How Effective is Antimicrobial Prophylaxis in Oral Procedures

An interesting article titled “Effectiveness of Antimicrobial Prophylaxis in Preventing the Spread of Infection as a Result of Oral Procedures: A Systematic Review and Meta-Analysis” appears in the 2016 Journal of Oral and Maxilofacial Surgery written by J. A. Moreno-Drada and H. A. Garcia-Perdomo (vol. 74, pp. 1313-1321). The article seeks to explore the effectiveness of prophylactic antibiotics (such as amoxicillin) for preventing localized infections of the oral cavity, neck, and thoracic cavity in patients undergoing oral procedures.

Bacteremia is well known to occur after dental procedures. Severe complications as a result of infections from bacteremia have been reported. Based on expert opinions, it has been recommended that prophylaxis be given to patients at high risk before manipulation of the gingiva or periapical region of the teeth and before perforation of the oral mucosa during dental procedures. However the use of prophylactic antibiotics is controversial. In some cases this could lead to antiobiotic resistance. In the face of bacterial resistance, infections can continue to disseminate through the anatomic planes and pathways with lower resistance, leading to complications, such as Ludwig angina, thoracic empyema, septicemia, necrotizing fasciitis, cavernous sinus thrombosis, mediastinal retinitis, cerebral abscess, meningitis, and bacterial endocarditis.

The study explored articles with women and men older than 18 years who underwent oral procedures and received a prophylactic antibiotic (single preoperative dose) or another intervention for the prevention of infection. Procedures that were emphasized in the selected articles were tooth extraction, oral implantation, and endodontic surgery. The primary outcome variables selected were infection of the oral cavity, infection of the neck, and infection of the thoracic cavity.

Of 329 articles found, 14 were included in qualitative and quantitative analyses. In total, 2,063 patients were included in the 14 studies; 6 studies evaluated oral infection as the outcome of interest, and 8 evaluated bacteremia. The authors found a decreased risk of infection using antibiotics after tooth extraction. No differences were found between the use of antibiotics and the use of placebo for endodontic surgery and dental implants. Subgroup analysis indicated that prophylactic antibiotic with amoxicillin was the most frequently used and it showed a protective effect.

The authors recommend higher-quality research with larger sample sizes that will better allow for the effectiveness of antibiotic prophylaxis after oral procedures to be evaluated. Most of the studies available all focus on tooth extractions. They also found the incidence of bacteremia decreased when using antibiotic prophylaxis when compared to placebo in patients undergoing tooth extraction.

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