Postoperative prophylactic antibiotic treatment in third molar surgery--a necessity?
OBJECTIVE
We evaluated the need for prophylactic postoperative oral antibiotic treatment in the removal of asymptomatic third molars.


METHODS
In a prospective study of more than 30 months, a total of 528 impacted lower third molars were surgically removed in 288 patients. All patients were referred to our department by a dentist or a general practitioner. No patient showed any sign of pain, inflammation, or swelling at the time of removal. Three groups were established. In the first group, antibiotic treatment with amoxicillin/clavulanic acid as an oral medication was carried out for 5 days postoperatively. In the second group, we used clindamycin. In the third group, the patients received no antibiotic treatment. Clinical and radiologic factors were recorded for each case, and the rationale for assigning the patients to the groups was strictly random. The surgical technique was the same in all cases, and the follow-up period was 4 weeks. Parameters that were evaluated were pain, differences in mouth opening, infection, the occurrence of dry socket, and adverse postoperative side effects.


RESULTS
We could not find any significant difference between the 3 groups regarding the evaluated parameters, but in 69.6% of the patients with dry socket, the teeth were partially erupted, which showed a significant difference.


CONCLUSIONS
The results of our study show that specific postoperative oral prophylactic antibiotic treatment after the removal of lower third molars does not contribute to a better wound healing, less pain, or increased mouth opening and could not prevent the cases of inflammatory problems after surgery, respectively, and therefore is not recommended for routine use.
Poeschl
Paul W
PW
University Hospital for Cranio-Maxillofacial and Oral Surgery, Vienna Medical School, Vienna, Austria. maxillofacials@hotmail.com
Eckel
Doris
D
Poeschl
Ellen
E
D000293:Adolescent; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000706:statistics & numerical data*; D002981:Clindamycin / Q000627:therapeutic use*; D004368:Dry Socket / Q000517:prevention & control; D006801:Humans; D008334:Mandible; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D014081:Tooth Extraction
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D019980:Amoxicillin-Potassium Clavulanate Combination