Many doctors prescribe antibiotics to patients after tooth extraction to prevent various complications. We decided to check whether this recommendation has scientific basis.
Recommendations for taking a course of antibiotics after tooth extraction can be meet on websites dental clinics And pharmacies, as well as in blogs. Some sources emphasize that this measure is especially important for patients who have had their “figure eight” (that is, wisdom teeth) removed. “In the absence of antibiotic therapy, serious complications may arise in the form of alveolitis and osteomyelitis of the jaw, and sometimes even the development of sepsis. The use of such drugs is necessary to relieve active inflammation or prevent tissue infection after surgery,” warn some profile portals. In March 2024, the publication "Daily Karelia“wrote about a resident of St. Petersburg who almost died after having a tooth removed in one of the clinics in the republic. The material emphasized that, contrary to the patient’s requests, the doctor did not prescribe her antibiotics.
Removal (or extraction) of a tooth is a surgical manipulation, in which it is removed from the tooth socket (alveoli). The dentist decides to perform this procedure if the tooth cannot be preserved as part of therapeutic treatment. However, this formulation does not mean at all that the tooth is affected by caries, severely damaged or inflamed. The doctor may resort to removing a completely healthy tooth - for example, in preparation for prosthetics, correcting the bite or correcting jaw anomalies.
Before the procedure, the doctor usually discusses with the patient options local or general anesthesia, as well as sedation. To delete dairy In teeth, topical anesthesia is used - application of a gel or spray, usually based on lidocaine, to the soft tissues. Doctors also turn to this technique to reduce sensitivity during other types of anesthesia that involve an injection. When removing frontal molars, doctors can use infiltration anesthesia, that is, inject an anesthetic into the soft gum tissue. If it is necessary to remove a chewing molar, they usually resort to conduction anesthesia - an anesthetic is injected into the area of the branches trigeminal nerve.
For the patient, infiltration and conduction anesthesia are almost the same - in both cases the doctor gives an injection into the gum (but in different places), but in the second case the numbness may last a little longer. When extracting a tooth from a patient who, for health reasons, needs to reduce the dose of pain medication, it may be suitable intraligamentary anesthesia, that is, the introduction of a drug between the tooth and gum. Sedation may required to reduce psychological discomfort in people who experience increased anxiety or suffer from phobias, as well as in the treatment of young children and patients with mental development disorders. As part of the procedure, doctors may use nitrous oxide, given through special nasal cannulas or a mask, and sleeping pills, which are administered intravenously (such as propofol).
After anesthesia and (if necessary) sedation, the doctor uses a special tool produces separation - separates the circular ligament from the tooth. Next, he grabs the tooth with forceps and moves towards the neck of the tooth under the gingival margin. Then, if the tooth is single-rooted, the dentist makes circular movements with forceps around the axis of the tooth (rotation), if it is multi-rooted, he swings it towards the tongue and back (luxation). The goal of both procedures is to loosen the bond between the tooth and the socket to minimize the risk of injury to the jaw. After this, he removes the tooth from the socket (traction).
When a tooth is removed, the dentist examines the socket to make sure there are no pieces of tooth left in it and then cleans it. A cotton swab or platelet mass - a dense clot rich in platelets and collagen, previously obtained from the patient’s blood and processed in a centrifuge. In some cases, dentists use sutures to tighten the edges of the socket.
Sometimes a tooth can be removed completely at once impossible - for example, if it is badly damaged and crumbles. In such cases, doctors make an incision in the gum and extract the tooth in parts. Similar tactics are used if the tooth has not fully grown.
Like any surgical procedure, tooth extraction can be accompanied by complications. They are usually divided into those that occur during surgery and after. To the first group include:
- injuries to the mucous membrane, adjacent tooth or crown of the antagonist tooth (that is, in contact when the upper and lower jaws close);
- pushing the root of the tooth being removed into the soft tissue of the gums (when removing the lower “eight”);
- dislocation or even fracture of the lower jaw;
- fracture of the alveolar process (the anatomical part of the upper jaw that bears teeth) or tubercle of the maxilla;
- perforation of the bottom of the maxillary (maxillary) sinus.
