Are antibiotics necessary after lower third molar removal?

Area of Science:

• Oral and Maxillofacial Surgery
• Infectious Disease Prevention
• Pharmacoeconomics

Background:

• Antibiotic prophylaxis is common practice following lower third molar removal (LTMR).
• Evidence supporting routine antibiotic use in LTMR without preoperative infection is debated.
• Optimizing antibiotic stewardship is crucial in surgical procedures.

Purpose of the Study:

• To evaluate the necessity of antibiotic prescriptions after lower third molar removal (LTMR).
• To assess infection rates and related clinical parameters in patients not receiving antibiotics.
• To compare outcomes between surgeons with varying clinical experience.

Main Methods:

• A cohort of 110 patients, free of antibiotics, underwent lower third molar removal (LTMR).
• Preoperative and postoperative (days 2 and 7) assessments included pain, infection, swelling, trismus, body temperature, C-reactive protein (CRP), and salivary neutrophil counts (SNC).
• Intraoperative parameters monitored included vital signs, anesthesia quality, local anesthetic use, bleeding, and surgery difficulty/duration.

Main Results:

• No systemic infections were observed post-LTMR.
• Minor variations noted in surgery duration, anesthetic use, anesthesia quality, bleeding, pain, trismus, CRP, and SNC.
• No significant changes in hemodynamic parameters, need for rescue analgesics, wound healing, swelling, or body temperature were reported.

Conclusions:

• Antibiotic prescriptions appear unnecessary for lower third molar removal (LTMR) when no preoperative infection is present.
• Findings support a reduction in routine antibiotic use for LTMR, promoting antibiotic stewardship.
• Further research could explore specific patient subgroups or risk factors.