Antibiotic prophylaxis for dentoalveolar surgery: is it indicated?

Use of Ozone in Veterinary Dentistry as an Alternative to Conventional Antibiotics and Antiseptics

This paper aims to assess the disinfecting capacity of a double-distilled ozonated water solution as an alternative to common antibiotic and antiseptic devices. Seventy-five dogs were subjected to the surgical procedures of scaling and dental extraction and included in three study groups: Group 1 subjected to antibiotic pre-treatment (association amoxicillin + clavulanic acid and ampicillin + metronidazole) and disinfection with chlorhexidine, and Group 2 and 3 devoid of preventive anti-microbial treatment in which disinfection was performed, respectively, with ozonated water and chlorhexidine. Sampling by bacteriological buffer was carried out to evaluate the bacterial count in the oral cavity. The analysis of the samples determined the total mesophilic bacterial count by seeding on the culture medium via the inclusion of PCA (Plate Count Agar). The results highlighted the anti-bacterial efficacy of intra-operative ozone as an alternative to pre-surgical antibiotic treatment.

Comparison between the prophylactic effects of amoxicillin 24 and 48 hours pre-operatively on surgical site infections in Japanese patients with impacted mandibular third molars: A prospective cohort study

INTRODUCTION

According to the guidelines, the dosage for mandibular wisdom tooth extraction (MWTE) varies within the administration period. There is a 24-fold difference between the minimum and maximum doses. If an appropriate antimicrobial can be administered without increasing incidence of surgical site infection (SSI), it may lead to a global action plan on antimicrobial resistance (AMR). Therefore, we prospectively surveyed incidence of SSI post-operatively and use of oral antibiotics (OA) for MWTE.

METHODS

Subjects were patients who underwent MWTE in our dental outpatient clinic from May 2019 to April 2020. Two groups were formed depending on type of administration period they received: 24 h and 48 h after surgery. The following information was collected: (1) patient factors (age, gender, body mass index, presence/absence of preoperative medication, diagnosis, impacted wisdom tooth status; (2) surgical factors (operative time, presence/absence of closure, presence/absence of hemostat, doctor career, type and frequency of painkiller); (3) relationship between administration period of OA and SSI occurrence; and (4) details of SSI.

RESULTS

Three hundred forty subjects were analyzed, all of which used amoxicillin. There were 106 cases in 24 h group and 234 cases in 48 h group. The total incidence of SSI was 1.1% (4/340 cases), with 0.9% (1/106 cases) in 24 h group and 1.3% (3/234 cases) in 48 h group; there was no difference between the two groups.

CONCLUSION

Our study suggests that amoxicillin (250 mg/dose every 8 h x 3 doses beginning 1 h before surgery) might be sufficient in preventing SSI in Japanese dental patients without SSI risk factors.

Non-impacted tooth extractions and antibiotic treatment: A RCT study

OBJECTIVES

A controlled, single-blind, randomized clinical trial was performed to evaluate usefulness of antibiotics in preventing pain and complications after tooth extractions and benefits of probiotics in reducing gastro-intestinal symptoms associated with antibiotic therapy.

MATERIALS AND METHODS

A total of 159 patients were enrolled in this trial. After tooth extractions, patients were allocated to one of the groups: group 1 received postoperatively amoxicillin + clavulanic acid; group 2 received the same antibiotic therapy with an adjunctive probiotic treatment; and group 3 received neither antibiotics nor probiotics. Follow-up visits were planned at 7, 14, and 21 days after tooth extractions (T1, T2, and T3), and parameters assessed were pain, presence of abscess, edema, fever, alveolitis, trismus, pain, difficulty in daily routine activities, and gastro-intestinal symptoms.

RESULTS

The number of patients reporting pain at T1 was significantly higher in the control group when compared to group 2 (p = .016), while no difference for pain intensity was observed between groups. No surgical site infection was observed in any of the groups. Intestinal symptoms seemed to be tackled by probiotic administration.

