Impact of oral antibiotics on health-related quality of life after mandibular third molar surgery: An observational study

Close follow-up instead of antibiotic therapy after mandibular third molar surgery: A clinical trial

Background

Prescribing antibiotics (AB) before or after third molar surgery is common among dentists and oral surgeons; however the effectiveness of AB therapy in reducing surgery complications is still contradictory.

Aim

The aim of this study is to evaluate the healing process after mandibular third molar surgery without AB therapy and to assess the role of close follow-ups on patient's perspective.

Methods

This study is a semi-empirical, prospective study conducted on 79 healthy patients. After surgical extraction of the impacted or semi-erupted mandibular third molar, assessment of pain, swelling (intergonial width), infection, and sub-periosteal abscess was done during the 1-month follow-ups of patients.

Results

The mean difficulty level of surgeries performed in this study was moderate. A significant relationship was found between the pain intensity and the psychological impact of follow-ups (p < 0.05). No fever or sign of infection were seen in any patient. The amount of swelling was significantly related to the difficulty level of surgery (p = 0.001); however, no significant correlation was found between the amount of pain and the level of difficulty.

Conclusion

Within the limitations of this study, it can be concluded that in order to reduce the hazards of AB therapy, close follow-up of patients after surgery can be advised.

Antibiotic prophylaxis in the prevention of dry socket and surgical site infection after lower third molar extraction: a network meta-analysis

Clinicians frequently prescribe systemic antibiotics after lower third molar extractions to prevent complications such as surgical site infections and dry socket. A systematic review of randomised clinical trials was conducted to compare the risk of dry socket and surgical site infection after the removal of lower third molars with different prophylactic antibiotics. The occurrence of any antibiotic-related adverse event was also analysed. A pairwise and network meta-analysis was performed to establish direct and indirect comparisons of each outcome variable. Sixteen articles involving 2158 patients (2428 lower third molars) were included, and the following antibiotics were analysed: amoxicillin (with and without clavulanic acid), metronidazole, azithromycin, and clindamycin. Pooled results favoured the use of antibiotics to reduce dry socket and surgical site infection after the removal of a lower third molar, with a number needed to treat of 25 and 18, respectively. Although antibiotic prophylaxis was found to significantly reduce the risk of dry socket and surgical site infection in patients undergoing lower third molar extraction, the number of patients needed to treat was high. Thus, clinicians should evaluate the need to prescribe antibiotics taking into consideration the patient's systemic status and the individual risk of developing a postoperative infection.

Antibiotics Efficiency in the Infection Complications Prevention after Third Molar Extraction: A Systematic Review

(1) Background: Antibiotics are used in every medical field including dentistry, where they are used for the prevention of postoperative complications in routine clinical practice during the third molar extraction. (2) Methods: This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The present systematic review aimed to evaluate and systematize the use of antibacterial drugs in order to prevent postoperative complications in outpatient oral surgery for wisdom teeth extraction. We conducted a systematic review using electronic databases such as Medline PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Considering inclusion and exclusion criteria, we included randomized clinical trials published up to 2021 investigating the antibiotic prescription for third molar extraction. (3) Results: We selected 10 studies after the application of inclusion and exclusion criteria. The results showed that the most widely used antibiotic was amoxicillin both with and without clavulanic acid, in different dosages and duration. There were no statistically significant differences between treatment groups for development of postoperative complications. (4) Conclusions: Based on the analysis of the included studies, penicillin is currently the most widely prescribed group of antibiotics. The widespread use of this antibiotic group can lead to antimicrobial resistance (AMR). Due to increasing prevalence of bacteria resistance to penicillins, clinicians should carefully prescribe these antibiotics and be aware that the widespread use of amoxicillin may do more harm than good for the population.

Oral Health-related Quality of Life (OHRQoL) Following Surgical Extraction of Impacted Mandibular Third Molars: Preliminary Observations in a Saudi Arabian Subpopulation

INTRODUCTION

OHQoL is crucial for the best preoperative assessment and development of suitable indications for mandibular third molar surgical extraction. The current study hopes to report QoL after surgical extraction of impacted mandibular third molars.

