Correlation of antibiotic prophylaxis and difficulty of extraction with postoperative inflammatory complications in the lower third molar surgery

Published:September 11, 2013DOI:


      Our aim was to investigate the correlation among antibiotic prophylaxis, difficulty of extraction, and postoperative complications in the removal of lower 3rd molars. A total of 1222 such extractions in 890 patients between January 2010 and January 2012 were analysed retrospectively. The difficulty of extraction measured by Pederson's index, antibiotic prophylaxis with cefditoren, and postoperative complications were recorded. The difficulty of extraction was significantly associated with postoperative complications (p = 0.03). There were no significant associations between antibiotic prophylaxis and postoperative complications in groups of equal difficulty (“easy” group (class I) p = 1.00; “moderate” group (class II) p = 1.00; and “difficult” group (class III) p = 0.65). There was a small but insignificant increase in the number of dry sockets and infections in class III cases. In conclusion, this study provides further evidence that antibiotic prophylaxis for the prevention of postoperative inflammatory complications is unnecessary for extraction of 3rd molars.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pedersen A.
        Interrelation of complaints after removal of impacted mandibular third molars.
        Int J Oral Surg. 1985; 14: 241-244
        • Boffano P.
        • Ferretti F.
        • Giunta G.
        • et al.
        Surgical removal of a third molar at risk for mandibular pathologic fracture: case report and clinical considerations.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114: e1-e4
        • Leung Y.Y.
        • Cheung L.K.
        Risk factors of neurosensory deficits in lower third molar surgery: an literature review of prospective studies.
        Int J Oral Maxillofac Surg. 2011; 40: 1-10
        • Alerany C.
        • Campany D.
        • Monterde J.
        • et al.
        Impact of local guidelines and an integrated dispensing system on antibiotic prophylaxis quality in a surgical centre.
        J Hosp Infect. 2005; 60: 111-117
        • Hawkey P.M.
        • Patel B.C.
        • Trees A.J.
        UK antimicrobial resistance strategy must be set in a wider context.
        BMJ. 2013; 346: f2999
        • Poeschl P.W.
        • Eckel D.
        • Poeschl E.
        Postoperative prophylactic antibiotic treatment in third molar surgery – a necessity?.
        J Oral Maxillofac Surg. 2004; 62: 3-9
        • Ataoğlu H.
        • Oz G.Y.
        • Candirli C.
        • et al.
        Routine antibiotic prophylaxis is not necessary during operations to remove third molars.
        Br J Oral Maxillofac Surg. 2008; 46: 133-135
        • Oikarinen K.
        Postoperative pain after mandibular third-molar surgery.
        Acta Odontol Scand. 1991; 49: 7-13
        • Garcia Garcia A.
        • Gude Sampedro F.
        • Gandara Rey J.
        • et al.
        Trismus and pain after removal of impacted lower third molars.
        J Oral Maxillofac Surg. 1997; 55: 1223-1226
        • Yuasa H.
        • Kawai T.
        • Sugiura M.
        Classification of surgical difficulty in extracting impacted third molars.
        Br J Oral Maxillofac Surg. 2002; 40: 26-31
        • Pederson G.W.
        Oral surgery.
        Saunders, Philadelphia1988
        • Bergdahl M.
        • Hedstrom L.
        Metronidazole for the prevention of dry socket after removal of partially impacted mandibular third molar: a randomised controlled trial.
        Br J Oral Maxillofac Surg. 2004; 42: 555-558
        • Rajasuo A.
        • Perkki K.
        • Nyfors S.
        • et al.
        Bacteremia following surgical dental extraction with an emphasis on anaerobic strains.
        J Dent Res. 2004; 83: 170-174
        • Sekhar C.H.
        • Narayanan V.
        • Baig M.F.
        Role of antimicrobials in third molar surgery: prospective, double blind, randomized, placebo-controlled clinical study.
        Br J Oral Maxillofac Surg. 2001; 39: 134-137
        • Kaczmarzyk T.
        • Wichlinski J.
        • Stypulkowska J.
        • et al.
        Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery.
        Int J Oral Maxillofac Surg. 2007; 36: 417-422
        • Siddiqi A.
        • Morkel J.A.
        • Zafar S.
        Antibiotic prophylaxis in third molar surgery: a randomized double-blind placebo-controlled clinical trial using split-mouth technique.
        Int J Oral Maxillofac Surg. 2010; 39: 107-114
        • Arteagoitia I.
        • Diez A.
        • Barbier L.
        • et al.
        Efficacy of amoxicillin/clavulanic acid in preventing infectious and inflammatory complications following impacted mandibular third molar extraction.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2005; 100: e11-e18
        • Lopez-Cedrun J.L.
        • Pijoan J.I.
        • Fernandez S.
        • et al.
        Efficacy of amoxicillin treatment in preventing postoperative complications in patients undergoing third molar surgery: a prospective, randomized, double-blind controlled study.
        J Oral Maxillofac Surg. 2011; 69: e5-e14
        • Berge T.I.
        • Gilhuus-Moe O.T.
        Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon.
        Acta Odontol Scand. 1993; 51: 389-397
        • Clauser C.
        • Barone R.
        Effect of incision and flap reflection on postoperative pain after the removal of partially impacted mandibular third molars.
        Quintessence Int. 1994; 25: 845-849
        • Yuasa H.
        • Sugiura M.
        Clinical postoperative findings after removal of impacted mandibular third molars: prediction of postoperative facial swelling and pain based on preoperative variables.
        Br J Oral Maxillofac Surg. 2004; 42: 209-214
        • Lago-Mendez L.
        • Diniz-Freitas M.
        • Senra-Rivera C.
        • et al.
        Relationships between surgical difficulty and postoperative pain in lower third molar extractions.
        J Oral Maxillofac Surg. 2007; 65: 979-983
        • Seymour R.A.
        • Meechan J.G.
        • Blair G.S.
        An investigation into post-operative pain after third molar surgery under local analgesia.
        Br J Oral Maxillofac Surg. 1985; 23: 410-418
        • Meechan J.G.
        • Seymour R.A.
        The use of third molar surgery in clinical pharmacology.
        Br J Oral Maxillofac Surg. 1993; 31: 360-365