Clinical evaluation of Artificial Intelligence Driven Remote Monitoring technology for assessment of patient oral hygiene during orthodontic treatment.

INTRODUCTION: This study aimed to clinically evaluate the accuracy of Dental Monitoring's (DM) artificial intelligence (AI) image analysis and oral hygiene notification algorithm in identifying oral hygiene and mucogingival conditions. METHODS: Twenty-four patients seeking orthodontic therapy were monitored by DM oral hygiene protocol during their orthodontic treatment. During the bonding appointment and at each of 10 subsequent adjustment visits, a total of 232 clinical oral examinations were performed to assess the presence of the 3 oral hygiene parameters that DM monitors. In each clinical timepoint, the subjects took an oral DM scan and received a notification regarding their current oral status at that moment in time. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate AI and clinical assessment of plaque, gingivitis, and recession. RESULTS: A total of 232 clinical time points have been evaluated clinically and by the DM AI algorithm. For DM's AI detection of plaque and calculus, gingivitis, and recession, the sensitivity was 0.53, 0.35, and 0.22; the specificity was 0.94, 0.96, and 0.99; and the accuracy was 0.60, 0.49, and 0.72, respectively. CONCLUSIONS: DM's oral hygiene notification algorithm has low sensitivity, high specificity, and moderate accuracy. This indicates a tendency of DM to underreport the presence of plaque, gingivitis, and recession.

Comparison of light transmittance and color changes between polyurethane and copolyester retainer materials after staining and destaining.

BACKGROUND: Retainers are the only effective approach to prevent orthodontic relapse. The aim of this study was to compare the changes in color and light-transmittance of rough and smooth thermoformed polyurethane and copolymer retainer samples after staining in different solutions and destaining with different approaches. METHODS: Four hundred copolyester (Essix® ACE) and 400 polyurethane (Zendura®) samples with different surface textures, smooth and rough, were stained in 4 different solutions (n = 100 per solution) over 28 days. Each of the four groups of 100 stained samples of each material was subdivided into 5 groups of 20 samples and subjected to different destaining solutions. Light transmittance and color changes were evaluated using a spectrometer and a spectrophotometer. Mean differences were compared using a two-way analysis of variance (ANOVA) and posthoc multiple comparison tests at P = 0.05. RESULTS: No significant differences in light transmittance were found between both untreated materials. Both materials were stained in a similar fashion and showed no significant differences between two materials after staining. Coffee and tea stained both materials more significantly than wine, but there was a significant difference of changes of color and light transmittance between rough and smooth surfaces during the destaining in coffee- and tea-stained samples of copolyester material. All destaining solutions were effective at removing all stains on the samples. The surface roughness of the material plays a significant role in the ability of the materials to be destained, demonstrating a more significant greater effect on cleaning rough samples for improvements in light-transmittance and greater changes in color. CONCLUSIONS: This study concluded that the surface of materials plays a significant role in the material destaining and staining. In addition, the different polymers used for retainer fabrication exhibited different responses during the destaining process depending on types of stains.

Effectiveness of AI-driven remote monitoring technology in improving oral hygiene during orthodontic treatment.

OBJECTIVE: This study aimed to evaluate the effectiveness of Dental Monitoring™ (DM™) Artificial Intelligence Driven Remote Monitoring Technology (AIDRM) technology in improving the patient's oral hygiene during orthodontic treatment through AI-based personalized active notifications. METHODS: A prospective clinical study was conducted on two groups of orthodontic patients. DM Group: (n = 24) monitored by DM weekly scans and received personalized notifications on the DM smartphone application regarding their oral hygiene status. Control Group (n = 25) not monitored by DM. Both groups were clinically assessed using Plaque Index (OPI) and the Modified Gingival Index (MGI). DM Group was followed for 13 months and the Control Group was followed for 5 months. Student-independent t test and paired t tests were used to investigate the mean differences between study groups and between time points for each group respectively. RESULTS: At all time points, the mean differences indicated that the DM group had lower OPI and MGI values than the control group. The mean value for OPI and MGI were statistically significantly lower in the DM group (OPI = 1.96, MGI = 1.56) than in the control group (OPI = 2.41, MGI = 2.17) after 5 months. A rapid increase in mean OPI and MGI values was found between T0 and T1 for both study groups. A plateau effect for OPI scores appeared to occur from T1 to T5 for both study groups, but the plateau effect seemed to be more pronounced for the DM group than the study group. The MGI values for both study groups also increased dramatically from baseline to T5, however, a plateau effect was not observed. CONCLUSIONS: The oral hygiene of orthodontic patients rapidly worsens over the first 3 months and plateaus after about 5 months of treatment. AIDRM by weekly DM scans and personalized active notifications may improve oral hygiene over time in orthodontic patients.

