After tooth extraction, many doctors prescribe antibiotics to patients to prevent various complications. We decided to check if this recommendation has scientific justifications.
Recommendations to drink a course of antibiotics after tooth extraction can Meet on sites dental clinic And pharmaciesas well as in Blogs. In some sources, it emphasizes that this measure is especially Important For patients who were removed "eight" (that is, a tooth of wisdom). “In the absence of antibiotic therapy, the appearance of formidable complications in the form of alveolitis and osteomyelitis of the jaw, and sometimes even the development of sepsis, is possible. The use of such drugs is necessary to relieve active inflammation or prevent tissue infection after surgery, ” - warn Some specialized portals. In March 2024, the publication "Daily Karelia"Wrote about a resident of St. Petersburg, who almost died after a tooth extraction in one of the clinics of the republic. The material emphasized that, contrary to the patient's requests, the doctor did not prescribe antibiotics to her.
The removal (or extraction) of the tooth is surgical manipulation, in which it is extracted from a tooth hole (alveoli). The dentist makes the decision to carry out this procedure if the tooth cannot be preserved in the framework of therapeutic treatment. However, such a wording does not mean at all that the tooth is affected by caries, greatly destroyed or inflamed. The doctor can resort to the removal of a completely healthy tooth - for example, in the framework of preparation for prosthetics, correction of a bite or correction of jaw anomalies.
Before the procedure, the doctor usually discusses with the patient Options local or general anesthesia, as well as sedations. For removal dairy Application anesthesia is used tooths - applying gel or spray to soft tissues, usually based on lidocaine. Doctors also turn to this technique in order to reduce sensitivity with other types of anesthesia that imply an injection. Removing frontal indigenous teeth, doctors can Use infiltration anesthesia, that is, to introduce the gum paintering into the soft tissue. If it is required to remove a chewing root tooth, they usually resort to conduction anesthesia - anesthetic is introduced into the branches trigeminal nerve.
For the patient, infiltration and conduction anesthesia almost does not differ - in both cases, the doctor makes an injection in the gum (but in different places), however, in the second case, numbness can last a little longer. When a tooth is removed in a patient who, due to health reasons, it is necessary to reduce the dose of painkillers, may fit Intralgent Anesthesia, that is, the introduction of the drug between the tooth and the gum. Sedation can It is necessary 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 disorders. Within the framework of the procedure, doctors can use ozot oxide supplied through special nasal cannulas or mask, as well as sleeping pills, which is administered intravenously (for example, proofol).
After anesthesia and (if necessary) sedation, the doctor with a special tool produces separation - separates a circular ligament from the tooth. Next, he wraps the tooth with tongs and moves towards the neck of the tooth under the gingival edge. Then, if the tooth is single -root, the dentist makes circular movements with tongs around the tooth axis (rotation), if multi -root, sways it towards the tongue and back (luxury). The goal of both procedures is to weaken the grip of the tooth with the hole in order to minimize the risk of jaw injury. After that, he extracts a tooth from the hole (traction).
When the tooth is removed, the dentist examines the hole to make sure that there are no parts of the tooth left, and processes it. At this place to stop bleeding, a cotton swab may be placed or Bombocytic mass - Previously obtained from the patient’s blood and a dense clot treated in a centrifuge, rich in platelets and collagen. In some cases, dentists apply seams to pull the edges of the hole.
Sometimes remove the tooth completely completely impossible - For example, if it is very destroyed and crumble. In such cases, doctors cut the gum and remove the tooth in parts. Similar tactics are used if the tooth does not grow completely.
Like any surgery, tooth extraction can be accompanied by complications. Usually they are divided into occurring during and after surgery. To the first group Relate:
- injuries of the mucous membrane, neighboring tooth or crown of the antagonist tooth (that is, in contact with the closure of the upper and lower jaws);
- pushing the root of the removed tooth into the soft tissue of the gums (when the lower "eight" is removed);
- dislocation or even fracture of the lower jaw;
- the shooting of an alveolar process (the anatomical part of the upper jaw carrying teeth on itself) or Buger of the upper jaw;
- Perforation of the bottom of the maxillary (sinuspicular) sinus.
