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 the number of surgical site infections or alveolar osteitis. A subgroup meta-analysis of 6 trials showed that preoperative antibiotics perorally or intravenously significantly reduced the incidence of surgical site infections. A meta-analysis of 5 trials showed that 2 g of preoperative oral amoxicillin was able to reduce the incidence of surgical site infections. In addition, pooled results showed that preoperative antibiotics significantly reduced the prevalence of alveolar osteitis. It was also found that a single dose of penicillin V decreased the incidence of alveolar osteitis [dry socket] occuring after wisdom teeth removal. It is important to keep in mind that the authors only included studies were the patients had undergone osteotomy during the removal of lower wisdom teeth.
The authors state
“The development of resistance to antibiotics should always be remembered when using antibiotics prophylactically and for treatment purposes. However, a single prophylactic dosage of an antibiotic has never been reported to result in the development of resistance.”
Even so the authors don’t appear to offer any clear recommendations and instead recommend a new RCT be designed and conducted.