Cone-beam computed tomography assessment of maxillary anterior alveolar bone remodelling in extraction and non-extraction orthodontic cases using stable extra-alveolar reference.

OBJECTIVE: To explore alveolar cortical positional change in response to tooth movement in extraction and non-extraction orthodontic cases, using cone-beam computed tomography (CBCT) and stable extra-alveolar references. MATERIALS AND METHODS: The pre-treatment (T1) and post-treatment (T2) CBCT scans of 25 extraction (EXT) and matched 25 non-extraction (Non-EXT) orthodontic cases were imported into Dolphin Imaging 3D, and oriented uniformly. Sagittal and axial CBCT cross-sections were traced using customized software-generated guides. The displacement of teeth and alveolar bone cortices were automatically measured using the palatal plane (PP) and the line perpendicular to PP and passing Sella as reference. Intra- and inter-group differences between T1 and T2 were analysed. Subjects were also superimposed three-dimensionally using Geomagic Control X for qualitative analysis of cortical remodelling. RESULTS: The EXT group showed incisor retraction, while the Non-EXT group exhibited statistically significant incisor anterior tipping (P < .05). In EXT, both the labial and palatal cortices are resorbed. Non-EXT showed labial cortex anterior modelling, and statistically significant palatal cortex resorption (P < .05). In both groups, statistically significant decrease in total and palatal alveolar widths, increase in labial widths, and palatal dehiscence were observed. Comparatively, EXT showed significantly more incisal total and palatal width decrease and palatal vertical bone loss. CONCLUSION: Labial cortical remodelling was shown to follow anterior tooth movement, but the palatal cortical response to incisor retraction and labial cortical remodelling in general remained inconclusive. Narrowing of the alveolar housing and palatal dehiscence were observed regardless of extraction following orthodontic treatment.

In-vivo evaluation of Artificial Intelligence Driven Remote Monitoring technology for tracking tooth movement and reconstruction of 3-dimensional digital models during orthodontic treatment.

INTRODUCTION: An in-vivo evaluation of the Dental Monitoring (DM; Paris, France) Artificial Intelligence Driven Remote Monitoring technology was conducted in an active clinical setting. Our objectives were to compare the accuracy and validity of the 3-dimensional (3D) digital models remotely generated from the DM application to 3D Digital Models generated from the iTero Element 5D intraoral scanner (Align Technologies, San Jose, Calif) of patients' dentition during in-vivo fixed orthodontic treatment. METHODS: The orthodontic treatment of 24 patients (aged 14-55 years) was tracked across an average of 13.4 months. Scans of the maxillary and mandibular arches of each patient were taken by an iTero intraoral scanner and with the DM application before treatment initiation without (T0) and with (T1) the fixed orthodontic appliances and at every in-person adjustment appointment (T2-T10). The global deviation between the reconstructed digital models from the DM and iTero scans was compared at each time point using Geomagic Control-X 2020 (3D Systems, Rock Hill, SC). Descriptive analysis was conducted to determine the mean deviation at each time point for the maxillary and mandibular arches, to compare the maxilla and mandible mean deviations at each time point to the null hypothesis mean of 0 mm and the paired mean of the average at each time point between the maxilla and mandible. RESULTS: The findings revealed no clinically significant difference between the reconstructed digital models generated by the iTero IOS and the remotely reconstructed digital dental models generated by the DM application. CONCLUSION: DM artificial intelligence tracking algorithm can track tooth movement and reconstruct 3D digital models to a clinically acceptable degree for orthodontic application.

COVID-19 infection rates and mitigation strategies in orthodontic practices.

