Introduction

The extraction of retained third molars is one of the most frequent procedures in common practice in dental of­fices and maxillofacial surgery. Common complications of the removal of retained third molar are pain, swelling, dysphagia and trismus and relatively frequent infectious com­plications as alveolitis and surgical wound infection. However, use of an an­tibiotic prophylaxis in third molar surgical removal re­mains controversial.

Aim

To compare the use of amoxicillin (1g) vs amoxicillin and clavulanate (875/125mg) after extraction of retained third molars for prevention of infectious complications.

Patients Profile

• N=546 (233 men and 313 women.)
• Age over 18 years old
• no allergy to penicillin or drugs used in this study
• the need for surgical removal of a retained third molar and assent

Methods

• 546 patients attending for removal a retained third molar
• After extraction, patients were assigned and divided into two groups
  • Group 1 (n=257)- amoxicillin and clavulanate (875/125mg) every 8 hours for 7 days
  • Group 2 (n=289)- amoxicillin (1g) every 8 hours for 7 days
• On the sixth day, all patients were recalled for investigating the possibility of infection, presence of diarrhea and further analgesic intake
• Registered variables were:
  • Pus. Patients were asked about the presence of purulent liquid through the wound or severe halitosis.
  • Fever above 38°C after the first 48 hours
  • Pain and relief of pain with anti-inflammatories and painkillers, which indicated the possibility of clinical diagnosis of alveolitis 
  • Inflammation persistent over time that does not im­prove during the week

Results

• Amoxicillin (1g) and amoxicillin/clavulanate (875/125mg) were equally effective in preventing infec­tion after third molar extraction.
  • There were no statistical differences between the two groups, the frequency of infection was 1.4%.
• Severe pain that would not relieve with medication was reported in 2.7% of patients.
• Most of the variables studied showed higher frequency in amoxicillin (1g) patients (Group 2), except the presence of fever above 38°C after the first 48 hours and com­plaint of gastrointestinal upset

*: chi-square test

• At least, 3 of 5 previous criterion

• For this variable, the results are done in mean and SD of the number of pill taken (test: t-Student)

Conclusions

• The study demonstrated amoxicillin (1g) and amoxicillin and clavulanate (875/125mg) had similar efficacy in preventing infection after retained third molar extraction
• Amoxicillin and clavulanate (875/125mg) resulted in more sig­nificant more gastrointestinal discomfort

Reference

 Med Oral Patol Oral Cir Bucal. 2014 Nov 1;19 (6):e612-5.