Antibiotic prophylaxis for dentoalveolar surgery: is it indicated?

Abstract

Usually dentists in Australia give patients oral antibiotics after dentoalveolar surgery as a prophylaxis against wound infection. When this practice is compared to the principle of antibiotic prophylaxis in major surgery it is found to be at variance in a number of ways. In major surgery, the risk of infection should be high, and the consequences of infection severe or catastrophic, before antibiotic prophylaxis is ordered. If it is provided then a high dose of an appropriate spectrum antibiotic must be present in the blood prior to the first incision. Other factors which need to be considered are the degree of tissue trauma, the extent of host compromise, other medical comorbidities and length of hospitalization. Standardized protocols of administration have been determined and evaluated for most major surgical procedures. Dentoalveolar surgery is undoubtedly a skilled and technically challenging procedure. However, in contrast to major surgical procedures, it has a less than five per cent infection rate and rarely has severe adverse consequences. Dentoalveolar surgery should be of short duration with minimal tissue damage and performed in the dental chair under local anaesthesia. Controlled studies for both mandibular third molar surgery and placement of dental implants show little or no evidence of benefit from antibiotic prophylaxis and there is an adverse risk from the antibiotic. This review concludes that there is no case for antibiotic prophylaxis for most dentoalveolar surgery in fit patients. In the few cases where it can be considered, a single high preoperative dose should be given.

Evaluation of an NHS practice-based minor oral surgery service

“…As antibiotics have questionable effectiveness in preventing postoperative complications, 25,26 they were not routinely prescribed. The decision to prescribe was based on the procedure undertaken (antibiotics were routinely prescribed postoperatively for surgical endodontics), surgical complexity, existing infection and history of complications following tooth removal.…”

Oro-antral fistulae and fractured tuberosities

“…In the absence of established acute infection there is no indication for postoperative antibiotics although the patient may benefit from a single dose at or just before surgery. 11 Chlorhexidine or a saline based mouthwash preparation will facilitate in the shifting of superficial debris and limit bacterial overgrowth. Of importance is the avoidance of any change in air pressure between the oral and nasal cavities including sinus air space.…”

Current Trend of Antimicrobial Prescription for Oral Implant Surgery Among Dentists in India

“…However, as in all oral surgical procedures, implant placement is also associated with some incidence of bacteraemia. The placement of implants involves the insertion of a foreign body into the bone through the bacteria laden oral cavity, further complicating the role of antimicrobial therapy in this procedure [21,22]. Adding to this dilemma is the fact that a majority of implants survive in the bone, with or without anti-microbial therapy [23].…”