An Observational Cohort Study on Delayed-Onset Infections after Mandibular Third-Molar Extractions

Abstract

Objectives The purpose of the present study was to investigate the occurrence and clinical features of delayed-onset infections after mandibular third-molar extractions. Method and Materials An observational cohort study was conducted on 179 patients undergoing mandibular third-molar extraction between January 2013 and December 2015, for a total of 217 extractions. Data were recorded at the time of extraction (T0), on suture removal seven days later (T1), and 30 days after the extraction, when patients were contacted and asked about their healing process (T2). The statistical analysis was performed with nonparametric tests. A p value lower than 0.05 was considered statistically significant. Results Eight delayed-onset infections were recorded, amounting to 3.7% of all extractions. The median time elapsing from the extraction to the delayed-onset infection was 35 days (IQR 28–40; min 24–max 49). Younger age and longer surgical procedures seemed to be more often associated with this complication. Conclusion Delayed-onset infections after third-molar extractions are relatively rare postoperative complications characterized by a swelling, usually with a purulent discharge. Patients should be informed of this possibility, which might develop even several weeks after the extraction.

Infection Control in Dentistry and Drug-Resistant Infectious Agents: A Burning Issue. Part 1

“…Results have been conflicting concerning the occurrence of bacteremia after dental procedures; antimicrobial prophylaxis before an invasive dental procedure does not prevent bacteremia, although it can decrease both its magnitude and its persistence [142]. Delayed-onset infections (DOI) after mandibular third molar extractions are rare complications and usually occur about 30 days after the extraction, but they may also develop much later on [143]. The bacteria identified in DOI are Fusobacterium, Prevotella, Bacteroides, and Peptostreptococcus.…”

A New Type of Chronic Wound Infection after Wisdom Tooth Extraction: A Diagnostic Approach with 16S-rRNA Gene Analysis, Next-Generation Sequencing, and Bioinformatics

“…Nevertheless, sometimes persistent subacute and chronic infections occur, where adequate therapy can be a great challenge for practitioners and where treatment can take a long time [ 6 ]. Especially, delayed-onset wound infections after third molar extraction, which occur several weeks after suture removal and after discharge [ 7 ], can cause varying symptoms affecting hard and soft tissues [ 7 , 8 , 9 , 10 , 11 ]. Figueiredo et al reported that those infections are normally caused by anaerobic bacteria of the oral flora, e.g., Fusobacterium, Peptostreptococcus , Porphyromonas, and Prevotella strains, which in most cases can be successfully treated with combinations of surgical revision and antibiotics [ 9 ].…”

“…Additionally, cases of osteomyelitis of the jaw after third molar surgery have been previously described [ 14 ]. As delayed-onset infections occur only several weeks post-intervention [ 7 , 10 ], other diseases of non-odontogenic origin like atypical mycobacteriosis, tuberculosis, or cat scratch disease, which can present with similar symptoms, also have to be taken into account [ 15 , 16 ].…”

Is there a need for postoperative antibiotics after third molar surgery? A 5‐year retrospective study

“…These include angulation of the impacted teeth, 6 use of oral contraceptives, 6 multiple extractions (both right and left third molars), 7 female sex, 8 heavy smoking, 9 and the absence of antibiotic prescription. 10 The use of antibiotics to prevent postoperative infection after third molar surgery is highly debated, with systematic reviews and meta-analyses reporting on both the effectiveness and ineffectiveness of antibiotics in preventing infections. 12 Evidence on the effectiveness of antibiotics in preventing infections after third molar surgery is crucial, as it has been previously shown that short-term antibiotic treatment could lead to persistence of resistant gut bacteria.…”