CONCLUSIONS

Pain was the most important symptom in the control group. Antibiotics were not necessary after non-impacted tooth extractions, and probiotics can reduce gastro-intestinal symptoms associated with antibiotics.

Prophylactic antibiotic regimens in dental implant failure: A systematic review and meta-analysis

BACKGROUND

In this systematic review and meta-analysis, the authors examine the efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens for prevention of dental implant failure in patients who are healthy overall.

TYPES OF STUDIES REVIEWED

The authors independently conducted electronic database and manual searches to identify randomized controlled trials (RCTs). The authors selected articles on the basis of eligibility criteria and assessed for risk of bias by using the Cochrane Handbook. Implant failure was the primary outcome studied; perimucositis or implantitis, prosthetic failure, and adverse events were secondary outcomes studied. The authors conducted random effects meta-analysis for risk ratios of dichotomous data and used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of Public Health) for qualitative assessment of administration schedules.

RESULTS

With duplicates removed, the authors screened 1,022 abstracts, reviewed 21 full-text articles, and included 8 RCTs that included 2,869 implants in 1,585 patients. Meta-analysis results indicated that AP resulted in a statistically significantly lower number of implant failures for all regimens combined (implant, P = .005; patient, P = .002), as well as preoperative (implant, P = .01; patient, P = .007), pre- and postoperative (implant, P = .04), and postoperative AP only (implant, P = .02), compared with no antibiotics. The authors found no statistically significant differences in analysis of comparative antibiotic treatments or secondary outcomes. The authors identified confounding variables.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Although meta-analysis results suggested that AP may reduce implant failure, definitive conclusions cannot be achieved yet. The overall nonsignificant differences reported in individual trials, limitations discussed, implant infection outcomes, and antibiotic-associated risks must be considered. Thus, the results for implant failure outcomes may not warrant the indiscriminate use of antibiotics in patients who are healthy who are receiving dental implants. Investigators must conduct large-scale RCTs to determine the efficacy of AP and various regimens, independent of confounding variables.

Is there a consensus on antibiotic usage for dental implant placement in healthy patients?

This systematic review aimed to determine whether there is consensus for antibiotic prescription in healthy patients undergoing implant placement. A search of PubMed, Embase and Medline databases was conducted in January 2016 to find published journal articles on the use of antibiotics in implant placement, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were prospective human clinical trials investigating antibiotic usage during implant placement. Fifteen studies were deemed suitable. In 13 studies, no statistical difference was found between antibiotic use and the incidence of prosthetic failure, implant failure and early postoperative infections. These were rated as having low to high risk bias. Contrary results were reported in two studies, both of which were rated as having a high potential for bias. In conclusion, antibiotic use in healthy patients for the prophylaxis of surgical infection associated with dental implant placement does not appear to improve clinical outcomes. Practitioners should apply principles of antimicrobial stewardship and not use antibiotics as a routine measure in healthy patients.

Are systemic antibiotics necessary in the prevention of wound healing complications after intra-alveolar dental extraction?

This double-blind, randomized controlled study was done to assess the necessity of systemic antibiotics in the prevention of wound healing complications after intra-alveolar dental extraction. A consecutive recruitment method was used to allocate participants to two treatment groups. Subjects in group A (antibiotics group, n=75) received amoxicillin and metronidazole for 5 days postoperatively, while those in group B (placebo group, n=75) were given identical-looking placebo drugs in place of the antibiotics. Postoperative socket healing complications, pain, and compliance with postoperative instructions were assessed postoperatively. Healing was uneventful in 129 patients (86%). Twenty-one patients (14%) developed wound healing complications. Dry socket was the most common complication in the antibiotics group (six subjects), while acutely inflamed sockets was the most common in the placebo group (five subjects). Non-adherence to postoperative instructions and postoperative pain were found to be significantly associated with the development of wound healing complications. The prescription of antibiotics after routine intra-alveolar dental extraction in healthy patients may not play any significant role in preventing wound healing complications. However, non-compliance with postoperative instructions might be associated with increased wound healing complications.

