Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled trials

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by Dr Trevor Watts.

Abstract

Systemic antibiotics given before treatment reduced levels of dry socket (alveolar osteitis: AO) and wound infection (WI) but NNTs were quite high.

Main

Ren Y-F, Malmstrom HS. J Oral Maxillofac Surg 2007; 65: 1909–1921

There is a long-standing controversy over the need for antibiotics to prevent AO after surgical removal of third molars (M3s). After a search of the literature, 17 randomised trials were found suitable for meta-analysis, but 1 was eliminated. This left 2,932 patients in 10 trials using broad spectrum antibiotics, and 6 using antianaerobics such as metronidazole.

AO occurred in 84 of 1,350 treated patients and 228 of 1,582 controls (OR = 2.2; P < 0.05), and 13 patients needed to be treated to prevent 1 case. Respective figures for WI were 44 of 1,110, and 78 of 1,286 (OR = 1.8; P < 0.05), with NNT of 25. Preoperative doses were necessary to prevent AO, and needed to be continued 2-7 days to prevent WI. The authors suggest using a penicillin if prophylaxis is necessary.