MATERIALS AND METHODS

This was a prospective study conducted in the Department of Oral and Maxillofacial Surgery, between January 2020 and April 2020. After consenting to partake in the study, patients' baseline demographics, indication for seeking third molar removal and laterality of impaction were recorded. All the surgical extractions were performed by the same surgeon. Pain was assessed pre and postoperatively with the numerical pain rating scale while QoL was assessed pre and postoperatively using the validated Arabic version of the 16 item United Kingdom Oral Health Related Quality of Life measure (UK-OHQoL).

RESULTS

A total of 92 patients were recruited. There are 41 (44.6%) males and 51 (55.4%) females with M:F of 1:1.2. Age range was between 18 and 48 years with a mean of (31.2 ± 6.6) years. Age group 20-29 years constitutes the highest number of patients. Subscales: eating, appearance, sleep, mood and work revealed more percentage complaints (42.9%, 23.4%, 24.7%, 28.6%, and 16.9%, respectively). Regarding mean domain and overall QoL scores, it was observed that there was gradual improvement in mean scores from the Pre-op values and the review periods with best mean QoL reported at POD 14.

CONCLUSION

Improvement in overall mean QoL scores during the review periods as compared with the preoperative score was observed. Eating, appearance, sleep, mood and work subscales revealed more percentage complaints.

Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial

Background

Surgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain.

Methods

A randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7.

Results

The surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001).

Conclusion

The association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery.

Trial registration: NCT04889781 (https://clinicaltrials.gov/), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1

Changes in Antibiotic Prescription After Tooth Extraction: A Population-Based Study from 2002 to 2018

OBJECTIVE

Microbial resistance due to antibiotic misuse is a worldwide problem. This study aimed to examine the trends in antibiotic prescription after tooth extraction in Korea.

METHODS

From the database of National Health Insurance Sharing Service, patients who underwent tooth extraction from 2002 to 2018 were selected as subjects, and 10% of them were selected via stratified sampling based on sex and age. Overall, 15,838,529 cases were observed for annual antibiotic prescription and broad-spectrum antibiotic prescription patterns. Additionally, standardized annual antibiotic use was calculated using a defined daily dose.

RESULTS

Prescriptions were issued in 13,429,770 (84.8%) of the tooth extraction cases, of which 12,179,185 (90.7%) included antibiotics. Logistic regression analysis revealed that the likelihood of prescribing antibiotics after tooth extraction decreased in 2003 compared to 2002 (odds ratio, 0.95) but increased from 2004 to 2018. In the case of the broad-spectrum antibiotic prescription rate, there was no clear trend between 2002 and 2012 (odds ratio, 0.89-1.07); however, over the last 5 years, the likelihood of broad-spectrum antibiotic prescription has steadily increased. The value of antibiotics based on the defined daily dose of 1000 patients per day was calculated to be 4.39 in 2002, exhibiting a steady increase later and reaching 6.97 in 2018, whereas that of broad-spectrum antibiotics was 1.68 in 2002 and has since been on the rise; the highest was 3.82 in 2018.

CONCLUSIONS

Antibiotic use after tooth extraction increased over the last 17 years; additionally, the rate of prescribing broad-spectrum antibiotics has increased over the last 5 years.

Postextraction infection and antibiotic prescribing among veterans receiving dental extractions

OBJECTIVE

To characterize postextraction antibiotic prescribing patterns, predictors for antibiotic prescribing and the incidence of and risk factors for postextraction oral infection.

DESIGN

Retrospective analysis of a random sample of veterans who received tooth extractions from January 1, 2017 through December 31, 2017.

SETTING

VA dental clinics.

PATIENTS

Overall, 69,610 patients met inclusion criteria, of whom 404 were randomly selected for inclusion. Adjunctive antibiotics were prescribed to 154 patients (38.1%).

INTERVENTION

Patients who received or did not receive an antibiotic were compared for the occurrence of postextraction infection as documented in the electronic health record. Multivariable logistic regression was performed to identify factors associated with antibiotic receipt.

