Infectious postoperative complications in oral surgery. An observational study

Prevalence and Factors Influencing Post-Operative Complications following Tooth Extraction: A Narrative Review

Background

Complications from dental extractions may result in multiple post-operative visits and adversely affect the patient's life. Preventing complications may decrease post-operative morbidity for the individual as well as lower societal costs, such as lost time from work and healthcare costs.

Objectives

This narrative review aims to assess the prevalence and factors influencing post-operative complications following tooth extraction, helping clinicians minimise the risk. Data Sources. Cross-sectional studies. Study Eligibility and Participants. Patients undergoing dental extractions. Our exclusion criteria included in vitro studies, animal studies, terminally ill patients, and tooth loss not due to dental extraction. Literature was collected from "PubMed" and "Web of Science" through search criteria based on the "PICO" framework. Twenty articles were used to formulate a prevalence table, and 156 articles were included for the factors influencing complications. Study Appraisal and Synthesis Methods. This narrative review was reported using the SANRA (a scale for the quality assessment of narrative review articles) checklist. Due to the scope of our narrative review and its associated objectives, the quality of cross-sectional studies (AXIS) will be conducted from the studies outlining the prevalence.

Results

Alveolar osteitis appears to be the most prevalent post-operative complication following tooth extraction. Predisposing factors can be significant in their ability to alter the risk of postoperative complications, and clinicians should provide patient-centred care to mitigate this risk. Limitations. Due to the breadth of context, a systematic review was not feasible, as it may have introduced heterogeneity.

Conclusion

This narrative review has highlighted an array of factors which can influence the prevalence of post-operative complications. Future research would benefit from individually reporting post-operative complications, reducing the heterogeneity in definitions of the complications, and including greater detail on the predisposing factors studied.

Decamethoxin and chlorhexidine bigluconate effect on the adhesive and biofilm-forming properties of Streptococcus mitis

The aim of the study

Was to investigate the effect of antiseptics on the adhesive and biofilm-forming properties of clinical S.mitis isolates isolated from the oral cavity of patients with an infectious and inflammatory post-extraction complication.

Materials and methods

Twenty four clinical isolates of S.mitis isolated from patients were studied. The studied antiseptics included 0.02% aqueous solution of decamethoxin and 0.05% solution of chlorhexidine bigluconate. Adhesion of clinical isolates under the action of decamethoxin and chlorhexidine bigluconate was determined by the method of V.I. Brillis. The biofilm-forming properties of clinical isolates were studied using the "microtiter plate test" according to G.D. Christensen.

Results

The studied clinical isolates of S.mitis are classified as highly adherent microorganisms. Action of decamethoxin on clinical isolates decreases the adhesion index of the studied isolates in comparison with the adhesion index of the control culture. Action of chlorhexidine bigluconate on S.mitis isolates increases of adhession of the studied clinical isolates in comparison with the control. After the effect of decamethoxin, the optical density of clinical isolates decreased considering the optical density results of the control. The clinical isolates left an average film-forming capacity even after chlorhexidine bigluconate action.

Conclusions

Clinical isolates of S.mitis are highly adherent microorganisms. The antiseptic decamethoxin decreases the adhesion index of these bacteria, while chlorhexidine bigluconate increases the adhesion index of clinical S.mitis isolates. Clinical S. mitis isolates have an average biofilm formation capacity index. The antiseptic decamethoxin inhibits the biofilm formation capacity of S.mitis from medium to low.

Use or abuse of antibiotics as prophylactic therapy in oral surgery: A systematic review

BACKGROUD

Antibiotics are a type of medication routinely prescribed by dental professionals; however, it is very common that the administration is not justified. Around 15% of dentists admit that they have administered antibiotics unnecessarily more than once a week. The objective of this project is to identify the effectiveness of the use of antibiotics as prophylactic therapy in oral surgery, and to carry out an analysis of the alternatives to pharmacological therapy.

METHODS

The search strategy was carried out in the PubMed, Scopus, and ScienceDirect databases. For study selection, a first filter was carried out by title and abstract, which mentioned the use of prophylactic antibiotics in some type of oral surgery. To establish the risk of bias, the JBI Critical Appraisal Checklist for Randomized Controlled Trials was utilized.

RESULTS

The type of antibiotics most prescribed as prophylactic therapy were beta-lactams, which were indicated in 100% of the studies. Penicillins predominated, observing amoxicillin as the most indicated drug in 54.1% of the studies (n = 13) followed by the use of amoxicillin in conjunction with clavulanic acid in 33.3% of the studies (n = 8). Of the 21 studies included, 17 mention that there is insufficient evidence to support the use of antibiotics as prophylactic therapy in patients who will undergo some type of oral surgery.

CONCLUSIONS

Without a doubt, the biggest challenge is to develop academic update strategies aimed at dentists with active clinical practice and dental students from educational and government institutions to provide updated information about the correct use of prescription drugs.

