An interesting article titled “Correlation of antibiotic prophylaxis and difficulty of extraction with post operative inflammatory complications in the lower third molar surgery” appears in the 2014 British Journal of Oral and Maxillofacial Surgery and written by J. Y. Lee and et al. (vol. 52, pp. 54-57). The article set out to investigate the correlation between antibiotic prophylaxis, difficulty of extraction, and postoperative complications of lower wisdom teeth. The authors say that indiscriminate antibiotic prophylaxis can lead to antimicrobial resistance and a shift in the microbial population.
The authors performed a retrospective analysis of extraction of lower wisdom teeth performed at Korea University Guro Hospital over a two year time frame starting in January 2010. The authors only included cases in which cefditoren pivoxil was prescribed as an antibiotic. In addition, patients that were kept in a hospital due to postoperative complications were excluded from the study. The patients were divided into two groups those given antibiotics and those not given antibiotics. A total of 1222 extractions in 890 patients were included in the study.
The authors found that overall the difficulty of extraction and post operative complications were significantly associated (p=0.03). In cases grouped by similar class of difficulty, it was found that there was no significant correlation between antibiotic prophylaxis and postoperative complications. The authors found the incidence of infection and dry socket tended to increase slightly in more difficult cases but this was not significant and did not justify antibiotic prophylaxis.
There are several drawbacks as pointed out by the authors with their findings. First, a 7 day antibiotic regime was prescribed which is considered excessive by most surgeons. Second, the surgeon did not use proper randomization of patients at the time of each surgery. The authors feel there data supports that the incidence of post operative inflammatory complications is correlated with the difficulty of extraction but not the use antibiotic prophylaxis.