history and physical (H&P) examinations to accurately diagnose dental infections before patients undergo the CT scan. Unlike H&Ps, CT scans are expensive and linked to long-term potential for cancer.

The researchers found that nearly 57% of the total ordered scans were unnecessary, meaning patients presented without what researchers labeled as "red-flag" signs at physical examination. This included voice change, elevated floor of mouth, signs of inflammation of deep fascial spaces, periorbital edema, nonpalpable inferior border of the mandible, dyspnea, dysphagia or odynophagia, and trismus. Furthermore, unnecessary scans were found to be most prevalent in those patients with infections classified as low risk, with more than 78% of scans deemed unnecessary. 

In conclusion, the study authors' wrote, "Establishing guidelines to standardize ordering is the first step oral and maxillofacial surgeons can take to decrease unnecessary CT scans. Guidelines, in theory, would decrease the amount of unnecessary scans ordered and standardize ordering practices among providers."