Do antibiotics prior to dental extractions reduce adverse post-operative outcomes?

This retrospective cohort study aimed to investigate whether antibiotic prophylaxis reduced or increased post-operative complications following dental extractions.

The cohort included 269,003 patients. In terms of participants, this sample consisted of Veteran Affairs Dental patients, who attended for a dental extraction between 01/01/2015- 31/12/2019. The intervention and comparator was whether or not patients had received an antibiotic prescription prior to their extraction, with the primary outcome a specified post-extraction complication (oral infection, dry socket or fever within 7 days of the extraction). Data was collected on patient demographics, medical history, and details regarding the extraction.

Multivariable logistic regression models were used to determine the association between antibiotic prescription prior to extraction and outcomes, alongside a sensitivity analysis that excluded antibiotics prescribed by a medical provider.

The cohort included 269003 patients, who attended 385,880 dental visits. During 122,810 visits (31.8%), patients received antibiotics prior to extraction, with amoxicillin the most frequently prescribed. Antibiotics were more commonly prescribed in those who received a surgical extraction. In total, 3387 patients experienced a complication. Of these patients, 1272 had received antibiotics, compared with 2115 who had not. The regression analysis determined that diabetes was a statistically significant modifier of an association. For patients without diabetes, receiving antibiotics increased the odds of a post-extraction complication.

In this sample of older people, there was no association between being prescribed antibiotics and post-extraction complications.