Antibiotics to prevent complications following tooth extractions.

Nov 2012

Lodi G, Figini L, Sardella A, Carrassi A, Del Fabbro M, Furness S.

Source

Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1/3, Milan, Italy, 20142.

Abstract

BACKGROUND:

The most frequent indications for tooth extractions are dental caries and periodontal infections, and these extractions are generally done by general dental practitioners. Antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection.

OBJECTIVES:

To determine the effect of antibiotic prophylaxis on the development of infectious complications following tooth extractions.

SEARCH METHODS:

The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 25 January 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1948 to 25 January 2012), EMBASE via OVID (1980 to 25 January 2012) and LILACS via BIREME (1982 to 25 January 2012). There were no restrictions regarding language or date of publication.

SELECTION CRITERIA:

We included randomised double-blind placebo-controlled trials of antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication.

DATA COLLECTION AND ANALYSIS:

Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. For dichotomous outcomes we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. The quality of the body of evidence has been assessed using the GRADE tool.

MAIN RESULTS:

This review included 18 double-blind placebo-controlled trials with a total of 2456 participants. Five trials were assessed at unclear risk of bias, thirteen at high risk, and none at low risk of bias. Compared to placebo, antibioticsprobably reduce the risk of infection in patients undergoing third molar extraction(s) by approximately 70% (RR 0.29 (95% CI 0.16 to 0.50) P < 0.0001, 1523 participants, moderate quality evidence) which means that 12 people (range 10-17) need to be treated with antibiotics to prevent one infection following extraction of impacted wisdom teeth. There is evidence thatantibiotics may reduce the risk of dry socket by 38% (RR 0.62 (95% CI 0.41 to 0.95) P = 0.03, 1429 participants, moderate quality evidence) which means that 38 people (range 24-250) need to take antibiotics to prevent one case of dry socket following extraction of impacted wisdom teeth. There is also some evidence that patients who have prophylactic antibioticsmay have less pain (MD -8.17 (95% CI -11.90 to -4.45) P < 0.0001, 372 participants, moderate quality evidence ) overall 7 days after the extraction compared to those receiving placebo, which may be a direct result of the lower risk of infection. There is no evidence of a difference between antibiotics and placebo in the outcomes of fever (RR 0.34, 95% CI 0.06 to 1.99), swelling (RR 0.92, 95% CI 0.65 to 1.30) or trismus (RR 0.84, 95% CI 0.42 to 1.71) 7 days after tooth extraction.Antibioticsare associated with an increase in generally mild and transient adverse effects compared to placebo (RR 1.98 (95% CI 1.10 to 3.59) P = 0.02) which means that for every 21 people (range 8-200) who receive antibiotics, an adverse effect is likely.

AUTHORS' CONCLUSIONS:

Although general dentists perform dental extractions because of severe dental caries or periodontal infection, there were no trials identified which evaluated the role of antibiotic prophylaxis in this group of patients in this setting. All of the trials included in this review included healthy patients undergoing extraction of impacted third molars, often performed by oral surgeons. There is evidence that prophylactic antibiotics reduce the risk of infection, dry socket and pain following third molar extraction and result in an increase in mild and transient adverse effects. It is unclear whether the evidence in this review is generalisable to those with concomitant illnesses or immunodeficiency, or those undergoing the extraction of teeth due to severe caries or periodontitis. However, patients at a higher risk of infection are more likely to benefit from prophylactic antibiotics, because infections in this group are likely to be more frequent, associated with complications and be more difficult to treat. Due to the increasing prevalence of bacteria which are resistant to treatment by currently available antibiotics, clinicians should consider carefully whether treating 12 healthy patients with antibiotics to prevent one infection is likely to do more harm than good.

An investigation of antibiotic prophylaxis in implant practice in the UK.

Oct 2012

Ireland RS, Palmer NO, Lindenmeyer A, Mills N.

Source

Warwick Dentistry, The University of Warwick, Coventry, CV4 7AL.

Abstract

Background: 

There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice.

Method: 

An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated.

Results:

 One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia.

Conclusions: 

Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic over prescribing and misuse.

British Dental Journal

Effects of antibiotics on dental implants: a review.

Feb 2012

Ahmad N, Saad N.

Source

Schulich School of Medicine & Dentistry, University of Western Ontario, Canada.

Abstract

There are many reasons for dental implant failure, the development of bacteremia is concern for dentists. This is due to the possibility of unfavorable result such as implant loss or the need for re-treatment. In general, antibiotic prophylaxis is recommended for high risk patients such as individuals with an immunodeficiency, infectious endocarditis, or previous prosthetic instrumentation.

However regarding clinically healthy, low and moderate risk individuals the use of antibiotics in implant dentistry is controversial. Another major concern regarding the over prescription of antibiotics is the selection of antibiotic resistant bacteria. A better understanding of the efficacy of prophylactic treatments regarding dental implantation is crucial. Thus a literature review and comparison of survival rates of dental implants with regimens of no, pre or post prophylaxis was performed using systematic literature review using reliable electronic databases.

Retrospective or prospective controlled studies were examined for the influence of preoperative and/or postoperative or no antibiosis on dental implant success rate. Of the 11406 implants used in this literature review, cases with no antibiotics had a 92 % success rate, cases with pre-op antibiotic alone had a 96% success rate, cases with post-op antibiotic alone had a 97% success rate and cases with both pre and post-op antibiotic had a success rate of 96%. Thus, the results from this literature review show a > 90% success rate when antibiotics are used compared to when they are not used. Thus, no benefit is seen from the use of antibiotic prophylaxis in low and moderate risk dental implant patients.

KEYWORDS: Dental implants; Pre-operative prophylactics; Post-operative prophylactics; Success rate.

PubMed

New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.

New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.

Curr Opin Infect Dis. 2008 Apr

Shanson D.
Department of Medical Microbiology, Great Ormond Street Hospital for Children, London, UK.

PURPOSE OF REVIEW: The British Society for Antimicrobial Chemotherapy and the American Heart Association have radically revised their guidelines for the antibiotic prophylaxis of endocarditis. This review discusses the evidence behind the most controversial changes and considers possible future developments.

RECENT FINDINGS: The new guidelines emphasize good oral hygiene for preventing viridans streptococcal endocarditis. Antibiotic prophylaxis for dental procedures is only recommended for patients with the highest-risk cardiac conditions. American Heart Association guidelines no longer recommend prophylaxis for urological and gastrointestinal procedures.

SUMMARY: While only up to 6% of endocarditis cases may be prevented by antibiotic prophylaxis there is controversy as to what to recommend for the individual cardiac patient undergoing a given procedure. The new guidelines about dental prophylaxis are based on epidemiological studies that failed to include sufficient subjects undergoing specific interventions. When considering viridans streptococcal rather than total bacteraemia rates, asserting that the prevalence of bacteraemia after invasive dental procedures is similar to that after toothbrushing may be incorrect. The British Society for Antimicrobial Chemotherapy report probably overestimates the risk of fatal anaphylaxis after an oral dose of amoxicillin. In contrast, the American Heart Association guidelines comment on the absence of any reports of fatal anaphylaxis associated with the antibiotic prophylaxis of endocarditis.

Lippincott, Williams & Wilkins