Journal of Korean Dental Science

Korean Academy of Dental Science (대한치의학회)
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Antibiotics in third molar surgery, justifiable or not?

  • Alrashdan, Mohammad S. (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Park, Jong-Chul (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, Ju-Hwan (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Yoo, Myung-Sook (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Pang, Kang-Mi (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Kim, Soung-Min (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, Jong-Ho (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University)
  • Received : 2009.10.21
  • Accepted : 2009.11.06
  • Published : 2009.12.30
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Abstract

Objectives : The purpose of this study was to evaluate the significance of antibiotics in reducing postoperative infection rates and other complications following third molar surgery. Patients and methods : Two groups of patients underwent surgical extraction of third molars. The antibiotics group, n=21, received a third generation cephalosporin antibiotic for 5 days, starting from the day of surgery. The non-antibiotics group, n=26, didn't receive any antibiotics and only received analgesics to control postoperative pain. Body temperature and hematologic findings including WBC, neutrophils, lymphocytes and monocytes counts were compared between the two groups at three intervals, preoperatively, 24 hours and 7-10 days postoperatively. Pain and swelling during the follow up period were also recorded in both groups and compared in the second part of the study. Results : In the first part of the study, comparison of body temperature, CBC components (except WBCs) showed no significant difference between the two groups during the follow up period. All parameters were within the normal range at all intervals, which indicated absence of infection. In the second part, 38% of patients in the antibiotic group, compared to 54% of the non-antibiotics group, had one or more complications during the follow up period. However, three patients from the antibiotic group compared to one from the nonantibiotics group reported having a swelling of some degree. Conclusion : Based on our objective parameters (body temperature and CBC components), both groups showed no signs of infection during the follow up period. However, the results related to pain and swelling were less conclusive, probably due to small number of patients included in the study. Accordingly, we are unable to provide definite recommendations on antibiotics use in third molar surgery.

Keywords

References

  1. Zeitler DL. Prophylactic Antibiotics for Third Molar Surgery: A Dissenting Opinion. J Oral Maxillofac Surg. 1995; 53:61-64. https://doi.org/10.1016/0278-2391(95)90503-0
  2. Bulut E, Bulut S, Etikan I, Koseoglu O. The value of routine antibiotic prophylaxis in mandibular third molar surgery: acutephase protein levels as indicators of infection. J oral Sci .2001; 43(2):117-122. https://doi.org/10.2334/josnusd.43.117
  3. Osborn TP,Frederickson G, Small IA, Torgerson TS. A Prospective Study of Complications Related to Mandibular Third Molar Surgery.1985; 43:767-769. https://doi.org/10.1016/0278-2391(85)90331-3
  4. Goldberg MH, Nemarich AN, Marco WP 2nd: Complications after mandibular third molar surgery: A statistical analysis of 500 consecutive procedures in private practice. J Am Dent Assoc 1985; 111:277, . https://doi.org/10.14219/jada.archive.1985.0098
  5. Bouloux GF,Steed MB, Perciaccante VJ. Complications of Third Molar surgery. Oral maxillofacial Surg Clin N Am .2007;19:117-128. https://doi.org/10.1016/j.coms.2006.11.013
  6. Blondeau F, Daniel NG. Extraction of Impacted Mandibular Third Molars: Postoperative Complications and Their Risk Factors. J Can Dent Assoc 2007; 73(4):325
  7. Martin MV,Kanatas AN, Hardy P. Antibiotic prophylaxis and third molar surgery.Br Dent J 2005; 198:327-330 https://doi.org/10.1038/sj.bdj.4812170
  8. Halpern LR, Dodson TB: Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery? J Oral Maxillofac Surg 2007; 65:177-185. https://doi.org/10.1016/j.joms.2006.10.016
  9. Ren YF, Malmstrom HS. Effectiveness of Antibiotic Prophylaxis in Third Molar Surgery: a Meta-Analysis of Randomized Controlled Clinical Trials. J Oral Maxillofac Surg 2007; 65: 1909-1921. https://doi.org/10.1016/j.joms.2007.03.004
  10. Lacasa JM, Jimenez JA, Ferras V,Bossom M., Sola-Morales O, Garcia-Rey C,Aguilar L, Garau J. Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized,double-blind, placebocontrolled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5mg). Int J. Oral Maxillofac.Surg 2007; 36: 321-327. https://doi.org/10.1016/j.ijom.2006.11.007
  11. Mitchell DA: A controlled clinical trial of prophylactic tinidazole for chemoprophylaxis in third molar surgery. Br Dent J 1986; 160:284. https://doi.org/10.1038/sj.bdj.4805844
  12. Peterson LJ. Antibiotic Prophylaxis Against Wound Infections in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg. 1990; 48: 617-620. https://doi.org/10.1016/S0278-2391(10)80477-X
  13. Monaco G, Staffolani C, Gatto MR, et al: Antibiotic therapy in impacted third molar surgery. Eur J Oral Sci 1999; 107:437-441. https://doi.org/10.1046/j.0909-8836.1999.eos107604.x
  14. Monaco G, Tavernese L, Agostini R, et al: Evaluation of antibiotic Prophylaxis in Reducing Postoperative Infection After Mandibular Third Molar extraction in Young patients . J Oral maxillofac Surg 2009; 67:1467-1472. https://doi.org/10.1016/j.joms.2008.12.066
  15. Curran JB, Kennett S, Young AR: An assessment of the use of prophylactic antibiotics in third molar surgery. Int J Oral Surg 1974;3:1, https://doi.org/10.1016/S0300-9785(74)80030-X
  16. Happonen RP, Backstrom AC, Ylipaavalniemi. Prophylactic use of phenoxymethylpenicillin and tinidazole in mandibular third molar surgery, a comparative placebo controlled clinical trial. Br J Oral Maxillofac Surg 1990; 28: 12-15. https://doi.org/10.1016/0266-4356(90)90003-4
  17. Bergdahl M, Hedstrom L: Metronidazole for the prevention of dry socket after removal of partially impacted mandibular third molar: A randomized controlled trial. Br J Oral Maxillofac Surg 2004; 42:555-558. https://doi.org/10.1016/S0266-4356(04)00136-6
  18. Kaczmarzyk T, Wilchlinski J,Stypulkowska J, et al. Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery. Int J Oral Maxillofac Surg. 2007; 36:417-422. https://doi.org/10.1016/j.ijom.2006.12.003
  19. Ataoglu H, Oz GY, Candirli C, et al. Routine antibiotic prophylaxis is not necessary during operations to remove third molars. Br J Oral Maxillofac Surg. 2008; 46:133-135. https://doi.org/10.1016/j.bjoms.2006.11.005
  20. Poeschl PW, Eckel D, Poeschl E: Postoperative prophylactic antibiotic treatment in third molar surgery-A necessity? J Oral Maxillofac Surg 2004; 62:3-8. https://doi.org/10.1016/S0278-2391(04)00911-5
  21. Piecuch JF, Arzadon J, Lieblich SE: Prophylactic antibiotics for third molar surgery: A supportive opinion. J Oral Maxillofac Surg 1995 ; 53:53-60. https://doi.org/10.1016/0278-2391(95)90502-2
  22. Sisk AL,Hammer WB, Shelton DW, et al. Complications following removal of Impacted Third Molars: The Role of the Experience of the Surgeon. J Oral Maxillofac Surg 1986; 44:855-859. https://doi.org/10.1016/0278-2391(86)90221-1
  23. Chiapasco M, De Cicco L, Marrone G. Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol 1993; 76:412-20. https://doi.org/10.1016/0030-4220(93)90005-O