Types, frequencies, and risk factors for complications after third molar extraction

https://www.bristolctoralsurgery.com/files/2015/03/dry-socket-critical-review.pdf

Contemporary views on dry socket (alveolar osteitis): A clinical appraisal of standardization, aetiopathogenesis and management: a critical review

Tooth extraction is a surgical treatment to remove teeth that are affected by decay or gum disease (performed by general dentists). The other common reason for tooth extraction, performed by oral surgeons, is to remove wisdom teeth that are poorly aligned/developed (also known as impacted wisdom teeth) or those causing pain or inflammation.
The risk of infection after extracting wisdom teeth from healthy young people is about 10%; however, it may be up to 25% in patients who are already sick or have low immunity. Infectious complications include swelling, pain, pus drainage, fever, and also dry socket (this is where the tooth socket is not filled by a blood clot, and there is severe pain and bad odour). Treatment of these infections is generally simple and involves patients receiving antibiotics and drainage of infection from the wound.
This review looks at whether antibiotics, given to dental patients as part of their treatment, prevent infection after tooth extraction. There were 18 studies considered, with a total of 2456 participants who received either antibiotics (of different kinds and dosages) or placebo, immediately before and/or just after tooth extraction. There were concerns about aspects of the design and reporting of all the studies. In all of the studies healthy people had extractions of impacted wisdom teeth done by oral surgeons.
This review provides evidence that antibiotics administered just before and/or just after surgery reduce the risk of infection, pain and dry socket after wisdom teeth are removed by oral surgeons, but that using antibiotics also causes more (generally brief and minor) side effects for these patients. Additionally, there was no evidence that antibiotics prevent fever, swelling or problems with restricted mouth opening in patients who have had wisdom teeth removed.
There was no evidence to judge the effects of preventative antibiotics for extractions of severely decayed teeth, teeth in diseased gums, or extractions in patients who are sick or have low immunity to infection. Undertaking research in these groups of people may not be possible or ethical. However, it is likely that in situations where patients are at a higher risk of infection that preventative antibiotics may be beneficial, because infections in this group are likely to be more frequent and more difficult to treat.
Another concern, which cannot be assessed by clinical trials, is that widespread use of antibiotics by people who do not have an infection is likely to contribute to the development of bacterial resistance.
The conclusion of this review is that antibiotics given to healthy people to prevent infections, may cause more harm than benefit to both the individual patients and the population as a whole.

Antibiotics to prevent complications following tooth extractions

Alveolar osteitis, “dry socket”, remains amongst the most commonly encountered complications following extraction of teeth by general dentists and specialists. A great body of literature is devoted to alveolar osteitis addressing the etiology and pathophysiology of this condition. In addition numerous studies are available discussing methods and techniques to prevent this condition. To this date though great controversy still exists regarding the appropriate terminology used for this condition as well as the actual etiology, pathophysiology, and best methods of prevention and treatment. This article is a comprehensive critical review of the available literature addressing the concepts and controversies surrounding alveolar osteitis. We aim to assist the dental health care professional with patient preparation and management of this commonly encountered postoperative condition should be encountered.

/pdf/alveolar-osteitis-a-comprehensive-review-of-concepts-and-5cka0s55ii.pdf

Alveolar osteitis: a comprehensive review of concepts and controversies.

Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery

The purpose of this study was to evaluate 2 methods that could be used universally to reduce the incidence of alveolar osteitis. In addition other variables including age and sex of patient preoperative aspirin use and discomfort and the use of oral contraceptives (OCs) were studied. A large controlled prospective study was completed with 952 surgical extraction sites in 476 patients. Postoperative dressings included lincomycin hydrochloride (Lincocin)/absorbable gelatin sponge (Gelfoam) oxytetracycline HCL-hydrocortisone acetate (Terra-Cortril)/absorbable gelatin sponge and absorbable gelatin sponge/saline. Bilaterally impacted mandibular 3rd molars of similar surgical difficulty were selected. Standard accepted surgical technique was used. Patients were seen 1 and 7 days after surgery or as needed. Lincomycin hydrochloride/absorbable gelatin sponge and oxytetracycline HC1-hydrocortisone acetate/absorbable gelatin sponge were effective in reducing the incidence of alveolar osteitis. Lincomycin hydrochloride/absorbable gelatin sponge is preferred because of the increased morbidity associated with dressings containing petrolatum products. Absorbable gelatin sponge alone is not effective in reducing the incidence of alveolar osteitis. Age and OC use were found to be significant factors in the incidence of this problem. (authors modified)

Olson Ra

Papers

Alveolar osteitis following surgical removal of mandibular third molars.