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Antibiotics to prevent complications following tooth extractions


Lodi, G., et al

Subject Keywords: Antibiotic prophylaxis, Infectious complications, Tooth extractions, Dental
Type: Article
Region: International (other)

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.



Rights: © The Cochrane Collaboration
Suggested citation:

Lodi, G., et al. (2012) Antibiotics to prevent complications following tooth extractions [Online]. Available from: [Accessed: 17th June 2019].


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