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Third-molar extractions are common dental procedures. They often involve impacted teeth, which means the teeth are not fully erupted and can cause problems. Impacted third molars, also known as wisdom teeth, frequently lead to infections, pain, and complications that require surgical removal.
One common complication after third-molar extraction is infection. Another frequent issue is alveolitis, also called dry socket. Dry socket occurs when the blood clot in the tooth socket dissolves or dislodges, leaving bone exposed and causing severe pain. This typically happens within three days after extraction. The incidence rate for dry socket ranges from 1% to 4% after extracting any
tooth. However, it can reach up to 45% specifically after mandibular (lower jaw) third-molar extractions.
Dentists often prescribe antibiotics to prevent these complications. However, the effectiveness and necessity of antibiotics for third-molar surgery have been debated. Antibiotics have risks and side effects, including allergic reactions and gastrointestinal issues. Overuse can also contribute to antibiotic resistance, a growing global health concern.
A recent systematic review analyzed 16 studies to determine the effectiveness of antibiotics in preventing complications after third-molar extractions. The main question was whether antibiotic prescription reduces postoperative complications, including infections and dry socket, in healthy patients.
The review included randomized controlled trials (RCTs), which compared antibiotics with placebos or no treatment. Several antibiotics were examined, including amoxicillin, amoxicillin–clavulanic acid, metronidazole, and clindamycin.
The results showed antibiotics significantly reduced infection risks. Among the antibiotics evaluated, amoxicillin combined with clavulanic acid was particularly effective. Studies indicated that using amoxicillin–clavulanic acid reduced the
risk of surgical-site infections notably more than placebo treatments.
Another effective antibiotic identified was metronidazole, especially for infection prevention. Patients treated with metronidazole experienced about a 49% reduction in infection risk compared to placebo groups. However, nitroimidazoles, a class of antibiotics including metronidazole, showed a higher dry socket rate compared to penicillin-based antibiotics.
Amoxicillin alone also provided benefits, reducing infections by about 44% compared to placebo treatments. However, amoxicillin–clavulanic acid consistently showed superior efficacy in preventing infections.
In terms of dry socket prevention, antibiotics also showed effectiveness. For instance, preoperative antibiotics significantly reduced the incidence of dry socket compared to no treatment. The review highlighted single-dose regimens as particularly beneficial. A single preoperative oral dose of 2 grams of amoxicillin significantly reduced both infection and dry socket rates. Similarly, a single dose of 0.8 grams of penicillin V effectively decreased the occurrence of alveolar osteitis.
Despite these findings, the systematic review emphasized careful consideration of antibiotic prescription. The effectiveness of antibiotics must be balanced against potential risks, including adverse reactions and antibiotic resistance. Clinicians should consider patient-specific factors, such as overall health and the complexity of the extraction procedure, before prescribing antibiotics.
Moreover, the review suggested further research to explore non-antibiotic interventions and patient-specific factors affecting postoperative outcomes. The complexity of third-molar extractions means various factors can influence healing, such as surgical technique, patient comorbidities, and bone quality.
The conclusions of this systematic review are clear. Antibiotics, particularly amoxicillin–clavulanic acid, effectively prevent postoperative infections and dry socket after third-molar extractions. However, their routine use should be carefully evaluated. Dentists should prescribe antibiotics judiciously, considering the patientʼs individual risk profile and specific clinical circumstances. Balancing antibiotic use with the goal of minimizing resistance is crucial for optimal patient outcomes and global health.
Future studies should focus on personalized treatment plans, integrating patient-specific risks and non-antibiotic therapies. Exploring alternative methods and clarifying optimal antibiotic timing and dosage will further refine clinical practices, ensuring the safest and most effective treatment for patients undergoing third-molar surgery.
De Angelis N, Denegri L, Miron IC, Yumang C, Pesce P, Baldi D, Delucchi F, Bagnasco F, Menini M. Antibiotic Prescription for the Prevention of Postoperative Complications After Third-Molar Extractions: A Systematic Review. Dentistry Journal. 2025; 13(3):107. https://doi.org/10.3390/dj13030107