Evaluation of treatment outcomes and clinical indications for antibiotic prophylaxis in patients undergoing implantation procedures

PURPOSE

The use of antibiotic therapy during implantation to reduce the risk of an early implant failure is widely discussed among clinicists. However, half an hour after the procedure a quarter of patients show bacteremia which could decrease the efficacy of the surgery. Implant failure is associated with destruction of bone tissue within the alveolar process and may lead to an alternative but compromised treatment plan. The aim of the study was to evaluate the influence of perioperative antibiotic protection on success of implantation.

MATERIAL AND METHODS

The retrospective study involved 1915 patients (females: 57.3%, males: 42.7%) with no systemic or local diseases, who required antibiotic therapy during surgical procedures. Group 1 comprised 203 patients with diagnosed vertical or horizontal bone atrophy within the alveolar ridge requiring reconstruction procedure before implantation. Group 2 included 1712 patients who did not need any surgical procedures before implantation. All the subjects took three types of antibiotics twice a day for 7 days. The data were statistically analyzed.

RESULTS

A total number of 3309 implants were placed. Implantation efficacy in group 1 amounted to 98.53% and in group 2 it was 99.24%. Complications occurred most commonly after administration of cephalosporin which proved to be statistically significant for the patients who underwent augmentation with a bone block before the implant procedure (p 0.0209).

CONCLUSIONS

Perioperative use of antibiotic therapy beneficially influences tissue healing, provides safety and success of the surgical procedure, as well as translates into high efficacy of implantation (99.52%).

Risk of wound infection and safety profile of amoxicillin in healthy patients which required third molar surgery: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to assess the risk of surgical wound infection and the adverse effects of amoxicillin in healthy patients who required excision of third molars. We identified eligible reports from searches of PubMed, Medline®, the Cochrane Library, Imbiomed, LILACS, and Google Scholar. Studies that met our minimum requirements were evaluated using inclusion and exclusion criteria and the Oxford Quality Scale. Those with a score of 3 or more on this Scale were included and their data were extracted and analysed. For evaluation of the risk of infection the absolute risk reduction, number needed to treat, and 95% CI were calculated. For evaluation of the risk of an adverse effect the absolute risk increase, number needed to harm, and 95% CI were calculated using the Risk Reduction Calculator. Each meta-analysis was made with the help of the Mantel-Haenszel random effects model, and estimates of risk (OR) and 95% CI were calculated using the Review Manager 5.3, from the Cochrane Library. A significant risk was assumed when the lower limit of the 95% CI was greater than 1. Probabilities of less than 0.05 were accepted as significant. The results showed that there was no reduction in the risk of infection when amoxicillin was given before or after operation compared with an untreated group or placebo. In conclusion, this study suggests that amoxicillin given prophylactically or postoperatively does not reduce the risk of infection in healthy patients having their third molars extracted.

Complex systematic review - Perioperative antibiotics in conjunction with dental implant placement

OBJECTIVES

The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews.

MATERIAL AND METHODS

A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed.

RESULTS

The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking.

CONCLUSION

Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient.

Antibiotics in dental practice: how justified are we

Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics. Dentists can make a difference by the judicious use of antimicrobials--prescribing the correct drug, at the standard dosage and appropriate regimen--only when systemic spread of infection is evident. The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry. This paper highlights the need for dentists to improve antibiotic prescribing practices in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. The literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors.

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

OBJECTIVES

The aim of our study was to evaluate antimicrobial prescription behaviour amongst dentists performing oral implant surgery in India.

STUDY DESIGN

Dentists performing oral implant surgery from different parts of India were personally approached during various national events such as conferences and academic meetings and information regarding their prescription habits for antimicrobial agents in routine oral implant surgery was collected using a structured questionnaire.

RESULTS

Out of a total sample of 332 dentists, 85.5 % prescribed 17 different groups or combinations of antibiotics routinely for oral implant surgery in the normal healthy patient. Majority preferred the peri-operative protocol of drug therapy (72.2 %) with variable and prolonged duration of therapy after surgery, ranging from 3 to 10 days. An antimicrobial mouthwash was routinely prescribed by all the doctors (14.5 %) not in favour of prescribing antimicrobials in a normal healthy patient.

