The role of antibiotics in preventing infection and its complications in dental surgical procedures

Background: This project was developed, based upon anecdotal evidence of a wide variety of practices for antibiotic prescribing around dental procedures which include route of administration of antibiotics, timing of the course prescribed when invasive procedures are planned, (before, after or both), length of course prescribed, narrow vs. broad spectrum agents prescribed, use of single or combination of antibiotics and the use of loading doses. The aim of the study was to ascertain if there is scientific evidence to support whether AB use can effectively reduce the postoperative infections after third molar (M3) extraction and dental implant placements (DIP). Method: This study utilised two main designs systematic review and meta analysis and a survey of dentists’ practice opinions. Following PRISMA-P© methodology, two systematic reviews of randomised controlled clinical trials were designed and registered on the PROSPERO© database. Searches were performed using PubMed©, Science Direct™ and the Cochrane© Database, plus the bibliographies of studies identified. The efficacy of prophylactic antibiotic, independent of regimen used, versus a placebo, control or no therapy, on outcomes in post M3 extraction, implant failure due to infection was the primary measured outcomes. Secondary outcomes: other post-surgical complications due to infection and AB adverse events. To provide additional insight and context, the results were compared with data from a survey of practising dental professionals conducted to determine their actual practice and opinions relating to antibiotic use, in the UK across a range of practice settings. Results: In the M3 extraction meta analysis, 16 RCTs were identified and analysed. Antibiotic use was reported to be statistically significant in preventing infection (p <001). Prevention of complications such as dry sockets was not statistically significant (p=0.34) and the NNT was larger than 5 (17 and 97 respectively) which indicates that the intervention not sufficiently effective to justify its use. In the DIP meta analysis, 12 RCTs were identified and analysed. Antibiotic use was reported to be statistically significant in preventing infection (p <001). Prevention of complications was not statistically significant (p=0.96) and the NNT was larger than 5 (14 and 2523 respectively) which indicates that the intervention not sufficiently effective to justify its use. The occurrence of side effects was not statistically significant in M3 extraction (p=0.88) or DIP (p=0.63). NNH was 55 for M3 extraction and 528 for DIP which indicate that the possible harm caused by the use of ABs exists, but it is very small and does not negate the ABs use when required. Finally, 145 general and specialist practicing dentists from different practice settings responded to the opinion survey. There were 42% of participants (n=61) who discouraged AB prophylactic use in M3 extractions in people with no systemic conditions who also preferred postoperative AB use when required. Where, 57.9%) of respondents (n=84) supported the short-term use of ABs (5-7 days) for M3 extraction and 53% (n=77) in DIP placement in patients with no relevant medical history. As an ad hoc finding, dentists reported on the negative impact of heavy smoking and oral parafunctional behaviour on DIP success. Conclusion: This novel combination of methods allowed for more informed conclusions and recommendations. Based on the calculated NNT, the use of prophylactic antibiotics to prevent infection in M3 extraction and DIP intervention was found to be not sufficiently effective to justify its use in patients without underlying medical conditions, which agrees with the fourth European Association for Osseointegration Consensus 2015. Clear clinical assessment pathways such as those used for medical conditions, based on the patients’ dental risk factors (e.g., oral health and bone health), physical risk factors (e.g., chronic or long-term conditions), other health determinants (e.g., smoking, high alcohol consumption) and demographics (e.g., age) are required to prevent unnecessary use of antibiotics. Future research comparing patients with and without underlying medical conditions are required, however a standardised dental infection clinical trials design and protocol are required to improve the quality of research and to unify reporting to allow better future systematic reviews.

Citation

Torof, E. (2023) The role of antibiotics in preventing infection and its complications in dental surgical procedures. University of Wolverhampton. http://hdl.handle.net/2436/625269

Publisher

University of Wolverhampton

URI

http://hdl.handle.net/2436/625269

Type

Thesis or dissertation

Language

en

Description

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.

Rights

Attribution-NonCommercial-NoDerivatives 4.0 International

cbn

Collections

Theses and Dissertations