Avoiding Amoxicillin During Wisdom Teeth: What are the Possible Problems

An interesting article titled “Dental Care Professionals Should Avoid the Administration of Amoxicillin in Healthy Patients During Third Molar Surgery: Is Antibiotic Resistence the Only Problem?” appears in the 2016 Journal of Oral and Maxilofacial Surgery written by Othoniel H. Aragon-Martinez and et al. (vol. 74, pp. 1512-1513). The authors attempt to explain why amoxicillin should not be used during wisdom teeth surgery. Amoxicillin is commonly used to prevent infections. Information from high quality clinical trials has shown that amoxicillin is not effective to reduce the risk of wound infections when it is received both preoperatively and postoperatively.  Recent evidence has shown that the administration of 250 mg of amoxicillin in healthy volunteers every 8 hours for 7 days produces  antibiotic resistance. The authors also discuss the topic of dysbiosis. Dysbiosis is a detrimental modification in the composition of the microbiome alongside altered microflora functions, which can be produced by antibiotic exposure, type of diet, lifestyle habits, and other factors. Amoxicillin causes marked alterations in fecal microbiota during the treatment course. Dysbiosis in can produce harmful changes in health, including the accumulation of antimicrobial resistances, increased susceptibility to infectious diseases, altered immune homeostasis, and deregulated metabolism. This could contribute to a delayed onset of local infection of wisdom tooth extraction. The author states “The present information suggests that intestinal and oral […]

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Are There Differences in Complications After Wisdom Teeth Surgery Depending on the Sedation Received?

An interesting article titled “Complications of Moderate Sedation Versus Deep Sedation/General Anesthesia for Adolescent Patients Undergoing Third Molar Extraction” appears in the 2016 Journal of Oral and Maxilofacial Surgery written by Gino Inverso and et al. (vol. 74, pp. 474-479).  The authors set out to determine if there is any difference in complications occurring after wisdom teeth surgery when patients are given either moderate sedation or deep sedation. For patients undergoing wisdom teeth surgery they may have some say in what level of sedation they receive and it may also be based on the desires of the surgeon. Specifically the authors examined the complications resulting from moderate sedation versus deep sedation/general anesthesia for adolescent patients undergoing wisdom teeth extraction. They sought to determine if any differences in complication risk exist between the two levels of sedation. The authors explored a database commissioned by the the American Association of Oral and Maxillofacial Surgeons (AAOMS) which is known as the Oral and Maxillofacial Surgery Outcomes System (OMSOS). A total of 79 surgeons in 58 sites across the 6 AAOMS districts participated in the data collection. The patients had data entered into the OMSOS from January 2001 to December 2010. The patients included in the present study had to be less than or equal to 21 and had wisdom teeth extracted in an ambulatory […]

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Using Dexmedetomidine For Wisdom Teeth Surgery

An interesting article titled “Sedation Protocol Using Dexmedetomidine for Third Molar Extraction” appears in the 2016 Journal of Oral and Maxilofacial Surgery written by Dae-Seung Ryu and et. al. (vol. 74, pp. 926.e1-926.e7). The article seems to determine a sedation protocol for dexmedetomidine. The authors state that IV sedation is often given in cases of wisdom teeth surgery with midazolam being a medication commonly used. When midazolam is combined with opioids it can cause respiratory depression. Dexmedetomidine is an alpa2-agonist acting on adrenoceptors in many tissues, including those in the nervous, cardiovascular, and respiratory systems. Compared with midazolam, the major advantage of dexmedetomidine is its minimal effect on the respiratory system. It also produces an analgesic effect which can help alleviate the sensation of pain after tooth extraction. The authors set out to study the pain, patient satisfaction, sedation depth, and adverse effects after wisdom teeth extraction using dexmedetomidine and to compare IV and intranasal (IN) routes of administration. The patients included in the study were in Seoul Korea. They  were required to have ipsilateral upper and lower third molars. The upper molar had to be a routine extraction and the lower molar had to be a surgical extraction. A total of 240 patients were randomly assigned to one of three groups. In group 1 wisdom teeth extractions were performed under local anesthesia only. In group 2 […]

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Retrieving a Broken Dental Needle Using a Minimally Invasive Technique

An interesting article titled “Use of Intraoperative Navigation for Minimally Invasive Retrieval of a Broken Dental Needle” appears in the 2015 Journal of Oral and Maxillofacial Surgery and written by Kyle M. Stein (vol. 73, pp. 1911-1916). The article describes retrieving a broken dental needle using a Medtronic StealthStation S7 surgical navigation system. The use of disposable needles in dentistry has rendered the occurrence of needle breakage an extremely rare event. However, this complication continues to occur, and can be caused by improper technique, inappropriate armamentarium, and unexpected patient movement. I have described a few cases of this occuring on the wisdom teeth complications page at http://www.teethremoval.com/complications.html. In almost every case, needle breakage occurs when an inferior alveolar nerve block is administered with 30-gauge short needles. In the article a case of a 13 year old female had a broken dental needle located in the right pterygomandibular space. The female had received local anesthesia via an inferior alveolar nerve block using a 30- gauge short (25-mm) dental needle for routine restorative dentistry in the lower right quadrant. She suddenly moved during the procedure causing the breakage. Cone beam computed tomography (CBCT) images were obtained for evaluation. Given the localized trauma, minimal […]

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Do Mesial Angled Wisdom Teeth Cause Problems to Adjacent Second Molars

An interesting article titled “Mesial Inclination of Impacted Third Molars and Its Propensity to Stimulate External Root Resorption in Second Molars—A Cone-Beam Computed Tomographic Evaluation” written by Anne Caroline Costa Oenning and et al. appears in the 2015 Journal of Oral and Maxillofacial Surgery (vol. 73, pp. 379-386). The authors explore cone-beam computed tomography (CBCT) scans to look at the teeth in the mouth. They look at the  presence of external root resorption (ERR) in second molars adjacent to horizontally and mesioangular impacted mandibular wisdom teeth. Unlike cavities, ERR is usually asymptomatic and aseptic, unless the pulp cavity has been involved or the lesion has been secondarily infected. Literature attributes the occurrence of this resorption to pressure from an adjacent impacted tooth. This pressure can activate clastic cells responsible for triggering resorption. Studies of periapical and panoramic radiographs have looked at the presence of ERR in second molars adjacent to impacted wisdom teeth. Most of these studies have reported a low prevalence of ERR in second molars ranging from 0.3% to 7%. Even so  cone-beam computed tomographic images have been compared with with panoramic images and the detection of ERR on second molars was found to 4.3 times greater with […]

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