Antibiotics necessary post wisdom teeth removal?

Skibunny77

Can i just enquire about the evidence base supporting antibiotic use as a preventative measure post wisdom tooth extraction? I am a breastfeeding mother due to have a lower wisdom tooth removed with local anaesthetic next week. I asked oral surgeon if antibiotics were necessary, he said 'better safe than sorry when the bone is cut' and didn't seem to want to explain further. I obviously want to avoid infection but just wonder if the rates of infection are significantly higher in patients who don't take antibiotics? I'm young and healthy, would rather let my immune system kick in first if it is okay to do so..

NotToScale

My personal opinion, I'd go with the oral surgeon's advice. I'm not sure that anyone other than an oral surgeon could second guess them on this.

If you're concerned about it, check if the antibiotic in question is passed though milk, many aren't or at least are considered to be very safe. If you ask a pharmacist or you gp they should be able to advise on this.

thomasdylan

The surgeon who is doing the procedure has recommended antibiotics, I'm not sure what can be gained from trying to get advice from people who won't be doing the procedure.

NotToScale

Advice on the concerns about on going breast feeding. As I said, there's nobody really in a position to second guess an oral surgeon on this, but you might want to get information on the specific antibiotic and breastfeeding.

Pharmacist and definitely GP would be able to advise whether it's necessary to temporarily bottle feed while taking them etc etc.

There are a lot of different antibiotics, so definitely explain that you're breastfeeding to the prescriber too.

If they think they're necessary, I wouldn't go against that advice. There is a lot of bacteria in your mouth and it's reasonable to assume they're as expert in this area as you can get.

If you've specific concerns about breastfeeding though, chat to your GP about what can be done in terms of pausing. They'll definitely be able to advise on that aspect.

Also think of it from the point of view that if you did get any infections that these antibiotics prevented, it could lead to a whole lot more hassle, risk and a lot more antibiotics. So I would definitely follow the surgeon's plan.

helimachoptor

sorry OP, we cant offer medical advice.

Oral Surgeon

Skibunny77 wrote: »

Can i just enquire about the evidence base supporting antibiotic use as a preventative measure post wisdom tooth extraction? I am a breastfeeding mother due to have a lower wisdom tooth removed with local anaesthetic next week. I asked oral surgeon if antibiotics were necessary, he said 'better safe than sorry when the bone is cut' and didn't seem to want to explain further. I obviously want to avoid infection but just wonder if the rates of infection are significantly higher in patients who don't take antibiotics? I'm young and healthy, would rather let my immune system kick in first if it is okay to do so..

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003811.pub2/full

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, antibiotics probably 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 that antibiotics 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 antibiotics may 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.

Antibiotics are 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.