Department of Oral & Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, India.
Department of Oral & Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, India.
J Evid Based Dent Pract. 2017 Sep;17(3):184-189. doi: 10.1016/j.jebdp.2017.04.007. Epub 2017 Apr 27.
The aim of this randomized double-blind controlled trial was to evaluate the role of antibiotics in the perioperative period of dental extractions in healthy patients.
The study population included patients visiting the outpatient department of our institute. Four hundred patients were selected and randomly divided into 4 groups and underwent routine dental extraction. In group A, patients were prescribed only anti-inflammatory drugs in the postoperative period. In group B, patients were prescribed antibiotics for 3 days and concomitant anti-inflammatory drugs in the postoperative period only. In group C, patients were prescribed a single dose of antibiotic 1 hour before the extraction procedure with no postoperative antibiotics, and only anti-inflammatory drugs were prescribed in the postoperative period. In group D, patients were prescribed mouthwash starting 15 minutes before the procedure and continuing twice daily for a period of 7 days along with anti-inflammatory drugs in the postoperative period. Patients were asked to follow up on the seventh postoperative day for suture removal and were evaluated for pain, swelling, dry socket, and local signs of infection. The study was approved by the Internal Ethics Review Committee of the institute.
No significant differences were seen among the groups with respect to pain (χ [1, N = 171] = 4.939, P = .552), swelling (χ [1, N = 171] = 10.048, P = .347), or postextraction complications.
Prophylactic antibiotics are not required during routine dental extractions in healthy patients. The use of antibiotic therapy without appropriate indications can result in the development of resistant organisms. However, a clear trend is seen in which practitioners overprescribe antibiotics as well as medications in general. The current evidence questions the benefits of prophylactic antibiotic therapy for patients undergoing dental extractions. In our opinion, there is no justification for routine antibiotic prophylaxis for dental extractions in healthy patients.
本随机双盲对照试验旨在评估健康患者拔牙围手术期使用抗生素的作用。
研究对象为我院门诊患者。共纳入 400 例患者，随机分为 4 组，行常规拔牙术。A 组患者术后仅予抗炎药；B 组患者术后予抗生素 3 天，同时予抗炎药；C 组患者术前 1 小时予单次剂量抗生素，术后不用抗生素，仅予抗炎药；D 组患者术前 15 分钟开始用漱口液，每日 2 次，连用 7 天，同时术后予抗炎药。术后第 7 天患者复诊拆线，评估疼痛、肿胀、干槽症和局部感染征象。本研究经机构内部伦理审查委员会批准。
4 组患者疼痛（χ[1，N=171]=4.939，P=0.552）、肿胀（χ[1，N=171]=10.048，P=0.347）或拔牙后并发症无显著差异。
健康患者行常规拔牙术时无需预防性使用抗生素。在无适当适应证的情况下使用抗生素治疗会导致耐药菌的产生。然而，目前确实存在一种趋势，即医生过度开具抗生素及一般药物。现有证据对接受拔牙术的患者预防性使用抗生素治疗的获益提出质疑。我们认为，健康患者常规拔牙术无预防用抗生素的指征。