RESULTS

There was no difference in the frequency of postextraction oral infection identified among patients who did and did not receive antibiotics (4.5% vs 3.2%; P = .59). Risk factors for postextraction infection could not be identified due to the low frequency of this outcome. Patients who received antibiotics were more likely to have a greater number of teeth extracted (aOR, 1.10; 95% CI, 1.03-1.18), documentation of acute infection at time of extraction (aOR, 3.02; 95% CI, 1.57-5.82), molar extraction (aOR, 1.78; 95% CI, 1.10-2.86) and extraction performed by an oral maxillofacial surgeon (aOR, 2.29; 95% CI, 1.44-3.58) or specialty dentist (aOR, 5.77; 95% CI, 2.05-16.19).

CONCLUSION

Infectious complications occurred at a low incidence among veterans undergoing tooth extraction who did and did not receive postextraction antibiotics. These results suggest that antibiotics have a limited role in preventing postprocedural infection; however, future studies are necessary to more clearly define the role of antibiotics for this indication.

Do perioperative antibiotics reduce complications of mandibular third molar removal? A double-blind randomized controlled clinical trial

OBJECTIVE

The aim of this study was to compare the effects of different antibiotic prophylaxis regimens versus placebo in relation to possible postoperative complications derived from the surgical extraction of impacted lower third molars.

STUDY DESIGN

The final study sample of this double-blind randomized controlled trial comprised 92 Caucasian volunteers. Patients were assigned to 3 groups by using a randomization table. Group 1 (n = 30) received 750 mg oral amoxicillin both before and after the surgery; group 2 (n = 32) received the same oral dose after surgery alone; and group 3 (n = 30) received placebo both before and after surgery. Infectious complications, postoperative pain, and inflammation intensity were measured. The requirement for and the timing of rescue medication were also measured.

RESULTS

Postoperative pain and inflammation intensity were significantly higher (P < .05) in group 3 than in groups 1 or 2 at 48 hours, 72 hours, and 1 week. A significantly higher proportion of group 3 required rescue medication (analgesics and rescue antibiotics) (P = .013) compared with groups 1 or 2.

CONCLUSIONS

Greater pain and inflammation were experienced by patients receiving placebo before lower third molar extraction than by those receiving antibiotics either before surgery or both before and after surgery. Other options, such as use of local antibiotics, should be considered to reduce the problems, including bacterial resistance, caused by overuse of systemic antibiotics.

Critical analysis of methodological quality of systematic reviews and meta-analysis of antibiotics in third molar surgeries using AMSTAR 2

The clinicians usually prescribe antibiotics to reduce post-operative complications during third molar surgeries. However, in the absence of clear conclusions regarding the use of antibiotics in third molar surgeries, present systematic review was planned to assess the quality of systematic reviews evaluating the efficiency of antibiotics in reducing post-operative complications. The literature search was done in Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, EMBASE, and Google scholar. Systematic reviews published in English during the period from January 1990 to December 2019 were included. The maxillary and mandibular third molars indicated for extraction either because of infection, orthodontic or prophylactic reasons were included. From 526 screened studies, thirteen reviews were qualified for qualitative analysis. The qualities of the included reviews were evaluated using the AMSTAR 2 tool. The included reviews were also evaluated based on the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. One high quality, eight moderate quality, three low quality, and one critically low-quality reviews were observed in the present review. No statistically significant difference was observed between the included reviews based upon the analysis of the number of authors, geographic region, impact factor of the published journal, year of publication, and the number of citations for each review. Considering the observations form the high and moderate-quality reviews, the present systematic review concludes that antibiotics effectively aid in reducing the post-operative complications and frequency of observation of dry socket.

