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

Oral Health Oral and maxillofacial surgery3 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

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

Current version only

Systemic 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)

CD003811.PUB3 (current) · 8 questions

Outcome	Effect	Evidence	Status / GRADE
Postsurgical infectious complications 1st to 14th day same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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 same question in other reviews	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

CD003811.PUB3 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	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)

CD003811.PUB3 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	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

Systemic antibiotic prophylaxis (any regimen; topical therapy excluded) administered before and/or after tooth extraction vs Placebo

Population: Patients undergoing tooth extraction (all 18 included trials: healthy patients undergoing impacted third molar/wisdom tooth extraction)

CD003811.PUB2 · 8 questions

Outcome	Effect	Evidence	Status / GRADE
Fever (6th-7th day) mean 6.5 days	RR 0.34 [0.06, 1.99] -26 [-37, 39] per 1000	4 studies · 816 participants	Low Downgraded: risk of bias, inconsistency
Trismus (dichotomous, 7th day) 7th day	RR 0.84 [0.42, 1.71]	2 studies · 175 participants	Ungraded
Swelling (7th day) 7th day	RR 0.92 [0.65, 1.30] -25 [-107, 92] per 1000	3 studies · 334 participants	Moderate Downgraded: risk of bias
Pain score (VAS 7th day; scale 1-100) mean 7 days	MD -8.17 [-11.90, -4.45]	4 studies · 372 participants	Moderate Downgraded: risk of bias
Dry socket mean 7 days	RR 0.62 [0.41, 0.95] -26 [-41, -4] per 1000 (fewer)	9 studies · 1429 participants	Moderate Downgraded: risk of bias
Pain (dichotomous, present/absent on 6th-7th day) mean 6.5 days	RR 0.60 [0.32, 1.11] -50 [-86, 14] per 1000	3 studies · 675 participants	Low Downgraded: risk of bias, inconsistency
Adverse effects mean 7 days	RR 1.98 [1.10, 3.59] 47 [5, 126] per 1000 (more)	5 studies · 930 participants	Moderate Downgraded: risk of bias
Local sign of infection mean 7 days	RR 0.29 [0.16, 0.50] -84 [-99, -59] per 1000 (fewer)	10 studies · 1523 participants	Moderate Downgraded: risk of bias

Systemic antibiotic prophylaxis (any regimen; topical therapy excluded) administered before and/or after tooth extraction vs Placebo

Population: Immunosuppressed patients (e.g. HIV infection, AIDS, diabetes, transplants) or patients with other conditions undergoing tooth extraction

CD003811.PUB2 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No studies: subgroup analysis based on the immune state of patients was not possible, as studies on immunosuppressed patients (or those with underlying conditions affecting immunity) were not identified by the searches.	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)

CD003811.PUB2 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	No studies: no trials identified evaluating antibiotic prophylaxis for extraction of teeth due to severe caries or periodontitis in general dental practice. All included trials were of impacted third molar (wisdom)…	0 studies	No studies

Any regimen of antibiotic prophylaxis (prescribed in the absence of infection) administered before or after tooth extraction vs Placebo or no treatment

Population: Anyone undergoing a tooth extraction, including extraction of impacted teeth

CD003811 · 8 questions

Outcome	Effect	Evidence	Status / GRADE
Fever	no estimate extracted	NR	No studies
Swelling	no estimate extracted	NR	No studies
Any adverse effect related to antibiotics	no estimate extracted	NR	No studies
Other post-surgical complications	no estimate extracted	NR	No studies
Pain	no estimate extracted	NR	No studies
Alveolar osteitis (dry socket)	no estimate extracted	NR	No studies
Post-surgical complications of putative infectious nature (local signs of infection)	no estimate extracted	NR	No studies
Trismus	no estimate extracted	NR	No studies

Any regimen of antibiotic prophylaxis (prescribed in the absence of infection) administered before or after tooth extraction vs Placebo or no treatment

Population: Immunosuppressed patients (e.g. HIV infection, AIDS, diabetes, transplants) or patients with other conditions (e.g. bone diseases) undergoing tooth extraction

CD003811 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	no estimate extracted	NR	No studies