Survey of Spanish dentists on the prescription of antibiotics and antiseptics in surgery for impacted lower third molars

Comparison of the effects of antibiotic therapy and photobiomodulation with red and infrared lasers on the healing of postextraction sockets of third molars: A randomised controlled trial

The aim of this study was to evaluate the effects of dual-wavelength photobiomodulation (PBMT) compared with antibiotic therapy with amoxicillin on postoperatory healing and symptoms after third molar extraction. Sixty patients were randomly allocated in a parallel model according to the adjunctive therapy applied after extraction of all 4 third molars in one single session (n = 15): CTR: no adjunctive therapy; ATB3: amoxicillin for 3 days; ATB7: amoxicillin for 7 days; PBMT: PBMT at dual wavelengths (λ 660 nm and λ 808 nm, 200 mW). Clinical analyses (assessment of oedema, mouth opening variation, and soft tissue healing) and patient-centred analyses (application of a visual analogue scale (VAS) to assess pain, inflammation, bleeding, difficulty during opening the mouth, and chewing) were performed at 3, 7, 14, 30, and 90 days after the surgical procedure. Radiographic analysis was performed to evaluate bone repair by observing the radiographic density and fractal dimension immediately and 90 days after tooth extraction. PBMT reduced the loss of mouth opening amplitude and the sensation of pain and oedema. There were no differences between the ATB and CTR groups. PBMT has a beneficial effect on postoperative control (reduction in inflammation and pain) after third molar extraction, and ATB does not have a beneficial effect on postoperative control after these surgeries. PBMT reduces morbidity after third molar extraction, whereas antibiotic therapy has no beneficial effect. Trial registration Brazilian Registry of Clinical Trials (REBEC-RBR- 4bct2 km-Date of registration: 12/06/2021) under number U1111 - 1263-9675.

Effect of Antibiotics on Clinical and Laboratory Outcomes After Mandibular Third Molar Surgery: A Double-Blind Randomized Clinical Trial

Objectives: This double-blind, randomized clinical trial aimed to evaluate the impact of 2 g of pre-operative amoxicillin on postoperative clinical outcomes and salivary prostaglandin E2 (PGE2) concentration following mandibular third molar removal. Methods: Eighteen healthy adult patients requiring impacted mandibular third molar extraction were randomly assigned to two groups: an experimental group (EG) receiving 2 g of amoxicillin and a placebo group (PG) receiving empty capsules, one hour before the surgery and before taking the first saliva sample. Primary outcomes measured were pain levels at different time points and salivary PGE2 concentrations measured before, 24 h, and 7 days after the surgery, while secondary outcomes included changes in maximum mouth opening (MMO) immediately after the surgery at 1 day and a week post-surgery, and facial swelling at 24 h and 7 days post-surgery. Results: The results showed no significant differences between the EG and PG in terms of pain levels, salivary PGE2 concentration, MMO changes, or facial swelling at different time points (p-values > 0.05). One instance of surgical site infection was noted in the PG in the 7-day follow-up session, but it was not statistically significant (p-value = 0.303). Correlation analyses indicated that a higher number of sutures and a higher difficulty index of surgery were associated with increased pain, while longer surgery duration and osteotomy were linked to more MMO changes and facial swelling (p-values < 0.05). In addition, while longer surgery duration and performing tooth section were correlated with lower PGE2 concentrations, PGE2 concentrations were positively correlated with pain levels (p-values < 0.05). Conclusions: Based on the results of this study, administering 2 g of prophylactic amoxicillin did not significantly affect postoperative clinical or laboratory outcomes in healthy patients undergoing mandibular third molar surgery.

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.

A comparative analysis of the efficacy of moxifloxacin and cefixime in the reduction of postoperative inflammatory sequelae after mandibular third molar surgery

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 moxifloxacin, had a pronounced effect on reducing all inflammatory sequelae (pain, edema, and trismus) as the most common postoperative complaints following mandibular third molar surgery, and also contributed to reducing the incidence of dry socket. Conclusion. Antibiotic prophylaxis with cefixime and, especially moxifloxacin, reduced the occurrence of postoperative inflammatory sequelae and alleviated discomfort. It is interesting, that both antibiotics, especially moxifloxacin, also contributed to reducing the incidence of postoperative dry socket, which is not provoked by inflammation. Therefore, further research into the underlying mechanisms behind such an effect is warranted.

The use and misuse of antibiotics in dentistry: A scoping review

BACKGROUND

To describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review.

TYPES OF STUDIES REVIEWED

The authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice. Two authors independently reviewed titles and abstracts by using detailed eligibility criteria. The authors placed no restrictions on study design or publication year. The authors qualitatively assessed studies by using a modified version of the Center for Evidence-Based Management's critical appraisal of a survey checklist.

