Dentaltown June 2017 - 40

message board

Antibiotics After Surgical Extractions
A Townie asks his peers for input about what, if anything, to prescribe

breezy11
Member Since: 07/04/14
Post: 1 of 123

I know many dentists (myself included) will prescribe antibiotics after any surgical extraction,
but I'm trying to figure out if it's really the best way to go or really a CYA situation. I do a ton of
surgical extractions at my office, so I'm just wondering what some of you do in cases where all
you need to do is very minor bone removal. Do you prescribe antibiotics in those cases?
My approach has been that if it's an intensive surgical extraction, I'll put them on seven
days of amox or equivalent. If it's very minor surgical extraction, I'll drop it down to 3-4 days.
What's your approach? ■
2/16/2017

AtreidesDDS
Member Since: 02/11/11
Post: 4 of 123

I work in public health and have seen a lot of postop infections after surgical extractions.
I now routinely prescribe a short course of antibiotics for any case where I elevate a flap and
perform a surgical extraction. I also have the patient swish with CHX prior to beginning the
procedure. My incidence of postop infections has really improved. ■
2/16/2017

Eazy Breezy
Member Since: 03/08/09
Post: 5 of 123

I give antibiotics if it was an intensive surgical extraction and there was an abscess/PARL/
pus. If they've got really gross nastily inflamed pus/oozing/perio gums, they'll get antibiotics
as well. Otherwise just some Norco for surgical without pus/infection. And tell them OTC
for simple. ■
2/16/2017

Sun Tzu
Member Since: 01/24/12
Post: 12 of 123

One size doesn't fit all. The general rule of thumb is that removing the cause of infection is
the best thing you can do, but we also have to consider the possibility of wound contamination,
particularly in an environment such as the oral cavity.
I definitely find pre-rinsing with chlorhexidine (0.2%) for 60 seconds immediately prior to
an extraction does help. If you put stuff in sockets (e.g. Benacel), I find dipping it in chlorhexidine gel too also helps. I also think that wearing sterile gloves plays a part.
Apart from their medical status, also consider the general state of their mouth. Is it really
icky? Was the extraction particularly involving? Was it a lower wizzie which had a lot of pus?
Digging near the sinus for a while? Think about where infections can spread. ■
2/18/2017

Retimo
Member Since: 02/23/12
Post: 13 of 123

I think there's a lot of pushback against over prescribing antibiotics, especially lately in the
literature and JADA. I stick to not prescribing unless there is pus, swelling, fever or trismus. One
other time might be with a patient who has symptomatic apical perio and necrotic pulp but you
can't address that day with a pulpectomy or ext. (There was an article in JADA less than a year
ago chastising IMO dentists for giving antibiotics for irreversible pulpitis)
Although I most often don't give oral antibiotics for surgical extractions, I do usually place
resorbable hemostatic gauze generously dusted with doxycycline. There are studies that show
topical antibiotics placed in sites after third molar extraction have reduced postop complications, especially dry socket. ■
2/18/2017

JUNE 2017 // dentaltown.com

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