The Role of Antibiotic Use in Third Molar Tooth Extractions: A Systematic Review and Meta-Analysis

Abstract

Background and Objectives: Anecdotal evidence suggested variation in practices for antibiotic prescribing around dental procedures including route of administration of antibiotics, timing of the course prescribed (before, after or both), length of course prescribed, narrow vs. broad spectrum agents prescribed, use of single or combination of antibiotics, and the use of loading doses. This review aims to investigate this disparity of practices and the absence of global and local recent consensus on the most appropriate antibiotic interventions around invasive dental procedures. Material and methods: Following PRISMA-P© methodology, a systematic review of randomised controlled clinical trials was designed, reviewed, and entered on the PROSPERO© website prior to commencement. Ethics approval was gained from the University of Wolverhampton Committee. Searches were performed using PubMed©, Science Direct™, and the Cochrane Database, plus the bibliographies of studies identified. They investigated studies examining the efficacy and safety of any antibiotic regimen tested, independent of regimen used, versus a placebo, control, or no therapy, on outcomes in post third molar extraction. Results: The primary outcome of interest was postoperative infection and secondary outcomes were other post-surgical related complications of infectious nature and antibiotic adverse events. Sixteen RCTs were identified that met the selection criteria. Antibiotic use was reported to be safe, causing few adverse events. Meta-analysis of infection events showed antibiotics reduced the risk of an infection by 69%, but routine use for prophylaxis in uncomplicated procedures was not supported, and their role in patients with comorbidities or impaired immunity remains controversial. The effect on the incidence of dry socket showed no difference based upon regimen used. No significant benefit was found with respect to reduction of intraoral inflammation, wound dehiscence, haematoma, and lymphadenopathy. Conclusion: The effect on postoperative pain reduction was inconclusive. Routine use of antibiotics around M3 extraction procedures is not supported, but their use in the presence of co-morbidities and or immunosuppression remains controversial to be confirmed by future studies.

A survey of dental professionals’ opinions around the use of antibiotics in molar 3 extractions and dental implant placement

“…This project was developed based upon anecdotal evidence of a wide variety of practices for antibiotic prescribing around dental procedures including route of administration of antibiotics, timing of the course prescribed when invasive procedures are planned (before, after, or both), length of course prescribed, narrow vs. broad spectrum agents prescribed, use of single or combination of antibiotics, and the use of loading doses. Additionally, there is a disparity of which (if any) antibiotic intervention is more effective than no intervention at all, or for which patients they should be prescribed to [ 13 , 14 ]. This project attempted to investigate this disparity of practices and the absence of global and local recent consensus on the most appropriate antibiotic interventions around invasive dental procedures.…”

“…Whilst this study was in progress, further guidance was published [ 19 – 20 ] together with this groups’ own systematic reviews and meta-analyses [ 13 – 14 ]. Guerrini et al , [ 19 ] is a narrative review that also describes the Italian, European and American guidelines.…”

“…For the 'how long do you recommend AB be used for M3 extraction? question, the prescribing recommendation of the BNF is 'use should be limited to short, or as required, courses' [14]. The most recommended duration was 5-7 days (84, 57.9%) or 3-4 days (11, 7.6%).…”

“…Insufficient evidence exists for specific AB dosage, or whether short or longer AB treatment protocols are required to prevent early implant failures. To address this, two systematic reviews and meta-analyses were undertaken on antibiotic use in molar 3 tooth extraction procedures [ 13 ], and on dental implant placements [ 14 ].…”

A Systematic Review on the Role of Antibiotics and Analgesics in Systemically Ill Patients Undergoing Tooth Extraction

“…In order to prevent infections caused by an unsterile environment, a lengthy or difficult procedure, patients with pre-existing immunosuppression, metabolic disorders (such as diabetes), underlying cardiac conditions, or pre-existing dental conditions, a small percentage of respondents explained that they administered post-extraction Antibiotic. There were 56 responders (38.6% of the total) who did not know whether using antibiotics would lessen the likelihood of infection after M3 extractions [ 20 ] (Tables 1 - 3 ).…”