antibiotic use in 3rds extractions

Question 1

A meta analysis completed in 2007 concluded what about the use of systemic antibiotics?

Answer 1

concluded that systemic antibiotics administered BEFORE surgery are effective in decreasing the frequency of alveolar osteitis and surgical site infections

Question 2

large cochran review regarding impated thirds and role of prophylactic concluded?

Answer 2

review concluded that prophylactic antibiotics decrease the risk of infection, dry socket, and pain after M3 extraction and result in an incerase in mild and transient adverse effects

Question 3

study regarding antibiotics and if they reduse the risk of inflammatory complications after 3rd molar removal in community practices

Answer 3

The study sample was composed of 2,954 patients. Three fourths (75.2%) of the sample received antibiotics in some form. The overall inflammatory complication (AO or SSI) frequencies in the antibiotic and nonantibiotic groups were 5.0 and 7.5%, respectively (P = .012). After adjusting for
differences between the two groups, statistical significance between the groups persisted

The results of this study suggest that antibiotic therapy, regardless of type, dose, frequency, or pattern of delivery, is associated with a decreased risk of inflammatory complications after
M3 removal.

Question 4

T/F timing of antibiotic dosing had significant effects on AO (alveolar osteitis) outcome

Answer 4

true – preoperative dosing
pre-multiday meaning before surgery and continuation of abx 3-7 days post op and presingle dose (30-90 mins before) were more effective than postoperative dosing strategies

Question 5

timing implication on antimicrobial dosing in decreasing risk of wound infections

Answer 5

systemic antibiotics were effective ONLY when dosing started PREOPERATIVELY and lasted 2-7 days

preoperative single dosing and postoperative dosing alone were not as effective for the prevention of wound infection.

Question 6

major findings in the meta-analysis of systemic antibiotic (both antimicrobial use and antianaerobics)

Answer 6

systemic antibiotics were effective in reducing the frequencies of AO and wound infection after surgical removal of impacted mandibular
third molars. On average, patients receiving systemic antibiotics were 2.2 times less likely to develop AO and 1.8 times less likely to develop wound infection after third molar surgery. The wide spectrum antibiotics, represented by various penicillin derivatives, and the narrow spectrum antianaerobics, represented by metronidazole, were both effective in reducing the frequency of AO, but the latter was not as effective as the former in reducing postoperative wound infections.

Question 7

decision to use abx prophylactically?
general

Answer 7

there is a place for abx prophylactically – sufficicent evidence to recommend single dose of penicllin or its derivatives 1 hr before surgical removal of impacted 3rd molars

For patients who have known risk factors for postoperative complications, such as smoking, poor oral hygiene, and older age, a single dose before surgery followed by 2 to 5 days of penicillin after surgery should be considered.
It must be emphasized, however, that systemic antibiotics are not the only route for prevention of postoperative complications. Topical applications of antiseptics (eg, chlorhexidine) and antibiotics (eg, tetracycline intrasocket dressing) are all viable alternatives. There are advantages and disadvantages for each of these strategies in clinical practices, and the
clinicians are encouraged to carefully evaluate the evidence for each choice and make an informed decision for the best interests of their patient