CONCLUSIONS

Our findings suggest that there is a trend of antimicrobial agent misuse by dentists performing oral implant surgery in India, both in terms of drugs used and the protocols prescribed. The majority of these dentists prescribed a variety of antimicrobial agents for prolonged durations routinely even in the normal, healthy patients.

Current evidence regarding prophylactic antibiotics in head and neck and maxillofacial surgery

Antibiotic prophylaxis is commonly used to decrease the rate of infections in head and neck surgery. The aim of this paper is to present the available evidence regarding the application of antibiotic prophylaxis in surgical procedures of the head and neck region in healthy patients. A systemic literature review based on Medline and Embase databases was performed. All reviews and meta-analyses based on RCTs in English from 2000 to 2013 were included. Eight out of 532 studies fulfilled all requirements. Within those, only seven different operative procedures were analyzed. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery, and operative tooth extractions. Unfortunately, little high-level evidence exists regarding the use of prophylactic antibiotics in head and neck surgery. In numerous cases, no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. Antibiotics are often given unnecessarily and are administered too late and for too long. Furthermore, little research has been performed on the large number of routine cases in the above-mentioned areas of specialization within the last few years, although questions arising with respect to the treatment of high-risk patients or of specific infections are discussed on a broad base.

Evaluation of the role of antibiotics in preventing postoperative complication after routine periodontal surgery: A comparative clinical study

Background and Objectives:

Aim of this randomly controlled clinical study was to evaluate the role of antibiotics to prevent postoperative complications after routine periodontal surgery and also to determine whether their administration improved the surgical outcome.

Materials and Methods:

Forty-five systemically healthy patients with moderate to severe chronic periodontitis requiring flap surgery were enrolled in the study. They were randomly allocated to Amoxicillin, Doxycycline, and control groups. Surgical procedures were carried out with complete asepsis as per the protocol. Postoperative assessment of patient variables like swelling, pain, temperature, infection, ulceration, necrosis, and trismus was performed at intervals of 24 h, 48 h, 1 week, and 3 months. Changes in clinical parameters such as gingival index, plaque index, probing pocket depth, and clinical attachment level were also recorded.

Results:

There was no incidence of postoperative infection in any of the patients. Patient variables were comparable in all the three groups. Though there was significant improvement in the periodontal parameters in all the groups, no statistically significant result was observed for any group over the others.

Conclusion:

Results of this study showed that when periodontal surgical procedures were performed following strict asepsis, the incidence of clinical infection was not significant among all the three groups, and also that antibiotic administration did not influence the outcome of surgery. Therefore, prophylactic antibiotics for patients who are otherwise healthy administered following routine periodontal surgery to prevent postoperative infection are unnecessary and have no demonstrable additional benefits.

Antibiotic prescription patterns among Swedish dentists working with dental implant surgery: adherence to recommendations

OBJECTIVES

To investigate antibiotic prophylaxis prescription behaviors among Swedish dentists working with dental implant surgery and the influence of scientific reviews.

MATERIAL AND METHODS

An observational questionnaire study was conducted in 2008 and 2012. Dental clinic addresses were found through online search services of Swedish telephone directories. The questionnaires were posted to eligible dentists (120 in 2008, 161 in 2012) in the Stockholm region, Sweden. Absolute frequencies were used to describe the data. Chi-square tests were applied to assess statistically significant differences.

RESULTS

The response rate was 75% in 2008 and 88% in 2012. In 2008, 88% of the dentists routinely prescribed antibiotic prophylaxis when performing implant surgery and 74% in 2012 (P = 0.01). There was a significant reduction in the dentists prescription patterns as 65% prescribed a single dose in 2012, compared to 49% in 2008 (P = 0.04). Amoxicillin was the drug of choice for 47% of the respondents in 2012, and 21% in 2008 (P = 0.01). Dentists without postgraduate clinical training were significantly more prone to extend antibiotic administration after surgery (P < 0.009).

