Clinical Factors Associated With Trismus and the Need for Tooth Extraction in Patients With Odontogenic Abscesses: A Retrospective Clinical Study

Objective: This retrospective study aimed to identify the clinical factors associated with the development of trismus and the need for tooth extraction in patients presenting with odontogenic maxillofacial space infections. Materials and methods: A total of 133 patients diagnosed with odontogenic maxillofacial space infection and treated at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, between May 2016 and May 2026 were retrospectively reviewed. Demographic characteristics, anatomical location of the infection, involved fascial spaces, causative tooth group, oral hygiene status, etiology of infection, presence of trismus, requirement for surgical drainage, and treatment modality were recorded. Factors associated with tooth extraction and trismus were analyzed using the Mann-Whitney U test, Pearson's chi-square test or Fisher's exact test, followed by multivariable logistic regression analysis. Results: The median age of the patients was 36 years, and 52.6% were male. Dental caries was the most common cause of infection (62.1%), while the mandibular posterior region (60.2%) and the submandibular space (50.4%) were the most frequently involved anatomical sites. Trismus was observed in 45.1% of the patients, and surgical drainage was required in 78.9%. Multivariable analysis demonstrated that increasing age independently increased the likelihood of tooth extraction (OR=1.037, 95% CI: 1.008-1.067; p=0.012). Posteriorly located infections were associated with a significantly greater probability of extraction than anterior infections (OR=3.290, 95% CI: 1.116-9.705; p=0.031). Deep fascial space involvement was identified as the strongest independent predictor of trismus (OR=5.046, 95% CI: 2.091-12.175; p<0.001). In addition, infections originating from third molars showed significant associations with deep fascial space involvement, trismus, and the need for tooth extraction. Conclusions: Advanced age and posteriorly located infections were independently associated with an increased need for tooth extraction, whereas deep fascial space involvement was the strongest predictor of trismus. Third molar-related infections demonstrated a more severe clinical presentation, characterized by higher rates of deep fascial space involvement, trismus, and tooth extraction. Early recognition of these clinical characteristics may facilitate risk stratification and support timely treatment planning in patients with odontogenic maxillofacial space infections.