Use of antibiotics after lower third molar surgery - useful or harmful procedure? A randomized, double-blind, placebo-controlled trial (original) (raw)
Related papers
Medicina Oral Patología Oral y Cirugia Bucal, 2020
Background: The objective of this study was to determine the effect of antibiotic prophylaxis in preventing postoperative infections after extraction of impacted mandibular third molars. Material and Methods: A Parallel-group, randomized, blind, placebo-controlled trial was performed. 154 patients were randomly allocated to 2 groups; experimental (n=77) receiving 2g amoxicillin 1 hour prior to surgery and control (n=77) receiving placebo. Primary outcome was postoperative infections and secondary outcome was the need for rescue analgesia. Results: 4.5% of patients developed postoperative infections, five patients of the control group (4 alveolar osteitis, 1 surgical site infection) and two of the experimental group (1 alveolar osteitis, 1 surgical site infection). Difference between groups was not statistically significant, RR=0.4 (95%CI 0.08-1.99, p=0.41) NNTB=26. Rescue analgesia intake was significantly higher in the control group (41 vs 18 patients of experimental group) RR=0.49 (95%CI 0.32-0.75, p<0.05) NNTB=3. Conclusions: The use of 2g amoxicillin 1 hour before surgery was not effective in significantly reducing the risk of postoperative infections from impacted mandibular third molars extraction, when compared to placebo. Nevertheless, antibiotic prophylaxis was associated with a reduced need for rescue analgesia.
Benefits of not Prescribing Prophylactic Antibiotics After Third Molar Surgery
Journal of Maxillofacial and Oral Surgery, 2015
Aim and Objective The aim of the study is to reinstate the fact that antibiotics are not required as prophylaxis for third molar surgery. So the standard of care after extraction of mandibular third molar surgery for all healthy patients should be a good anti-inflammatory regimen rather than a antibiotic prophylaxis. Context Surgical removal of impacted mandibular third molar is the most common procedure and many complications are usually encountered in this procedure likepain, trismus, infection, swelling, inflammation and nerve damage. Now, the question that arises is does the age old practice of prescribing postoperative antibiotics solve these problems or adds on some new. The data collected and analysed in our observational study, however, reinstates that instead, it is the proper aseptic precautions and good anti-inflammatory regimen that are more important than the prophylactic antibiotics (Pasupathy and Alexander in J Craniofac Surg, 2011). Moreover, giving antibiotics means opening up the loopholes to bacterial resistance. Settings and Design A retrospective analysis of the data collected from 40 patients coming to the department of Dental and Implant Surgery, Karamsad, Anand between October 2014 and December 2014, operated for third molar surgery was carried out. Materials and Methods Data from 40 patients requiring disimpaction of mandibular third molar was analysed. Postoperatively, only anti-inflammatory medication was prescribed to all the patients. Results None of the patients showed any of the signs or symptoms of infection.
Vojnosanitetski pregled, 2020
Background/Aim. There is no scientific evidence that the prophylactic use of antibiotics as a part of the mandibular third molar surgery is effective in suppressing postoperative pain, edema, trismus, and dry socket. The aim of the study was to investigate the effects of antibiotics from the fluoroquinolone (moxifloxacin) and cephalosporin (cefixime) groups in reducing postoperative inflammatory sequelae (pain, edema, and trismus), as well as in possibly reducing the incidence of dry socket after mandibular third molar surgery. Methods. This double-blind study was completed by 157 subjects, comprising two study groups (who received the aforementioned antibiotics) and a control group, who received placebo tablets. Subjects were assessed on the first, second, and seventh day following surgery. In the postoperative course, patients were monitored for the occurrence, intensity, and duration of postoperative inflammatory sequelae and dry socket. Results. Both antibiotics, especially moxi...
Efficacy of Antimicrobial therapy in Third Molar Surgery - A Comparative Study
IOSR Journals , 2019
Purpose Third molar extraction is most common procedures performed in oral and maxillofacial surgery. The most common complications after surgical extraction of third molar are pain, swelling, trismus, pyrexia, etc. The use of routine antibiotics therapy in patient undergoing surgical third molar extraction is controversial. The objective of the study were: 1. To evaluate the efficacy of antibiotics in pain, swelling, trismus, temperature and wound healing postoperatively; 2. To minimize the adverse effects of antibiotics; and 3. To decrease total operative cost factor. Material and methods Present study comprises 50 extractions of mandibular as well as maxillary third molar of patients who attended the OPD of Department of Oral and Maxillofacial Surgery, UCMS-CODS, Bhairahawa, Nepal from December 2018 to August 2019. The patients were divided into two groups: 1. Test group – who received antibiotics postoperatively for 5 days; 2. Control group – did not receive antibiotics. Patients were evaluated postoperatively on 1st day, 3rd day, 7th day and on 14th day. Result Fiftypatient were selected in this study, post operative pain, swelling, infection, trismus, temperature, wound healing were measured and analyzed. Statistically no significant difference were recorded. Conclusion Post operative uses of antibiotics do not seem to be necessary for reducing the post operative complications in cases of third molar extraction. Further studies with large number of patients should be carried out.