CONCLUSIONS

There is a wide variation in the choice of compound and prescription patterns of prophylactic antibiotic prior to implant insertion. A reduction in antibiotic prescription to a single dose was observed comparing 2008 and 2012, probably influenced by scientific reviews. Dentists with postgraduate education are more likely to limit antibiotic usage.

Observational study of the use of Symphytum 5CH in the management of pain and swelling after dental implant surgery

OBJECTIVE

To assess the effect of Symphytum 5CH on the postoperative pain and swelling after placement of a titanium dental implant.

MATERIAL AND METHODS

Data on pain and swelling following pure titanium implants were reviewed. Patients were treated postoperatively with ketoprofen only or ketoprofen and Symphytum 5CH, according to the treating dentist's usual practice. Demographics and baseline characteristics were recorded and compared. Pain and swelling were compared between the two treatment groups using the Wilcoxon rank sum test and ordinal logistic regression, estimating odds ratios and confidence intervals.

RESULTS

100 implants in 57 patients (28 males, 29 females) were treated with ketoprofen alone; 100 implants in 60 patients (14 males, 46 females) with ketoprofen and Symphytum. The group treated with ketoprofen and Symphytum appeared to have a better response in terms of both pain and swelling. Ordinal logistic regression: pain 0.23, 95% CI 0.13-0.41; swelling 0.24, 95% CI 0.13-0.44. Correction for demographics and implant characteristics greatly widened the confidence intervals so that the results were no longer statistically significant (pain: OR = 0.15, 95% CI 0.07-34.56; swelling OR = 0.18, 95% CI 0.07-46.78).

CONCLUSIONS

Adding Symphytum 5CH to conventional analgesia may reduce pain and swelling after minor dental implant surgery. No firm conclusion can be drawn since the results are confounded by baseline differences, principally gender. Further, randomized, studies should be conducted.

Strategies used to inhibit postoperative swelling following removal of impacted lower third molar

Postoperative swelling following different surgical strategies is an area of great interest. The main part of literature on the topic deals with swelling after extraction of low impacted third molar. In this review, we have analyzed publications of the last 20 years with a pubmed search using the following key words: impacted third molar, swelling third molar, wisdom tooth, edema jaw, corticosteroids and extraction third molar, antibiotic prophylaxis and tooth extraction. Attention has often been focused on corticosteroid therapy administered by diverse routes (orally, IV, IM, topically) and at different time schedules (before or after surgery or both). This investigation revealed how the use of different molecules and dosages makes the obtained results hardly comparable. Similar conclusions can be drawn from studies aimed at evaluating the efficacy of antibiotic therapy administered either before or after surgery. A complete review has also to take into account different surgical strategies used including various flaps, no traumatic osteothomy, and primary or secondary closure. The use of pharmacological therapy and application of an ice pack is critical in the postoperative period and has always provided positive results. However, even if it is difficult to come to definite conclusions, due to the variability of the design of studies analyzed, the postoperative discomfort identified with edema, pain and trismus following wisdom tooth removal is influenced by various factors such as the difficulty of the surgical procedure involved, age and gender of the patient, and experience of the surgeon. The pharmacological therapy when performed with corticosteroids seems to improve control of the postoperative swelling related with this kind of surgeries.