Mostly these complications arise Due to the medical error, primarily the wrong choice of tools or violation of the technique of tooth extraction, as well as due to pathological processes in the jaw (Osteomyelitis, benign and malignant tumors). From the problems that appear during the procedure, the subsequent administration of antibiotics cannot protect.
Complications after tooth extraction can also be diverse. The frequency of their occurrence Analyzed A group of Australian scientists, which in 2024 published meta -analysis of relevant studies. It included 176 articles, 20 of which described the prevalence of individual complications, and another 156 - various factors that can contribute to the patient’s predisposition. Scientists were especially interested in complications after the removal of wisdom teeth. The most common complication was the alveolar osteet (aka a dry hole), which arises Due to the loss or leaching of a blood clot from the hole of the tooth and mechanical injury of the hole or the ingress of pathogenic bacteria into it. The probability of such a problem can reach 12.7% when removing “eights” and 39.12% as a whole when removed tooths. Intensively intense oral hygiene after the tooth is excessive to fall in the blood clot after the use of an irrigator or too active by the brush in the corresponding area), damage to the clot in attempts to feel the area of removal with the tongue, and eating hard food. Risk higher In smokers taking oral contraceptives, elderly people, as well as those suffering from diabetes and immunodeficiency.
Although bacteria play a certain role in the development of osteitis, and antibiotics can be used for its treatment, the prevention of this complication is ineffective with their help. Kokrainovsky review 2021, which included 23 studies of the effectiveness of prescribing antibiotics after removing wisdom tooths, showed that out of 46 people who will take antibiotics from possible osteitis, such therapy will protect only one. At the same time, simple rinse of the mouth with chlorhexidine reduces His risk is 42%.
Among other most common complications are bleeding and damage to the alveolar nerve. Antibiotics cannot cope with them because of their mechanism of action. In the fourth place, the pain that painkillers can relieve, but by no means antibiotics. Osteomyelitis (inflammation of the bone tissue of the jaw), as well as an abscess (purulent inflammation of tissues) is less common. These two processes, indeed, can occur due to bacteria-therefore, taking antibiotics can be justified. However, the data of the same Kokrainsky review Showthat the preventive prescription of these drugs is not very effective - for 19 patients taking drugs, it will be possible to prevent only one case of infection. Therefore, the authors of the study came to the conclusion that antibiotics are not shown to healthy patients for healthy patients, they will need some likely later and only for those who have already developed.
Indirectly confirms this point of view results Studies of the international group of scientists published in 2019. Experts compared the bacterial flora in the oral cavity in patients who took antibiotics after the tooth, in patients who did not take, and in volunteers who did not remove their teeth and who did not take antibiotics. Comparison was carried out on the day of the procedure, after one, two, three and four weeks, as well as three and six months later. Three groups did not have a statistical difference in the number of potential pathogens in the oral cavity, so these drugs would somehow “cleanse” the mouth from bacteria and protect from infections, groundlessly.
In this case, an unjustified antibiotic taking can bring to diarrhea, abdominal pain, nausea, headache, rash and fungal infections. Home danger The uncontrolled use of these drugs is the development of antibiotic resistance, that is, the stability of bacteria for treatment, and the increase in the number of superbacteria, which cannot be destroyed by any existing antibiotic. Doctor of Medical Sciences, Professor NIU High Vasily Vlasov In the commentary, “verified” noted that recently the enthusiasm of dentists in the use of antibiotics has 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 infection complications,” the expert explained.
Taking antibiotics after tooth extraction can be Justified For some patients, these are people who have undergone infectious endocarditis (inflammation of the inner shell of the heart), having Chronic kidney disease, artificial joints, heart defects suffering from immunodeficiency and autoimmune diseases, as well as undergoing chemotherapy.
Thus, as the studies show, the benefits of the preventive use of antibiotics after the extraction of the tooth are small. They are necessary only for some groups of patients, and for the majority the use of such drugs after tooth extraction is excessive precaution.
Image on the cover: GPT 4O
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