BACKGROUND: COVID-19 has impacted and increased risks for all populations, including orthodontic patients and providers. It also changes the practice management and infection control landscape in the practices. This study aimed to investigate the COVID-19 infection and vaccination status of orthodontic providers and mitigation approaches in orthodontic practices in the United States during 2021. METHODS: A validated 50-question research electronic data capture (REDCap) browser-based questionnaire was distributed to 12,393 orthodontists and pediatric dentists who reported actively providing orthodontic treatment. Questions were designed to collect demographic data of respondents, evaluate the COVID-19 mitigation approaches, and evaluate the history of COVID-19 infection and vaccination status of the orthodontic providers. Associations of demographic and the COVID-19 mitigation approaches were assessed using chi-square tests at the significance level of 0.05. RESULTS: Four hundred fifty-seven returned the survey (response rate 3.69%) for analysis. Most respondents were vaccinated, and increased infection control measures in response to the pandemic. Half of the respondents practiced teledentistry and switched to digital impression systems. Two-thirds reported difficulties in attaining PPEs due to the increased cost and scarcity of PPEs. About 6% of respondents reported a history of COVID-19 infection, and 68.9% of their staff had COVID-19 infection. Statistically significant associations were found between increased practice experience with difficulties in acquiring PPE (p = .010). There were no significant associations between races of respondents, geographic location, and years of practicing when cross-tabulated with vaccination status or COVID-19 infection rate (p > .05). CONCLUSION: Increased infection control strategies were employed in almost all orthodontic practices in addition to existing universal precaution. Most of the orthodontic providers and their staff members were vaccinated. While staff's infection rates were an issue, doctors' infection rates remained low.

The use of teleorthodontics during the COVID-19 pandemic and beyond - perspectives of patients and providers.

BACKGROUND: The COVID-19 pandemic significantly impacted dental services, resulting in reduced staff availability, limited appointments, and some dental clinics even being forced to close their doors. Despite these challenges, the need for dental consultants remained present, particularly in emergency situations. One area of orthodontics that had seen a surge in demand during the pandemic is Teleorthodontics. With the help of Teleorthodontics, orthodontic consultations, assessments, and even treatment monitoring could be conducted remotely, making it a safe and convenient option for patients during those challenging times. AIM: This survey aimed to evaluate the acceptance of patients and their orthodontists on the use of different modes of communication through Teleorthodontics during the COVID-19 pandemic and their willingness to continue using this in the future. METHODS: An online survey instrument in Qualtrics was distributed to orthodontic patients at the University of Illinois, Chicago. The survey was available on a rolling basis for up to 6 months. A total number of 364 partients voluntarily participated in the survey. The Faculty and Residents were also asked to participate in a survey through recruitment via their UIC email addresses. RESULTS: According to our survey, both patients and providers showed acceptance of Teleorthodontics and have used it in different forms during orthodontic treatment. The application is easy-to-use, convenient, and not at all time-consuming. Overall satisfaction with using this application was recorded at 92%, with 66% of patients stating that it saved them time by eliminating the need to travel to the orthodontic clinic. 30% of providers found that the interaction with patients using Teleorthodontics was a positive experience and would recommend it in future. CONCLUSION: Teleorthodontics has shown great potential, particularly in follow-up cases, and holds promise as a valuable tool for online remote dental consultations in the future.

Accuracy of Dental Monitoring 3D digital dental models using photograph and video mode.

INTRODUCTION: This study aimed to test the accuracy of the 3-dimensional (3D) digital dental models generated by the Dental Monitoring (DM) smartphone application in both photograph and video modes over successive DM examinations in comparison with 3D digital dental models generated by the iTero Element intraoral scanner. METHODS: Ten typodonts with setups of class I malocclusion and comparable severity of anterior crowding were used in the study. iTero Element scans along with DM examination in photograph and video modes were performed before tooth movement and after each set of 10 Invisalign aligners for each typodont. Stereolithography (STL) files generated from the DM examinations in photograph and video modes were superimposed with the STL files from the iTero scans using GOM Inspect software to determine the accuracy of both photograph and video modes of DM technology. RESULTS: No clinically significant differences, according to the American Board of Orthodontics-determined standards, were found. Mean global deviations for the maxillary arch ranged from 0.00149 to 0.02756 mm in photograph mode and from 0.0148 to 0.0256 mm in video mode. Mean global deviations for the mandibular arch ranged from 0.0164 to 0.0275 mm in photograph mode and from 0.0150 to 0.0264 mm in video mode. Statistically significant differences were found between the 3D models generated by the iTero and the DM application in photograph and video modes over successive DM examinations. CONCLUSIONS: 3D digital dental models generated by the DM smartphone application in photograph and video modes are accurate enough to be used for clinical applications.

Nonsurgical approach to Class I open-bite malocclusion with extrusion mechanics: a 3-year retention case report.