Effects of antibiotics on dental implants: a review

There are many reasons for dental implant failure, the development of bacteremia is concern for dentists. This is due to the possibility of unfavorable result such as implant loss or the need for re-treatment. In general, antibiotic prophylaxis is recommended for high risk patients such as individuals with an immunodeficiency, infectious endocarditis, or previous prosthetic instrumentation. However regarding clinically healthy, low and moderate risk individuals the use of antibiotics in implant dentistry is controversial. Another major concern regarding the over prescription of antibiotics is the selection of antibiotic resistant bacteria. A better understanding of the efficacy of prophylactic treatments regarding dental implantation is crucial. Thus a literature review and comparison of survival rates of dental implants with regimens of no, pre or post prophylaxis was performed using systematic literature review using reliable electronic databases. Retrospective or prospective controlled studies were examined for the influence of preoperative and/or postoperative or no antibiosis on dental implant success rate. Of the 11406 implants used in this literature review, cases with no antibiotics had a 92 % success rate, cases with pre-op antibiotic alone had a 96% success rate, cases with post-op antibiotic alone had a 97% success rate and cases with both pre and post-op antibiotic had a success rate of 96%. Thus, the results from this literature review show a > 90% success rate when antibiotics are used compared to when they are not used. Thus, no benefit is seen from the use of antibiotic prophylaxis in low and moderate risk dental implant patients.

KEYWORDS

Dental implants; Pre-operative prophylactics; Post-operative prophylactics; Success rate.

Oro-antral fistulae and fractured tuberosities

This paper, in discussing oro-antral fistulae and fractured tuberosities, aims to guide the dentist through the assessment and reduction of risk when removing maxillary molar teeth that are closely related to the maxillary sinus. However, complications are inevitable and the management of these will also be discussed.

Pain levels after third molar surgical removal: an evaluation of predictive variables

AIM

The aim of this prospective study was to evaluate the pain course after surgical removal of third molars.

MATERIALS AND METHODS

The sample consisted of 100 consecutive patients. Pain intensity was assessed by means of a visual analog scale (VAS).

RESULTS

At day 1, moderate and severe pain were observed predominantly in patients who had surgery in the mandible (p < 0.001) and for patients younger than 24 years (p = 0.009), while more patients who weekly consumed mate tea (Ilex paraguariensis) showed pain classified as none or light (p = 0.017). At day 2, the profile of pain moderate/severe was more prevalent for patients who had surgery in the mandible (p < 0.001) with the report of difficult surgery (p = 0.042) and with odontotomy performed (p = 0.033). In the third postoperative day, severe/moderate pain was associated with surgery in the mandible (p < 0.001) and with odontotomy (p = 0.021) and ostectomy (p = 0.028) performed, with report of long and difficult procedure (p = 0.023), surgeries which last more than sixty minutes (p < 0.026), and for those patients who developed postoperative inflammatory complications (p < 0.001).

CONCLUSION

Higher pain complains could be expected for patients who have long and difficult mandibular third molar surgery characterized by odontotomy and ostectomy.

CLINICAL SIGNIFICANCE

Pain after third molar surgery is a common sequele. It is indispensable for the dentists to be apt in handling and preventing it as far as possible and know possible variables that may influence or increase these pain levels. It can be a clinical advantage. Better understanding the pain characteristics may guide the dentist through preoperative decisions.

Antibiotic prescribing practices by dentists: a review

Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse.

Antibiotic prophylaxis in third molar surgery: A randomized double-blind placebo-controlled clinical trial using split-mouth technique

The use of prophylactic antibiotics to reduce postoperative complications in third molar surgery remains controversial. The study was a prospective, randomized, double blind, placebo-controlled clinical trial. 100 patients were randomly assigned to two groups. Each patient acted as their own control using the split-mouth technique. Two unilateral impacted third molars were removed under antibiotic cover and the other two were removed without antibiotic cover. The first group received antibiotics on the first surgical visit. On the second surgical visit (after 3 weeks), placebo capsules were given or vice versa. The second group received antibiotics with continued therapy for 2 days on the first surgical visit and on the second surgical visit (after 3 weeks) placebo capsules were given or vice versa. Pain, swelling, infection, trismus and temperature were recorded on days 3, 7 and 14 after surgery. Of 380 impactions, 6 sockets (2%) became infected. There was no statistically significant difference in the infection rate, pain, swelling, trismus, and temperature between the two groups (p>0.05). Results of the study showed that prophylactic antibiotics did not have a statistically significant effect on postoperative infections in third molar surgery and should not be routinely administered when third molars are removed in non-immunocompromised patients.

