Cochrane · intervention · CD003811
Antibiotics to prevent complications following tooth extractions
Lodi, G, Azzi, L, Varoni, EM, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
10
current version
GRADE rated
8
No studies
2
Included studies
23
as reported
No studies 2 · 20%Ungraded 0 · 0%Very low 6 · 60%Low 2 · 20%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Anyone undergoing a tooth extraction, including extraction of impacted teeth | The 23 included studies randomised more than 3206 participants (2583 analysed); 21 of 23 studies were of third-molar extraction, one of routine intra-alveolar extraction, and one of complex oral surgery; all but one enrolled healthy patients |
| Intervention | Any regimen of systemic antibiotic prophylaxis (i.e. prescribed in the absence of infection) administered before or after tooth extraction. Topical antibiotic therapy was not included | Amoxicillin (n=7); Amoxicillin/clavulanate (n=3); Amoxicillin and metronidazole (n=1); Azidocillin (n=2); Clindamycin (n=3); Doxycycline (n=1); Erythromycin (n=1); Metronidazole (n=6); Penicillin (n=2); Phenoxymethylpenicillin (n=1); Tinidazole (n=2) |
| Comparison | Placebo | Placebo (n=23) |
| Outcomes | Postsurgical complications of putative infectious nature: alveolar osteitis (dry socket), pain, fever, swelling, trismus; Other postsurgical complications; Any adverse effect related to antibiotics | Postsurgical infectious complications (n=12); Dry socket (n=13); Pain dichotomous 6th-7th day (n=3); Pain score VAS 7th day (n=4); Fever 6th-7th day (n=4); Swelling 7th day (n=4); Trismus 7th day (n=3); Adverse effects (n=8) |
| Study designs | Randomised controlled trials with a double-blind design (participants and assessors); cross-over studies included provided the washout period was at least six weeks | Randomised double-blind placebo-controlled trials (n=23); 16 at high, 4 at unclear, 3 at low risk of bias; 19 provided usable data |
| Timing | Not specified | Follow-up periods varied from 2 days to 8 weeks, with most studies following participants for 7 days |
Search date: 2020-04. Databases: Cochrane Oral Health Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; LILACS BIREME Virtual Health Library; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP)
Questions and results
Show all 3 versionsSystemic antibiotic prophylaxis (any regimen; topical therapy excluded) administered before and/or after tooth extraction vs Placebo
Population: People undergoing tooth extraction (21 of 23 trials: healthy patients undergoing impacted third molar extraction; 1 routine intra-alveolar extraction; 1 complex oral surgery)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postsurgical infectious complications 1st to 14th day | RR 0.34 [0.19, 0.64] -55 [-68, -30] per 1000 (fewer) | 12 studies · 1728 participants | Low Downgraded: risk of bias, indirectness |
Pain (continuous, VAS 0-10 cm, 7th day) 6th to 7th day | MD -0.26 [-0.59, 0.07] | 4 studies · 422 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dry socket 1st to 7th day | RR 0.66 [0.45, 0.97] -22 [-35, -2] per 1000 (fewer) | 13 studies · 1882 participants | Low Downgraded: risk of bias, indirectness |
Swelling (7th day) 7th day | RR 0.80 [0.50, 1.27] | 4 studies · 452 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Presence of pain (dichotomous, yes/no on 6th-7th day) 6th to 7th day | RR 0.59 [0.31, 1.12] -51 [-87, 15] per 1000 | 3 studies · 675 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Adverse effects 1st to 7th day | RR 1.46 [0.81, 2.64] 32 [-13, 113] per 1000 (more) | 8 studies · 1277 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Trismus (dichotomous, 7th day) 7th day | RR 0.77 [0.42, 1.41] | 3 studies · 199 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Fever (6th-7th day) 6th to 7th day | RR 0.66 [0.24, 1.79] -14 [-31, 32] per 1000 | 4 studies · 475 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Systemic antibiotic prophylaxis (any regimen; topical therapy excluded) administered before and/or after tooth extraction vs Placebo
Population: Immunosuppressed / immunocompromised patients (e.g. HIV infection, AIDS, diabetes, transplants) undergoing tooth extraction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No studies: none of the 23 included trials evaluated tooth extraction in immunocompromised patients; subgroup analysis based on immune status was not possible as no such studies were identified. | 0 studies | No studies |
Systemic antibiotic prophylaxis (any regimen; topical therapy excluded) administered before and/or after tooth extraction vs Placebo
Population: Patients undergoing tooth extraction for severe dental caries or periodontal disease in general dental practice (non-third-molar / decayed teeth)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No studies in general dental practice for removal of decayed teeth. PUB3 added one routine intra-alveolar extraction trial and one complex oral surgery trial (2 of 23 non-third-molar), but the single intra-alveolar… | 0 studies | No studies |