Antibiotic prophylaxis not completely effective for post-extraction complications, States study

A new study published in the Journal of Public Health Dentistry found mild protective impact of antibiotic prophylaxis against post-extraction problems or subsequent medical care usage. For many dentists, extracting a tooth is a standard practice. Even though it's a popular therapy, there is a chance that it can cause postoperative problems including discomfort, edema, and trismus and other issues. Due to the possibility of dry socket (DS) and surgical site infection (SSI), tooth extraction is considered a clean-contaminated procedure. Therefore, prophylactic antibiotics have long been used by dentists to avoid DS and SSI.

Amoxicillin, either by itself or in conjunction with clavulanic acid, is the most often prescribed antibiotic for preventing postoperative infection following extraction. Prophylactic antibiotic use is useful in preventing problems in high-risk patients and is recommended when there is an active infection during surgery. Therefore, this study by Jessina McGregor and colleagues assessed the relationship between the Veterans Affairs Healthcare System's antibiotic prophylaxis and unfavorable outcomes after tooth extraction.

This study used a retrospective cohort analysis of individuals who had tooth extractions from 2015 to 2019 for this investigation. Prophylactic use of antibiotics was the primary exposure. Alveolar osteitis and surgical site infections were examples of post-extraction complications that occurred within seven days. Subsequent medical care for an oral problem that occurred within seven days was the secondary outcome. Antibiotic prophylactic was evaluated for its independent impact on each outcome using multivariable logistic regression models.

122,810 (31.8%) of the 385,880 dental extraction visits involved antibiotic prophylaxis. In all, 3387 (0.9%) people had a post-extraction oral problem, and 350 (0.09%) people sought medical attention for it within a week. Diabetes was a statistically significant (p = 0.01) impact modifier in multivariable analysis of the relationship between antibiotic prophylaxis and post-extraction complications.

Antibiotic prophylaxis was shown to be substantially related with a higher likelihood of post-extraction complications among visits from patients without diabetes, but no significant effect was seen when it came to visits from patients with diabetes. Also, prophylactic antibiotic use did not substantially correlate with post-extraction healthcare. Overall, the results indicate that it might be time to reevaluate the widespread application of antibiotics in such low-risk situations, given problems only occurred in 0.9% of instances. Antibiotics had no discernible impact on complications in diabetic individuals.

Source:

McGregor, J. C., Wilson, G. M., Gibson, G., Jurasic, M. M., Evans, C. T., & Suda, K. J. (2024). The effect of antibiotic premedication on postoperative complications following dental extractions. In Journal of Public Health Dentistry. Wiley. https://doi.org/10.1111/jphd.12634