Patients' perception of recovery after third molar surgery following postoperative treatment with moxifloxacin versus amoxicillin and clavulanic acid: a randomized, double-blind, controlled study

PURPOSE

To analyze the impact of the postoperative administration of moxifloxacin (MXF) on oral function and quality of life after third molar (TM) surgery.

MATERIALS AND METHODS

A single-center, prospective, randomized, double-blind, controlled clinical trial was designed. The study population consisted of 100 patients who underwent impacted TM extractions. Patients were distributed into 2 groups of 50 individuals each. Postoperatively, one group was administered MXF (400 mg/24 hours for 5 days); the positive control group received amoxicillin and clavulanic acid (AMX-CLV) (500/125 mg/8 hours for 5 days). Follow-up was performed for 7 postoperative days, during which the patient recorded information on pain, the use of rescue analgesia, undesirable effects of the medication, difficulty in speaking, difficulty in chewing, diet consistency, difficulty performing oral hygiene, asthenia, time in bed, going out of the house, and returning to work.

RESULTS

The administration of MFX was significantly associated with headache, and AMX-CLV was significantly associated with diarrhea. Greater difficulty in chewing and performing oral hygiene was observed in the AMX-CLV group compared with the MXF group. The percentage of patients who tolerated a diet of normal consistency was significantly higher in the MXF group compared with the AMX-CLV group. During the first 4 days of follow-up, the percentage of patients who returned to work was significantly higher in the MXF group than in the AMX-CLV group.

CONCLUSIONS

Moxifloxacin shortens the period of postoperative recovery in terms of oral function and return to work. Therefore, MXF could be a useful option in TM surgery when antibiotics are indicated, particularly if patients are allergic to beta-lactams, their oral flora is resistant to macrolides, or they are intolerant of either of these antibiotics.

Retrospective analysis of 736 implants inserted without antibiotic therapy

PURPOSE

The routine use of antibiotics in oral implant treatment seems to be widespread. The principle of antibiotic prophylaxis before oral surgical procedures in patients at risk for endocarditis or in those who are severely immunocompromised is well established. Antibiotic therapy in conjunction with implant surgery in fit patients and its correlation with failure and success rates remains poorly documented, however. The debate regarding overprescription of antibiotics raises the need for a critical evaluation of proper antibiotic coverage in association with implant treatment. The purpose of this study was to retrospectively show and value the outcomes of dental implant treatment without antibiotic prophylaxis.

MATERIALS AND METHODS

The study included 437 consecutively treated patients, in whom a total of 736 implants were placed. The population received no prophylactic antibiotics, but received anti-inflammatory therapy (nimesulide 100 mg twice daily or Arnica montana 5C 3 times a day) for 3 days postoperatively. Healing was evaluated at second-stage surgery (4 to 6 months postoperatively). Failure was defined as removal of the implant due to either signs of infection or nonosseointegration of the implant, according to the criteria for success described by Albrektsson and Coll in 1988.

RESULTS

The implant survival rate in the sample (96.2%) was no lower than the high success rates published in the literature using various antibiotic regimens.

CONCLUSIONS

Our findings support the results of several recent reviews of minor use of antibiotics in oral surgery. These findings suggest that the use of antibiotics for routine oral implants may not be as beneficial as once believed and that clinicians should look forward to the reduction of their unnecessary use. The use of antibiotic prophylaxis before oral surgical procedures remains a controversial issue, poorly documented in the literature.

An audit of 600 referrals to a primary care based oral surgery service

AIM

To identify potential problems in the quality of care when oral surgery is provided in the primary health care setting.

METHOD

Retrospective analysis of referral patterns, waiting times, treatment with clinical and histological diagnosis, including complications of 600 patients referred to a practice-based oral surgical referral service.

RESULTS

Fifty-three patients were not treated. Seventy-nine percent of patients were treated within four weeks of referral. The most common procedure performed was surgical removal of impacted third molar teeth. The most frequently observed complications were dry socket (n = 31/703), pain and inflammation associated with resorbable sutures (n = 11/453), and post-operative infection (n = 9/547). One patient with post-operative infection required care in the acute hospital setting.

