No benefit from prophylactic antibiotics in third molar surgery

This was a randomised controlled trial in a hospital environment.

After surgical removal of third molars postoperative treatment was with oral amoxicillin-clavulanic acid (AC) or clindamycin (CL) or no antibiotics (C). The surgical technique was the same in all cases, and the follow-up period was 4 weeks.

Parameters evaluated were pain, differences in mouth opening, infection, the occurrence of dry socket, and adverse postoperative side effects.

A total of 528 lower third molars were surgically removed in 288 patients during a period of 30 months. The patients' mean age was 20.7 years (age range, 14-61 years). No severe complications such as perimandibular abscess or cellulitis occurred in any patient in any group. There was no significant difference between the groups in the overall occurrence of local infection symptoms after surgery (range, 3.4-4.4%; mean, 3.98%), nor for other parameters. Interestingly, 69.6% of the patients with dry sockets had partially erupted third molars. This rate was the same in each group (62.5% versus 75%) and did not vary significantly. Reported adverse effects were similar in each group (15.3% for AC, 12.2% for CL, 13.9% for C).

The results show that specific postoperative oral prophylactic antibiotic treatment after the removal of lower third molars does not contribute to better wound healing, less pain nor increased mouth opening, and could not prevent the cases of inflammatory problems after surgery, respectively. It is therefore not recommended for routine use.