RESULTS

The authors identified 1,912 studies but considered only 118 studies eligible for review. Most included studies were either cross-sectional surveys (81 studies) or prescription audits (25 studies) from various geographic locations. Publication dates ranged from 1982 through 2017. The authors examined prophylactic and therapeutic antibiotic use in 48 and 29 studies, respectively. Another 29 studies examined the use of both prophylactic and therapeutic antibiotics in dentistry. Overall, dentists prescribed a wide variety of antibiotic regimens for various clinical and nonclinical indications. Dentists have acquired their prescribing knowledge from a variety of sources and have changed their antibiotic prescribing practices throughout their careers for various reasons.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Considering the seriousness of antibiotic resistance, the authors highlight trends in antibiotic prescribing practices, characterize factors contributing to the use and misuse of antibiotics in dentistry, provide insight into the importance of antibiotic stewardship in the oral health setting, and encourage dentists to reflect on their antibiotic prescription practices.

Does the use of amoxicillin/amoxicillin-clavulanic acid in third molar surgery reduce the risk of postoperative infection? A systematic review with meta-analysis

The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin-clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin-clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P<0.001). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin-clavulanic acid was found to be effective (RR 0.21, P<0.001). The risk of adverse effects was significantly higher in the amoxicillin-clavulanic acid group (RR=4.12, P=0.023) than in the amoxicillin group (RR 1.57, P=0.405). In conclusion, amoxicillin-clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.

Efficacy of amoxicillin and amoxicillin/clavulanic acid in the prevention of infection and dry socket after third molar extraction. A systematic review and meta-analysis

Background

Prophylactic use of amoxicillin and amoxicillin/clavulanic acid, although controversial, is common in routine clinical practice in third molar surgery.

Material and Methods

Our objective was to assess the efficacy of prophylactic amoxicillin with or without clavulanic acid in reducing the incidence of dry socket and/or infection after third molar extraction. We conducted a systematic review and meta-analysis consulting electronic databases and references in retrieved articles. We included double-blind placebo-controlled randomized clinical trials published up to June 2015 investigating the efficacy of amoxicillin with or without clavulanic acid on the incidence of the aforementioned conditions after third molar extraction. Relative risks (RRs) were estimated with a generic inverse-variance approach and a random effect model using Stata/IC 13 and Review Manager Version 5.2. Stratified analysis was performed by antibiotic type.

Results

We included 10 papers in the qualitative review and in the quantitative synthesis (1997 extractions: 1072 in experimental groups and 925 in controls, with 27 and 74 events of dry socket and/or infection, respectively). The overall RR was 0.350 (p< 0.001; 95% CI 0.214 to 0.574). We found no evidence of heterogeneity (I2=0%, p=0.470). The number needed to treat was 18 (95% CI 13 to 29). Five studies reported adverse reactions (RR=1.188, 95% CI 0.658 to 2.146, p =0.567). The RRs were 0.563 for amoxicillin (95% CI 0.295 to 1.08, p=0.082) and 0.215 for amoxicillin/clavulanic acid (95% CI 0.117 to 0.395, p<0.001).

Conclusions

Prophylactic use of amoxicillin does not significantly reduce the risk of infection and/or dry socket after third molar extraction. With amoxicillin/clavulanic acid, the risk decreases significantly. Nevertheless, considering the number needed to treat, low prevalence of infection, potential adverse reactions to antibiotics and lack of serious complications in placebo groups, the routine prescription of amoxicillin with or without clavulanic acid is not justified.

Key words:Meta-analysis, amoxicillin, infection, removal, dry socket, third molar.

Do systemic antibiotics prevent dry socket and infection after third molar extraction? A systematic review and meta-analysis

OBJECTIVES

The use of antibiotics to prevent dry socket and infection is a controversial but widespread practice. The aim of the study is to assess the efficacy of systemic antibiotics in reducing the frequencies of these complications after extraction.

STUDY DESIGN

A systematic review and meta-analysis, according to the PRISMA statement, based on randomized double-blind placebo-controlled trials evaluating systemic antibiotics to prevent dry socket and infection after third molar surgery. Databases were searched up to June 2015. Relative risks (RRs) were calculated with inverse variance-weighted, fixed-effect, or random-effect models.

RESULTS

We included 22 papers in the qualitative and 21 in the quantitative review (3304 extractions). Overall-RR was 0.43 (95% confidence interval [CI] 0.33-0.56; P < .0001); number needed to treat, 14 (95% CI 11-19). Penicillins-RR: 0.40 (95% CI 0.27-0.59). Nitroimidazoles-RR: 0.56 (95% CI 0.38-0.82). No serious adverse events were reported.

CONCLUSIONS

Systemic antibiotics significantly reduce the risk of dry socket and infection in third molar extraction.