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 edition of the Journal of Oral and Maxillofacial Surgery (vol. 74, pp.1512-1513) written by Aragon-Martinez et al. The article discusses some of the reasons why antibiotics such as amoxicillin should not be given to healthy patients having wisdom teeth extracted. The topic of whether or not to have antiobitics before or after wisdom teeth surgery has been discussed on this site before, see for example 1) Antibiotics for Dental Use Contributing to SuperBugs 2) Patient’s Perception of Antibiotic Need After Teeth Removal, and 3) The Effect of a Single Dose of Antibiotics Prior to Wisdom Teeth Surgery.
In the article by Aragon-Martinez it is discussed how amoxicillin dosages for wisdom teeth removal range from giving 1 to 2 g before surgery to 500 mg every 8 hours for 5 to 7 days after surgery. They mention that high-quality clinical trials have shown that amoxicillin is not effective to reduce the risk of wound infections for wisdom teeth surgery. They also mention how it has been shown that giving a healthy patient 250 mg of amoxicillin every 8 hours for 7 days produces antibiotic resistance–related genes in the intestinal metagenome. The gene load is increased and there is a pattern of protection against antibiotics. Thus long term exposure to antibiotics like amoxicillin can cause antibiotic resistance. This development of antibiotic resistance is enough to make it so that routine long term dosages of antibiotics should not be continued in oral and maxillofacial surgery.
In the article though the authors point out another reason for concern with antibiotics known as dysbiosis which a detrimental modification in the composition of the microbiome alongside altered microflora functions. Studies have shown that a course of amoxillican of 500 mg every 8 hours for 5 days among healthy patients causes alterations in the profile of fecal microbiota and the fecal microbiota may not return to normal for 60 days. Dysbiosis can lead to increased susceptibility to infectious diseases, altered immune homeostasis, and deregulated metabolism. In cases where patients have received 750 mg of amoxicillin every 8 hours for 7 days after wisdom teeth surgery there have been delayed local infections that occur 16 to 79 days after surgery. These local infections that result can be resistant to amoxicillin.
The authors state:
“In our opinion, the use of amoxicillin has no scientific evidence of benefit in preventing a local infection during third molar [wisdom teeth] surgery, whereas this antibiotic exposure may produce deleterious effects, such as dysbiosis-related diseases and potential infections with resistance pathogens, in the healthy patient.”
The article also mentions that amoxicillin can increase the rate of sugar metabolism and promote energy extraction from dietary carbohydrates which can contributed to obesity. Furthermore it is fairly well known that amoxicillin can cause side effects such as nausea, diarrhea, and gastric pain. The authors also speculate that in some patients it could take longer than 60 days after a course of amoxicillin for the microflora to return to normal. It is clear the authors feel that amoxicillin should not be given for wisdom teeth surgery and particularly a long dosage of amoxicillin for healthy patients.