Journal of Maxillofacial and Oral Surgery, 2013
Your article is protected by copyright and all rights are held exclusively by Association of Oral and Maxillofacial Surgeons of India. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".
Prophylactic Antibiotics for Third Molar Surgery: An Enigma or Panacea?
IOSR Journal of Dental and Medical Sciences, 2014
The removal of impacted third molars is a common procedure in oral and maxillofacial surgery. There is controversy about use of antibiotics as prophylaxis to prevent complications after third molar removal. Several authors claim that prophylactic antibiotics are useful in preventing postoperative complications and infections after third molar removal. Decreased pain, swelling and trismus are reported. Quality of life is stated to be higher when antibiotics are prescribed. On the other hand, additional studies were not able to demonstrate the effectiveness of antibiotic prophylaxis. The purpose of this study is to review the literature regarding the appropriateness of the routine use of antibiotics for third molar surgery.
Purpose: To estimate and compare the frequencies of inflammatory complications after third molar (M3) surgery in subjects receiving intravenous prophylactic antibiotics or saline placebo. Materials and Methods: Using a placebo-controlled, double-blind, randomized clinical trial, the investigators enrolled a sample composed of subjects who required extraction of at least 1 impacted M3 and requested intravenous sedation or general anesthesia. The predictor variable was treatment group classified as active treatment (penicillin or clindamycin for penicillin-allergic subjects) or placebo (0.9% saline). Study medications were randomly assigned. Both surgeon and subject were blinded to treatment assignment. The medication was administered intravenously prior to any incision. The outcome variable was postoperative inflammatory complication classified as present or absent and included alveolar osteitis (AO) or surgical site infection (SSI). Other variables were demographic, anatomic, or operative. Descriptive and bivariate statistics were computed. Statistical significance was set at P < .05, single-tailed test of hypothesis. Results: The sample was composed of 118 subjects (n = 59 per study group). In the active treatment group, there were no postoperative inflammatory complications. In the placebo group, 5 subjects (8.5%) were diagnosed with SSI, (P = .03). No subject met the case definition for AO. All SSIs were associated with the removal of partial bony or full bony impacted mandibular M3s. Conclusion: In the setting of third molar removal, these results suggest that the use of intravenous antibiotics administered prophylactically decrease the frequency of SSIs. The authors cannot comment on the efficacy of intravenous antibiotics in comparison to other antibacterial treatment regimens, eg chlorhexidine mouthrinse or intrasocket antibiotics.
International Journal of Oral and Maxillofacial Surgery, 2019
The aim of this prospective study was to determine the antibiotic bioavailability of a prophylactic protocol in patients undergoing third molar surgery. Samples from 25 patients were analysed (average age 21 AE 3.89 years, range 18-33 years; 14 female). The patients received single-dose prophylaxis of 2 g amoxicillin orally 1 hour prior to third molar surgery. Venous blood (1.5 ml) and blood from the third molar socket (1.50 ml) were obtained. The amoxicillin plasma concentration was determined in both samples by high performance liquid chromatography with a diode-array detector (HPLC/DAD). Their associations with demographic variables (age, height, weight, body mass index (BMI), sex) and antibiotic exposure time were analyzed using linear regression models. The mean amoxicillin plasma level detected in the venous blood was 1.21 AE 1.17 mg/ml (range 0.49-6.34 mg/ml) and in the third molar socket was 4.14 AE 2.24 mg/ml (range 0.86-7.46 mg/ml) (P < 0.001). No relationship was observed between the bioavailability of the drug and the patient biometric indices evaluated. The prophylactic administration of 2 g amoxicillin in third molar surgery showed greater bioavailability in the molar socket than the concentrations established as necessary to inhibit the growth of microorganisms that cause oral infections. The results show the need to review the current infection control protocols in oral surgery in light of the overestimated doses observed.