Antibiotics After Tooth Extraction?

A study published in February 2015 by the Journal of Oral and Maxillofacial Surgery evaluated the perceptions patients hold regarding the value of taking antibiotics following tooth removal. This study found that 2/3 of patients having tooth extraction expected to have antibiotics prescribed after the procedure. 70% of these patients expected that taking the antibiotic would help prevent infection. Antibiotic Use With Routine Tooth Extraction Many teeth are removed by general dentists everyday. Many of these doctors routinely prescribe antibiotics to every patient undergoing such a procedure. The unfortunate truth is that this blanket application of medication is based mostly upon tradition and not in science. The use of antibiotics in conjunction with routine tooth removal from healthy patients has not been demonstrated to be of any value for preventing infection, reducing pain, or any other purpose. Certain patients do require antibiotic administration prior to any invasive oral procedure. This is because even a small amount of bacteria introduced into the blood stream may have catastrophic outcomes. These patients include, but are not limited to, those with prosthetic heart valves, history of infection in the heart or heart valves, and certain patients with implanted prosthetic joints or other body parts, those suffering from immunosuppressive illnesses, and those taking immunosuppressive drugs. Antibiotic Use With More Complicated Tooth Extraction The use of antibiotics in this application has been studied extensively. For those patients having impacted wisdom teeth removed, the evidence seems conclusive that antibiotic use before and/or after the surgery has several benefits.
  • Patients experience
    • Lower incidence of post-surgical infection
    • Less likelihood of developing dry socket (alveolar osteitis)
    • Less pain
    • Less swelling
One might assume from the above that antibiotics should always be prescribed for patients having impacted wisdom teeth removed. The answer is not that simple. Firstly, the likelihood of experiencing any of the complications above, that antibiotics reportedly reduce, is quite small even without antibiotics. Only about 5% of patients having impacted wisdom tooth removal will develop an infection. This translates to mean between 12 and 20 patients would take an antibiotic to prevent one infection. The second important point is that a significant number of those receiving antibiotics will experience a post-surgical infection or other difficulty in spite of the antibiotic therapy. Because antibiotics are prescribed so frequently, many have come to think of them as harmless. This is far from true. Antibiotics are responsible for a long list of possible negative side effects, some of which may be life threatening. Of further importance is the fact that the likelihood of experiencing a problem solely caused by the antibiotic is about equal to the probability of experiencing a problem from the tooth removal, but potentially much more severe.
  • Antibiotics are not advisable around routine tooth extraction except
    • For patients with underlying health problems that may compromise their ability to resist infection, or make the risk of infection more significant.
    • The area is acutely infected prior to surgery.
    • Other extenuating circumstances exist.
  • Antibiotics are probably not advisable for patients having “routine” impacted tooth removal unless
    • The extraction is exceptionally difficult.
    • The patient has underlying health problems compromising the ability to resist infection.
    • The area is acutely infected prior to surgery.
    • Other extenuating circumstances exist.
There are a host of other reasons why your doctor may recommend taking an antibiotic in conjunction with your surgery which are beyond the scope of this article. However, it is important to know that antibiotics are not always useful, could be harmful, and to understand the reasoning behind the prescription. Have You Been Advised To Have A Tooth Removed? The doctors of the Surgical Arts Centre have a more than 50 years combined experience in treating problems of the head and neck, including tooth removal. We would love to discuss how we might help. Call 406-549-6600 to schedule a consultation.
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