Anterior open bite is one of the most challenging malocclusions for orthodontic treatment. The high incidence of relapse is a major concern. Therefore, accurate initial examination, diagnosis, treatment plan, and consideration of habitual risk factors are crucial for a successful outcome without unwanted sequelae. Excellent patient compliance for retainer wear is also a critical factor. This case report shows the 3-year stability of a nonsurgical and nonextraction orthodontic treatment of a 5-mm anterior open-bite malocclusion in a 12-year-old girl with extrusion mechanics and habit modification. After 2 years of orthodontic treatment, excellent outcomes were achieved. With an appropriate retention protocol, the long-term stability of the treatment was favorable.

Correlations of spheno-occipital synchondrosis, cervical vertebrae, midpalatal suture, and third molar maturation stages.

OBJECTIVES: To estimate the joint correlations among cervical vertebrae maturation (CVM), spheno-occipital synchondrosis (SOS), midpalatal suture maturation (MPS), and third molar mineralization (TMM) and to assess the predictive potential of SOS on CVM and MPS. MATERIALS AND METHODS: 570 pretreatment cone-beam computed tomogram (CBCT) scans from three private practices were analyzed, and MPS, CVM, SOS, and TMM stages were categorized and recorded by two independent investigators. Intra- and inter-rater reliability tests were evaluated with weighted Cohen's kappa tests. Spearman correlation coefficients for ordinal data were used to estimate the pairwise correlations among SOS, CVM, MPS, and TMM. To evaluate if SOS could predict CVM and MPS, ordinal regression models were estimated and cross-validated. RESULTS: The analysis demonstrated a robust positive correlation between SOS and CVM (r = 0.845) and between SOS and MPS (r = 0.742). A significant correlation was also observed between CVM and MPS (r = 0.659). Further correlations were identified between TMM and SOS (r = 0.444), TMM and MPS (r = 0.392), and TMM and CVM (r = 0.358). Ordinal regression models indicated the potential of using SOS as a predictive marker for CVM and MPS stages. CONCLUSIONS: With a comprehensive analysis, SOS is strongly correlated with CVM and MPS, and SOS stage can be used to predict CVM and MPS using ordinal regression. Since MPS stages are challenging to categorize due to their anatomy, this finding suggests a diagnostic tool using SOS stages or when more information on skeletal maturity of the patient is desired.

Consideration of root position in virtual tooth setup for extraction treatment: A comparative study of simulated and actual treatment results.

Objective: The purpose of the present study was to compare the root positions in virtual tooth setups using only crowns in a simulated treatment with those achieved in the actual treatment. Methods: Pre- and post-treatment intraoral and corresponding cone beam computed tomography (CBCT) scans were obtained from 15 patients who underwent orthodontic treatment with premolar extraction. A conventional virtual tooth setup was used for the treatment simulation. Pre- and post-treatment three-dimensional digital tooth models were fabricated by integrating the patients' intraoral and CBCT scans. The simulated root positions in the virtual setup were obtained by merging the crown in the virtual setup and root in the pre-treatment tooth model. The root positions of the simulated and actual post-treatment tooth models were compared. Results: Differences in root positions between the simulated and actual models were > 1 mm in all teeth, and statistically significant differences were observed (p < 0.05), except for the maxillary lateral incisors. The differences in the inter-root angulation were > 1° in all teeth, and statistically significant differences were observed in the maxillary and mandibular canines. Conclusions: The virtual tooth setup using only crown data showed errors over the clinical limits. The clinical application of a virtual setup using crowns and roots is necessary for accurate and precise treatment simulation, particularly in extraction treatment.

Evaluation of the (hu)MANid program for sex and ancestry estimation in a diverse, contemporary CT scan-based sample.

Human remains from forensic and bioarcheological contexts are often fragmentary, requiring methods for estimating a forensic profile that are based upon limited skeletal features. In 2017, Berg and Keryhercz created an online application, (hu)MANid, that provides sex and ancestry estimation from mandibular morphoscopic traits and linear measurements. In this study, we examine the utility of the (hu)MANid application in a diverse, urban US adult sample (aged 20-45; n = 143) derived from computed tomography (CT) scans. We secondarily conduct a preliminary analysis of the program's utility in a sample of adolescents (aged 15-17; n = 40). Six morphoscopic, and eleven morphometric traits were recorded as directed by the literature associated with the (hu)MANid program. Percent correct classification and posterior predictive values were calculated for the sex and ancestry estimations output by the program; chi-squared tests were employed to compare self-reported and predicted ancestry. In the adult sample, sex was accurately predicted for 75.52% of the sample. Ancestry prediction, however, was less favorable ranging from 19.3% to 50% correct. For the adolescent sample, correct sex estimation (45%) did not surpass what could occur by chance alone, though ancestry prediction fared better than in the larger adult sample (percent correct prediction overall average: 47.5%, range 35.71%-71.43%). The (hu)MANid application shows utility for use with CT scan-derived adult samples for sex estimation, but caution is warranted for ancestry estimation and use with samples that may not have reached full adult maturity.

