Tag Archives | oral surgery

The Effect of a Single Dose of Antibiotics Prior to Wisdom Teeth Surgery

An interesting article titled “A Systematic Review on Effect of Single-Dose Preoperative Antibiotics at Surgical Osteotomy Extraction of Lower Third Molars” appears in the 2016 Journal of Oral and Maxilofacial Surgery and written by Karoline Brørup Marcussen and et. al. (vol. 74, pp. 693-703). The authors sought to conduct a systematic review of randomized controlled trials to evaluate the effectiveness of a single dose of preoperative antibiotics for preventing infection and alveolar osteitis [dry socket] in lower wisdom tooth surgery performed with osteotomy. Using antibiotic prophylaxis to reduce the incidence and severity of postoperative complications in surgical removal of impacted lower wisdom teeth is controversial. All randomized controlled trials  (RCTs) evaluating the effect of all types of prophylactic antibiotics administered 20 to 120 minutes preoperatively versus no antibiotics or placebo on the incidence of infection after surgical removal of lower impacted wisdom up to 1 week after surgery, were reviewed by the authors. In the search, 196 search hits were found. From these, 50 potentially relevant reports and 9 relevant reviews were identified. From these 7 RCTs were included and 3 additional were turned up in other searchers. Three RCTs reported infections, 4 RCTs reported alveolar osteitis, and 3 RCTs reported both infections and alveolar osteitis as outcomes. Finally a total of  1,390 patients from 10 RCTs were included. The meta-analysis showed that the use of antibiotics significantly reduced […]

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Comparing Ibuprofen and Etodolac on Swelling and Pain After Wisdom Teeth Removal

An interesting article titled “Comparative Assessment of the Effect of Ibuprofen and Etodolac on Edema, Trismus, and Pain in Lower Third Molar Surgery: A Randomized Clinical Trial” appears in the 2016 Journal of Oral an Maxilofacial Surgery written by Julio Cesar Silva de Oliveira and et al. (vol. 74, pp. 1524-1530). The authors set out to explore if ibuprofen or etodolac is more effective in managing pain, swelling, and trismus after wisdom teeth removal. After wisdom teeth removal symptoms such as swelling, pain and limited mouth opening (trismus) can present. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the rapid relief of moderate pain in inflammatory conditions and soft tissue trauma. The mechanism of action of NSAIDs is the inhibition of the release of cyclooxygenase (COX), an enzyme that is responsible for the production of prostaglandins (PGs). Ibuprofen is an NSAID which inhibits COX-1 and COX-2. Etodolac differs from other NSAIDs by being more selective to the inducible COX-2. Specifically the authors set out to peform a double-blind, randomized, paired crossover study to compare the antiinflammatory effects of ibuprofen, 600 mg, with those of etodolac, 300 mg, both used with dexamethasone, 4 mg, given preoperatively, on pain, edema, and mouth-opening limitation. A total of 20 patients were included treated at Aracatuba Dental School in Brazil. For the first treatment, 1 hour before […]

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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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Bleeding After Dental Extractions in Patients on Warfarin

An interesting article titled “Postoperative Bleeding Following Dental Extractions in Patients Anticoagulated With Warfarin” written by Anthony Febbo and et al. appears in the 2016 Journal or Oral and Maxilofacial Surgery (vol. 74, pp. 1518-1523). The article sought to explore the risk of bleeding in patients on warfarin after dental extraction. Warfarin is the most common anticoagulant used in Australia which can be used to prevent life-threatening thromboembolic events, such as stroke and deep vein thrombosis from occuring in patients at risk. Varying viewing points exisist as how to best handle these patients when a tooth or teeth need to be extracted. Some options include stopping the anticoagulant before extraction or continuing to use it while local hemostatic techniques are used. However ceasing the anticoagulant could be deadly so it is not generally used. The therapeutic effect of warfarin is measured as prothrombin time and communicated as the international normalized ratio (INR) with most patients between a value of 2 and 3 for INR. Prior studies have shown a rate of bleeding after dental extraction of approximately 2 to 8% for patients on warfarin but this includes specialistic centers with highly trained dentists or oral surgeons. The authors sought to […]

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