Health-related quality of life of patients treated with chemoradiotherapy plus or minus prophylactic antibiotics to reduce the number of pneumonias for locally advanced head and neck cancer, the PANTAP study

OBJECTIVES

The recent PANTAP trial showed that administration of prophylactic antibiotics in locally advanced head and neck carcinoma (LAHNC) patients treated with chemoradiotherapy reduced fever, hospitalization and costs. The current study describes the effect of prophylactic antibiotics on health-related quality of life (HRQoL), another secondary endpoint of the trial.

MATERIALS AND METHODS

In this multicenter randomized trial, LAHNC patients treated with chemoradiotherapy received prophylactic antibiotics or standard care. HRQoL was assessed at baseline (before chemoradiotherapy), day 28 of chemoradiotherapy (one day before starting prophylactic antibiotics), the final day of radiotherapy, and 3.5 months after the end of chemoradiotherapy, using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC H&N35 module, and the Performance Status Scale for Head & Neck cancer patients (PSS-HN).

RESULTS

Ninety-five patients were randomized: 48 patients were allocated to the standard group and 47 patients to the prophylaxis group. Thirty-four patients in the standard group (70.8%) and 28 patients in the prophylaxis group (59.6%) completed the questionnaires at baseline and at follow-up. No significant differences in HRQoL were found at baseline and at day 28. At the end of radiotherapy, the prophylaxis group performed better on almost all functional subscales of the EORTC QLQ-C30 and reported less symptoms. At the end of follow up, almost no differences were seen between the two treatment groups.

CONCLUSION

Prophylactic antibiotics during chemoradiotherapy for LAHNC patients improved HRQoL at the end of the radiotherapy, however no differences were found 3.5 months after the end of chemoradiotherapy.

Antibiotic Prophylaxis on Third Molar Extraction: Systematic Review of Recent Data

The aim of this paper was to highlight the most widely antibiotic protocols applied to the dental field, especially in the surgical treatment of impacted wisdom teeth. Once these protocols were screened, all the possible advantages or disadvantages for each drug and each posology were recorded in this review. In recent years, the need to use these protocols has been debated in the literature. The data obtained by this review underlined how antibiotic protocols applied to oral surgery treatments only included surgeries performed on patients who did not present other systemic pathologies. The first literature review obtained 140 results, and then after the application of the inclusion criteria, 12 papers were selected. The results showed that the most commonly used protocol involved the use of penicillin and clavulanate, obtaining safe clinical and prophylactic results in the management of infections. This widely used protocol seems to guarantee high predictability and safety. The presented review highlights the current possibility of antibiotic resistance affecting patients due to drug misuse. Further clinical studies are required to state specific guidelines; however, oral surgeons involved in third molar surgery should evaluate the local and general health conditions of the patients before suggesting any drug measures for patients.

The effects of amoxicillin with or without clavulanic acid on the postoperative complaints after third molar surgery: a retrospective chart analysis

Purpose:

The aim of this chart-based retrospective study was to evaluate the effects of orally administered amoxicillin alone or amoxicillin combined with clavulanic acid on the frequency of post-operative complications and patients’ comfort after mandibular third molar surgery.

Materials and Methods:

The records of patients who had undergone lower third molar surgery between October 2014 and December 2015 were examined. A total of 62 patients who had fully impacted teeth in mesioangular position and who had been prescribed same type and dose of anti-inflammatory drug were included in this study. Among them, 32 subjects were found to have been prescribed 500 mg amoxicillin trihydrate orally every 8 h for 5 days (Group A) and 30 patients 500 mg amoxicillin trihydrate plus 125 mg potassium clavulanate orally every 8 h for 5 days postoperatively (Group AC). Post-operative pain levels, swelling, presence of trismus, frequency of alveolar osteitis and quality of life (QoL) scores were gathered from patients’ charts and were statistically compared.

Results:

Analysis of the variables showed that there were no significant differences between the Groups A and AC regarding pain levels, swelling, trismus and QoL scores. The frequency of alveolar osteitis was found to be 1.6% in the Group A, however, no significant difference was observed among study groups.

Conclusion:

Within the limitations of this retrospective chart review, it can be stated that amoxicillin and amoxicillin with clavulanic acid might provide similar outcome in terms of patient comfort following third molar surgery.