The Effects of Staining and Cleaning on the Color and Light Transmittance Changes of a Copolyester Retainer Material with Different Surface Textures.

This study evaluated the efficacy of different cleaning methods with respect to changes in the color and light transmittance of both rough and smooth thermoformed, copolyester retainer specimens, after staining in different solutions. Four hundred copolyester sheets (Essix ACE) specimens were fabricated over molds with different surface textures, smooth and rough. The specimens were stained in four different solutions (n = 100 per solution) over 28 days; then, each of the four groups of 100 stained specimens was sub-divided into five groups of 20 specimens and subjected to a different destaining solution. The specimens were sub-divided with half subjected to an additional ultrasonic cleaning procedure. Light transmittance and color changes were analyzed using a spectrometer/integrating sphere assembly and a spectrophotometer. Mean difference comparisons were performed using appropriate statistical tests at p = 0.05. All five destaining solutions proved to be effective at removing coffee and tea stains. The surface roughness of the retainer material plays a significant role in the ability of cleaning solutions to remove stains, demonstrating a greater effect on cleaning rough specimens with respect to improvements in light transmittance and greater changes in color. Additionally, an ultrasonic cleaning unit generally enhanced the ability of all five solutions to clean the tea-stained specimens. However, the enhancements were only significant for light transmittance.

Positivity rates of SAR-CoV-2 infection in orthodontic patients at the orthodontic clinic, University of Illinois Chicago.

COVID-19 has impacted and increased risks for healthcare providers, including orthodontists. There is no information regarding the potential transmission risks in the orthodontic community. This study aims to compare the positivity rate of SARS-CoV-2 infection in orthodontic patients at the University of Illinois Chicago (UIC) orthodontic clinic to the positivity rate of the local population in Chicago. All orthodontic patients who sought treatment at the UIC orthodontic clinic from June 16 to October 31, 2021, were invited to participate in the study. Three milliliters of saliva from the participants were collected in the sample collection tubes and subjected to a polymerase chain reaction (PCR) based assay to detect SAR-CoV-2. All participants' age, sex, history of COVID-19 infection, and vaccination status were recorded. The COVID-19 positivity rates of Chicago, Cook County of Illinois, and the orthodontic clinic at UIC were compared. One thousand four hundred and thirty-seven orthodontic patients aged 6 to 70 years old (41.8% males and 58.2% females) participated in the study. Among all participants, nine participants tested positive for SARS-CoV-2 (5 males and 4 females). During the study, the average COVID-19 positivity rate at the UIC orthodontic clinic was 0.626%. All of the positive participants were asymptomatic, and two of the participants had a history of COVID-19 infection. Among all positive participants, three participants had received complete COVID-19 vaccination. An increased frequency of positive cases at the orthodontic clinic was observed during the time of high positivity rate in Chicago and Cook County. A potential risk of COVID-19 transmission from patients to orthodontic providers remains, even with asymptomatic and vaccinated patients.

Podocan-like protein: a novel small leucine-rich repeat matrix protein in bone.

Recently, significant attention has been drawn to the biology of small leucine-rich repeat proteoglycans (SLRPs) due to their multiple functionalities in various cell types and tissues. Here, we characterize a novel SLRP member, "Podocan-like (Podnl) protein" identified by a bioinformatics approach. The Podnl protein has a signal peptide, a unique cysteine-rich N-terminal cluster, 21 leucine-rich repeat (LRR) motifs, and one putative N-glycosylation site. This protein is structurally similar to podocan in SLRPs. The gene was highly expressed in mineralized tissues and in osteoblastic cells and the high expression level was observed at and after matrix mineralization in vitro. Podnl was enriched in newly formed bones based on immunohistochemical analysis. When Podnl was transfected into osteoblastic cells, the protein with N-glycosylation was detected mainly in the cultured medium, indicating that Podnl is a secreted N-glycosylated protein. The endogenous Podnl protein was also present in bone matrix. These data provide a new insight into our understanding of the emerging SLRP functions in bone formation.