Basically these complications arise due to medical error, primarily the wrong choice of instruments or violation of the tooth extraction technique, as well as due to pathological processes in the jaw (osteomyelitis, benign and malignant tumors). Subsequent use of antibiotics cannot protect against problems that arise during the procedure.
Complications after tooth extraction can also be varied. Frequency of their occurrence analyzed a group of Australian scientists who published a meta-analysis of relevant studies in 2024. It included 176 articles, 20 of which described the prevalence of individual complications, and another 156 described various factors that may predispose a patient to them. Scientists were especially interested in complications after wisdom teeth removal. The most common complication was alveolar osteitis (aka dry socket), which arises due to the loss or washing out of a blood clot from the tooth socket and mechanical injury to the socket or the entry of pathogenic bacteria into it. The probability of such a problem can reach 12.7% when removing “eights” and 39.12% in general when removing teeth. Excessive oral hygiene after tooth extraction (for example, using an irrigator or too active movements of the brush in the corresponding area), damage to the clot in attempts to feel the extraction area with the tongue, or eating hard food can contribute to the loss of a blood clot. Risk higher in smokers, taking oral contraceptives, elderly people, as well as those suffering from diabetes and immunodeficiencies.
Although bacteria play some role in the development of osteitis, and antibiotics can be used to treat it, they are ineffective in preventing this complication. Cochrane review A 2021 study that included 23 studies on the effectiveness of prescribing antibiotics after wisdom teeth removal found that of 46 people who would take antibiotics for possible osteitis, such therapy would protect only one. In this case, a simple mouth rinse with chlorhexidine reduces his risk is 42%.
Other common complications include bleeding and alveolar nerve damage. Antibiotics cannot cope with them due to their mechanism of action. In fourth place in terms of prevalence is pain, which can be relieved by painkillers, but not by antibiotics. Less common are osteomyelitis (inflammation of the bone tissue of the jaw), as well as abscess (purulent inflammation of tissue). These two processes can indeed occur due to bacteria - therefore, taking antibiotics may be justified. However, data from the same Cochrane review showthat the prophylactic use of these drugs is not very effective - for every 19 patients taking the drugs, only one case of infection will be prevented. Therefore, the study authors concluded that prophylactic antibiotics are not indicated for healthy patients; they are likely to be needed later and only for those who have already developed a complication.
This point of view is indirectly confirmed results research by an international group of scientists published in 2019. Experts compared the bacterial flora in the oral cavity in patients who took antibiotics after tooth extraction, in patients who did not, and in volunteers who did not have teeth removed and who did not take antibiotics. Comparisons were made on the day of the procedure, one, two, three and four weeks later, and three and six months later. There was no statistical difference in the number of potential pathogens in the oral cavity of the three groups, so there is no basis to believe that these drugs will somehow “cleanse” the mouth of bacteria and protect against infections.
At the same time, unjustified use of antibiotics can bring to diarrhea, abdominal pain, nausea, headache, rash and fungal infections. Home danger uncontrolled use of these drugs leads to the development of antibiotic resistance, that is, resistance of bacteria to treatment, and an increase in the number of superbugs that cannot be destroyed by any existing antibiotic. Doctor of Medical Sciences, Professor of the National Research University Higher School of Economics Vasily Vlasov in the “Verified” commentary, he noted that dentists’ enthusiasm for using antibiotics has recently decreased. “Under the influence of accumulating scientific data, these drugs began to be used only for infected wounds and in patients with a high risk of complications of infection,” the expert explained.
Taking antibiotics after tooth extraction may be acquitted for some patients, these are people who have had infective endocarditis (inflammation of the inner lining of the heart), having chronic kidney disease, artificial joints, heart defects, those suffering from immunodeficiencies and autoimmune diseases, and those undergoing chemotherapy.
Thus, as research shows, the benefit of prophylactic antibiotics after tooth extraction is small. They are necessary only for some groups of patients, and for most, the use of such drugs after tooth extraction is an excessive precaution.
Cover image: GPT 4o
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