Is perioperative antibiotic prophylaxis in the case of routine surgical removal of the third molar still justified? A randomized, double-blind, placebo-controlled clinical trial with a split-mouth design

Abstract

Introduction Since antimicrobial resistance, caused by various factors including antibiotic overuse and abuse, is a severe challenge, the necessity of perioperative antibiotic prophylactic for surgical third molar removal remains a contentious topic. This study determined whether perioperative antibiotic prophylaxis can reduce surgical site infections (SSIs), swelling, and pain in the case of surgical removal of wisdom teeth. Material and methods A randomized, double-blind, placebo-controlled clinical trial with a split-mouth design. A study medication of 2 g amoxicillin, administered 1 h before the third molar removal, followed by 1.5 g each for the first 3 postoperative days, was compared with placebo medication. The primary outcome variable (SSI), secondary clinical parameters (swelling and trismus), and patient-centered outcome measures (bleeding, swelling, pain, and pain medication intake) were documented until postoperative day 7. Statistical analyses were done with a paired t test, t test for independent samples, Chi-square test, and McNemar test, including effect sizes. Results Primary outcome SSI, in total 11%, and clinical parameters swelling and trismus were not significantly different between the two groups. The patient-centered outcome measures (bleeding, swelling, and pain) did not significantly differ, except for postoperative bleeding in the EG on day 0. No significant result was found with pain medication intake postoperative on days 0–7. Conclusions Perioperative administration of oral antibiotics neither revealed additional benefits in patient-related outcome measures nor reduced postoperative complications compared with the placebo group indicated at routine surgical removal of noninflamed wisdom teeth. Clinical relevance Taking antimicrobial resistance into account, clear recommendations for administering drugs, particularly antibiotics, are critical in oral surgery.

What’s new for the clinician– summaries of recently published papers

“…Worldwide drug misuse and overuse are some of the reasons we are currently facing AMR (antimicrobial resistance) 1 . The declining efficacy of antimicrobial medication has become a reality in the form of superbugs, such as methicillinresistant staphylococcus aureus or extremely drug-resistant tuberculosis 1 .…”

“…Worldwide drug misuse and overuse are some of the reasons we are currently facing AMR (antimicrobial resistance) 1 . The declining efficacy of antimicrobial medication has become a reality in the form of superbugs, such as methicillinresistant staphylococcus aureus or extremely drug-resistant tuberculosis 1 . The World Health Organization (WHO) defined a "Global action plan on antimicrobial resistance" with a focus on five strategic objectives: the improvement of awareness and understanding of antimicrobial resistance (AMR), increase in surveillance and research, decrease in the incidence of infections, pursuit of sustainable financing, and optimization of the application of antimicrobial drugs.…”

“…The World Health Organization (WHO) defined a "Global action plan on antimicrobial resistance" with a focus on five strategic objectives: the improvement of awareness and understanding of antimicrobial resistance (AMR), increase in surveillance and research, decrease in the incidence of infections, pursuit of sustainable financing, and optimization of the application of antimicrobial drugs. Kirnbauer and colleagues (2022) 1 reported on a noninferiority trial of a placebo medication in conventional surgical removal of the noninflamed wisdom teeth, while focusing on surgical site infections (SSIs), swelling, trismus, and the patient's subjective well-being compared with perioperative antibiotic prophylaxis with amoxicillin.…”

“…Also, coffee consumption has been reported to be inversely associated with markers of inflammation and endothelial dysfunction. 1 Struppek and colleagues from Germany (2022) 1 reported on a study that sought to assess the strength of the association between coffee consumption and periodontitis using state-of-the-art, comprehensive phenotyping.…”

Managing Oral Health in the Context of Antimicrobial Resistance

“…The actual tendency, mostly to lessen the development of AMR, is to reduce the use of prophylactic antibiotics. Current evidence has led to the recommendations [ 61 ] to not use antibiotics to prevent postoperative complications after (1) extraction of impacted wisdom teeth [ 77 ], (2) surgical extractions of teeth or retained roots, (3) minor surgical removal of soft tissue lesions, and (4) peri-radicular surgery. Moreover, antibiotics are not recommended for the prevention of pain associated with irreversible pulpitis [ 64 ].…”