A novel proteolytic processing of prolysyl oxidase.

Lysyl oxidase (LOX) is an amine oxidase that is critical for the stability of connective tissues. The secreted proLOX is enzymatically quiescent and is activated through proteolytic cleavage between residues Gly(162) and Asp(163) (residue numbers according to the mouse LOX) by bone morphogenetic protein (BMP)-1 gene products. Here we report a novel processing of proLOX identified in vitro and in vivo. Two forms of mature LOX were identified and characterized by their immunoreactivity to specific antibodies, amine oxidase activity, and mass spectrometry. One form was identified as a well-characterized BMP-1 processed LOX protein. Another was found to be a truncated form of LOX resulting from the cleavage at the carboxy terminus of Arg(192). The truncated form of LOX still appeared to retain amine oxidase activity. The results from the proLOX gene deletion and mutation experiments indicated that the processing occurs independent of the cleavage of proLOX by BMP-1 gene products and likely requires the presence of LOX propeptide. These results indicate that proLOX could be processed by two different mechanisms producing two forms of active LOX.

Ameloblastin regulates cell attachment and proliferation through RhoA and p27.

The matrix adhesion protein ameloblastin (AMBN) is one of the unique components of the mineralizing matrix of bones and teeth. Here we focused on two types of cells expressing AMBN - mouse dental follicle cells (mDF) and mouse periodontal ligament cells (mPDL) - to decipher AMBN function in developing dental, periodontal, and bone tissues. To test AMBN function, cell culture dishes of mDF and mPDL were exposed to either full-length or C-terminal (amino acids 137-407) recombinant Ambn protein. Alternatively, cells were subjected to transient transfection using an Ambn-small hairpin (sh) RNA vector. Our cell culture studies documented that dishes coated with full-length AMBN promoted the attachment of mPDL and mDF cells as early as 1 h after seeding. In order to identify potential intermediaries that might aid the effect of AMBN on adhesion, RhoA expression levels in AMBN-coated and uncoated control dishes were assessed. These studies indicated that AMBN induced RhoA expression 4 h after seeding, especially in mPDL cells. After 4 h of culture, the cell cycle inhibitor p27 was also up-regulated. In addition, exogenous AMBN and its C-terminal fragment reduced the proliferation of mDF and mPDL. Finally, transient transfection of mDF and mPDL cells with the Ambn-shRNA vector resulted in the down-regulation of p27 in mPDL cells. Together, these data indicate that AMBN affects cell adhesion via RhoA and cell cycle progression through p27.

Maxillofacial space infection experience and risk factors: a retrospective study of 222 cases.

BACKGROUND: Maxillofacial space infection (MSI) experience review is beneficial for its management. AIM: To identify potential risk factors predisposing to the exacerbation of MSI and a prolonged length of stay (LOS). METHODS: We performed a comprehensive retrospective review of medical records of 222 MSI patients admitted in Center of Stomatology during 1993-2019. RESULTS: About 63.5% of 222 patients had an odontogenic infection, and submandibular space was the most involved space. Streptococcus spp. was the most common organism isolated (72.4%). Multiple-space cases had more systemic diseases, respiratory difficulty, and life-threatening complications and exhibited worse clinical characteristics (higher white-blood-cell-count, higher body temperature, and restricted mouth opening) than single-space cases (P < 0.05). No significant difference in LOS was found between multiple-space cases and single-space cases. Diabetes and hypertension both accounted for 35.1% in life-threatening cases. Multiple-space infection (60.4%), respiratory difficulty (11.7%), and systemic conditions (43.2%) were identified as critical risk factors associated with life-threatening complications in MSI patients (P < 0.001). A significantly prolonged LOS was found in cases aged ≥ 60 years or with systemic diseases. Community outpatient treatment shortened 1.9 days of LOS compared with self-medication before admission during 2010-2019 (P < 0.05). CONCLUSION: Comprehensive managements are advisable for MSI patients with multiple-space infection, respiratory difficulty, systemic diseases to avoid disseminated exacerbation, and occurrence of life-threatening complications. Community outpatient treatment was beneficial to a reduced LOS. Timely access to dental outpatient management and simultaneously steady control of diabetes and hypertension was advocated. Improved coverage of insured dental outpatient treatment should be stressed.