Abstract
Introduction: Antibiotic prescribing practices in dental procedures vary widely, including the type of antibiotic, route of administration, timing, and course length.
Objectives: This study aimed to determine the scientific evidence to support the use of antibiotics in reducing postoperative infections after third molar extraction (M3) and dental implant placement (DIP).
Methods: The study used two main designs: a systematic review and meta-analysis of randomised controlled clinical trials and a survey of practising dental professionals to determine their actual practice and opinions relating to antibiotic use.
Results: The results of the study showed that the use of prophylactic antibiotics was statistically significant in preventing infection in both M3 extraction (p< 0.001) and DIP (p< 0.001) procedures. However, the prevention of other complications, such as dry sockets, was not statistically significant in either procedure (M3 extraction: p= 0.34; DIP: p= 0.96), and the NNT was larger than 5 in both cases (M3 extraction: 17 and DIP: 14), which suggests that the intervention was not sufficiently effective to justify its routine use. Antibiotic adverse effects were insignificant in M3 extraction (p= 0.88) or DIP (p= 0.63) procedures. The NNH for M3 extraction was 55, while for DIP, it was 528. This suggests that while antibiotics may pose a small risk of harm, it is not significant enough to outweigh the potential benefits of using antibiotics when necessary.The survey of dental professionals revealed that 42% of respondents discouraged the prophylactic use of antibiotics in M3 extractions for patients without systemic conditions, preferring to use antibiotics postoperatively when required. However, 57.9% of respondents supported the short-term use of antibiotics (5‒7 days) in M3 extraction and 53% in DIP placement for patients without a relevant medical history. Additionally, dentists reported the negative impact of heavy smoking and oral parafunctional behaviour on DIP success. Based on the calculated NNT, using prophylactic antibiotics to prevent infection in M3 extraction and DIP interventions was insufficient to justify its routine use in patients without underlying medical conditions. This conclusion aligns with the fourth European Association for Osseointegration Consensus in 2015. The study suggests that clear clinical assessment pathways are necessary to prevent the unnecessary use of antibiotics, considering the patient's dental risk factors, physical risk factors, other health determinants, and demographics. Furthermore, future research comparing patients with and without underlying medical conditions is necessary, and a standardised dental infection clinical trial design and protocol are required to improve the quality of research and to unify reporting to allow better future systematic reviews.
Conclusions: This study recommends clear clinical assessment pathways to prevent the unnecessary use of antibiotics in dental procedures. The study provides valuable insights into the use of prophylactic antibiotics and highlights the need for evidence-based practice in this area. This study provides a more informed conclusion and recommendations by combining a systematic review, meta-analysis, and a survey of dentists' practice opinions.
Objectives: This study aimed to determine the scientific evidence to support the use of antibiotics in reducing postoperative infections after third molar extraction (M3) and dental implant placement (DIP).
Methods: The study used two main designs: a systematic review and meta-analysis of randomised controlled clinical trials and a survey of practising dental professionals to determine their actual practice and opinions relating to antibiotic use.
Results: The results of the study showed that the use of prophylactic antibiotics was statistically significant in preventing infection in both M3 extraction (p< 0.001) and DIP (p< 0.001) procedures. However, the prevention of other complications, such as dry sockets, was not statistically significant in either procedure (M3 extraction: p= 0.34; DIP: p= 0.96), and the NNT was larger than 5 in both cases (M3 extraction: 17 and DIP: 14), which suggests that the intervention was not sufficiently effective to justify its routine use. Antibiotic adverse effects were insignificant in M3 extraction (p= 0.88) or DIP (p= 0.63) procedures. The NNH for M3 extraction was 55, while for DIP, it was 528. This suggests that while antibiotics may pose a small risk of harm, it is not significant enough to outweigh the potential benefits of using antibiotics when necessary.The survey of dental professionals revealed that 42% of respondents discouraged the prophylactic use of antibiotics in M3 extractions for patients without systemic conditions, preferring to use antibiotics postoperatively when required. However, 57.9% of respondents supported the short-term use of antibiotics (5‒7 days) in M3 extraction and 53% in DIP placement for patients without a relevant medical history. Additionally, dentists reported the negative impact of heavy smoking and oral parafunctional behaviour on DIP success. Based on the calculated NNT, using prophylactic antibiotics to prevent infection in M3 extraction and DIP interventions was insufficient to justify its routine use in patients without underlying medical conditions. This conclusion aligns with the fourth European Association for Osseointegration Consensus in 2015. The study suggests that clear clinical assessment pathways are necessary to prevent the unnecessary use of antibiotics, considering the patient's dental risk factors, physical risk factors, other health determinants, and demographics. Furthermore, future research comparing patients with and without underlying medical conditions is necessary, and a standardised dental infection clinical trial design and protocol are required to improve the quality of research and to unify reporting to allow better future systematic reviews.
Conclusions: This study recommends clear clinical assessment pathways to prevent the unnecessary use of antibiotics in dental procedures. The study provides valuable insights into the use of prophylactic antibiotics and highlights the need for evidence-based practice in this area. This study provides a more informed conclusion and recommendations by combining a systematic review, meta-analysis, and a survey of dentists' practice opinions.
| Original language | English |
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| Pages | 20 |
| Number of pages | 1 |
| Publication status | Published - 2023 |
| Event | FIP Pharmacy Practice Research summer meeting 2023: for PhD students, postdoctoral fellows and supervisors - University of Granada, Granada, Spain Duration: 03 Jul 2023 → 04 Jul 2023 https://fip.eventsair.com/2023-ppr-summer-meeting/ https://pharmacyeducation.fip.org/pharmacyeducation/article/view/2435/1595 (Published abstracts) |
Other
| Other | FIP Pharmacy Practice Research summer meeting 2023 |
|---|---|
| Country/Territory | Spain |
| City | Granada |
| Period | 03/07/23 → 04/07/23 |
| Other | The FIP Pharmacy Practice Research Special Interest Group (PPR SIG), in collaboration with University of Granada, is hosting an international event — “Pharmacy practice research summer meeting for PhD students, postdoctoral fellows and supervisors” — on 3 and 4 July 2023 in Granada, Spain. The main scope of the PPR SIG is to increase pharmacy practice contributions to global health by providing greater access to the latest high-quality international pharmacy practice research. During this meeting both starting-out and experienced researchers will be able to collaborate on major PPR themes. PhD students and their supervisors, researchers, academics, professional organisations and practitioners involved in research are welcome to join this face-to-face meeting to present their work and to start building new global pharmacy networks. Accepted abstracts will be published in the Pharmacy Education journal. Selected authors will be invited to present their work either through poster or oral presentation and interact with the audience during the event. The best presentations will receive an award. Certificates of attendance and presentations will be provided. |
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