Firmicutes Dysbiosis After Chlorhexidine Prophylaxis in Healthy Patients Submitted to Impacted Lower Third Molar Extraction

Prophylaxis with antiseptic and antibiotic therapy is common in impacted lower third molar surgeries, despite the lack of consensus among professionals and researchers in the indication for healthy patients. The aim of the present preliminary study was to verify the impact of prophylaxis therapy with antiseptic and antibiotic in healthy patients submitted to impacted lower third molar extraction, according to oral microorganism quantification. Eleven patients submitted to impacted lower third molar extraction, under prophylactic therapy with 0.12% chlorhexidine and amoxicillin in four experimental phases, were evaluated. Our results showed no significant reduction in total bacteria load, as well as in Bacteroidetes and C. albicans loads in the oral cavity, after prophylactic therapy with antiseptic and antibiotic. On the other hand, there was a significant difference between the Firmicutes levels across the follow-up, and this effect seems to be large (ηp²=0.94). Post-hoc test demonstrated that the levels of Firmicutes in T1 were higher than T0, T2, and T3, suggesting a microbiota dysbiosis, when 0.12% chlorhexidine use, which may be responsible for selection of antibiotic-resistant microorganisms. Our results alert for an overuse of antiseptic and antibiotics by dentists and for a better evaluation of the available protocols.

Managing Cardiac Patients: Dentists' Knowledge, Perceptions, and Practices

OBJECTIVES

Dental patients may require invasive treatment, and awareness of their medical conditions is essential for optimal care. We assessed the knowledge, perceptions, and attitudes of dentists practicing in Saudi Arabia (SA) and their associations with managing patients with common cardiac conditions.

METHODS

A national survey of knowledge and attitudes of practicing dentists towards patients with common cardiac conditions was conducted from May 2019 to July 2020 in SA. The survey comprised a newly developed, validated, electronic, self-administered English questionnaire.

RESULTS

Overall, 282 dentists completed the survey, of whom 45.5% perceived cardiac patients as difficult to manage, while 64.5% stated that they refer these patients to cardiologists before dental intervention. Regarding knowledge about cardiac conditions, 72% achieved an overall knowledge score <55%; however, their infective endocarditis scores were better. Consultants and specialists (P < .001), those with a PhD/board certification (P = .013), dentists with prior education on cardiac patient management (P = .002), and those working with a cardiologist (P = .016) scored higher on knowledge. Conversely, private dentists (P = .003) and those referring patients to cardiologists before treatment (P = .003) scored lower. Dentists' knowledge of cardiovascular diseases in women was low; only those who believed women experience a greater risk of cardiac complications achieved a higher score. Approximately 90.1% wished to receive education regarding cardiac patient management.

CONCLUSIONS

Knowledge of cardiac patient management was suboptimal in this study. Dentists perceived cardiac patients as difficult to manage, but wished to learn more regarding optimal management. Thus, postgraduate education programmes that promote optimal dental management strategies for cardiac patients are necessary.

Delayed-onset infections after lower third molar surgery: a Hungarian case-control study

OBJECTIVE

Delayed-onset infection is defined as infectious swelling and trismus accompanied by pain or the presence of suppuration starting approximately 30 days after surgery. This study aimed to describe the occurrence and potential predisposing factors of delayed-onset infection.

STUDY DESIGN

A retrospective case-control study of 223 lower third molar surgeries was performed. Participants were selected from among 1102 outpatients who underwent surgery between January 2013 and June 2018 at Semmelweis University. The inclusion criterion for the case group was inflammation of the operated area after suture removal. Patients in the control group were healthy nonsmokers <26 years old who healed without complication. Statistical analysis was performed using the Shapiro-Wilk test, the Mann-Whitney U test, and Fisher's exact test.

RESULTS

Complications occurred only in patients <26 years old approximately 29.5 days after surgery. A significantly higher risk was observed for younger age, total soft tissue coverage, deeper impaction, lower Nolla stage (P < .001), mesioangular direction (P = .002), and full bone coverage (P < .05). Distal space was inversely correlated with complications (P < .001).

CONCLUSIONS

Lower Nolla stage, total soft tissue coverage, lack of distal space, deeper impaction, or mesioangular tilt may promote delayed-onset infection. Follow-up of at-risk patients and the maintenance of oral hygiene are recommended.

Strategic Use of CAD-CAM Interim Restoration for the Recovery of the Vertical Dimension of Occlusion in the Posterior Partially Edentulous Jaw

Occlusal contact loss occasionally occurs following the placement of implant-supported fixed dental prostheses in the posterior region. This complication is caused by the change in the vertical dimension of occlusion after the recovery of mastication. The change is probably related to the prosthesis sinking phenomenon and previous mandibular dislocation. The use of interim prostheses could help re-establish the vertical dimension of occlusion. The definitive prostheses can then be accurately fabricated using digital techniques in the newly established vertical dimension. In this case report, we introduce a protocol incorporating a computer-aided design and computer-aided manufacturing (CAD-CAM) interim prosthesis and digital techniques to minimize the occurrence of unexpected initial occlusal changes in the prosthetic treatment of implant-supported prostheses in the posterior region.