CONCLUSION

Acknowledging the small sample, it was safe and effective to diagnose and treat a broad spectrum of patients and oral surgical problems in the primary health care setting.

Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection

AIM

The aim of this retrospective study was to assess the influence of systemic and local bone and intra-oral factors on the occurrence of early implant failures, i.e. up to the abutment connection.

MATERIAL AND METHODS

The surgical records of 2004 consecutive patients from the total patient population who had been treated in the period 1982-2003 (with a total of 6946 Brånemark system implants) at the Department of Periodontology of the Catholic University Leuven were evaluated. For each patient the medical history was carefully checked. Data collection and analysis mainly focused on endogenous factors such as hypertension, coagulation problems, osteoporosis, hypo-hyperthyroidy, chemotherapy, diabetes type I or II, Crohn's disease, some local factors [e.g. bone quality and quantity, implant (length, diameter, location), type of edentulism, Periotest value at implant insertion, radiotherapy], smoking habits and breach of sterility during surgery.

RESULTS

A global failure rate of 3.6% was recorded. Osteoporosis, Crohn's disease, smoking habits, implant (length, diameter and location) and vicinity with the natural dentition were all significantly associated with early implant failures (p<0.05).

CONCLUSION

The indication for the use of oral implants should sometimes be reconsidered when alternative prosthetic treatments are available in the presence of possibly interfering systemic or local factors.

Analgesic and anti-inflammatory dose–response relationship of 7.5 and 15mg meloxicam after lower third molar removal: a double-blind, randomized, crossover study

Fifty patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Meloxicam 7.5 or 15 mg was once daily administered in a double-blind, randomized and crossover manner after the surgery for 4 days. Objective and subjective parameters were recorded for comparison of postoperative courses. Patients treated with 7.5mg meloxicam who underwent osteotomy reported higher pain scores at 1.5, 3, 4, 10, 12 and 16 h (P<0.05) and ingested a greater amount of rescue analgesic medication (P<0.05) than those who did not require osteotomy. A higher percentage of patients who underwent osteotomy medicated with 7.5mg meloxicam needed rescue medication as compared to those who did not require osteotomy (P<0.05). There was a similar mouth opening at suture removal compared with preoperative values for both doses (P>0.05). There were no significant differences concerning swelling observed on the 2nd or 7th postoperative days in comparison with baseline (P>0.05) between the two doses. Pain, trismus and swelling after lower third molar removal not requiring osteotomy can be successfully controlled by a dose regimen of 7.5mg meloxicam once daily. For more aggressive extractions 15 mg meloxicam is advisable.

The dental implications of bisphosphonates and bone disease

In 2002/2003 a number of patients presented to the South Australian Oral and Maxillofacial Surgery Unit with unusual non-healing extraction wounds of the jaws. All were middle-aged to elderly, medically compromised and on bisphosphonates for bone pathology. Review of the literature showed similar cases being reported in the North American oral and maxillofacial surgery literature. This paper reviews the role of bisphosphonates in the management of bone disease. There were 2.3 million prescriptions for bisphosphonates in Australia in 2003. This group of drugs is very useful in controlling bone pain and preventing pathologic fractures. However, in a small number of patients on bisphosphonates, intractable, painful, non-healing exposed bone occurs following dental extractions or denture irritation. Affected patients are usually, but not always, over 55 years, medically compromised and on the potent nitrogen containing bisphosphonates pamidronate (Aredia/Pamisol), alendronate (Fosamax) and zolendronate (Zometa) for non-osteoporotic bone disease. Currently, there is no simple, effective treatment and the painful exposed bone may persist for years. The main complications are marked weight loss from difficulty in eating and severe jaw and neck infections. Possible preventive and therapeutic strategies are presented although at this time there is no evidence of their effectiveness. Dentists must ask about bisphosphonate usage for bone disease when recording medical histories and take appropriate actions to avoid the development of this debilitating condition in their patients.