Antibiotic prophylaxis may lower the risk of dry socket (DS) and surgical site infection (SSI) following lower third-molar (LM3) extraction, according to a study recently published in the Journal of Evidence-Based Dental Practice.
However, dental professionals should evaluate the need for antibiotics based on each patient's condition and medical history, the author wrote.
"Low-level evidence suggests that prophylactic antibiotics can reduce the risk of DS and SSI after LM3 surgery in healthy patients,” wrote the author, Omer Waleed Majid of the Mosul University College of Dentistry in Iraq (J Evid Based Dent Pract, February 26, 2025, 102128).
To assess the effectiveness of antibiotic prophylaxis in reducing DS and SSI after LM3 extraction, a systematic review was conducted to analyze randomized controlled trials (RCTs) from 1999 to 2021. It included healthy patients undergoing LM3 extraction, comparing oral antibiotics with placebo or no treatment. The primary outcomes were the incidence of DS, SSI, and antibiotic-related adverse reactions, Majid wrote.
As a result of the search, 16 RCTs with 2,158 patients and 2,428 LM3 were included. While individual studies found no significant differences in DS rates between groups, a pooled meta-analysis showed antibiotics significantly reduced DS risk (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.33 to 0.90; p = 0.02; I² = 0%) with a number needed to treat (NNT) of 25.
The network meta-analysis found no major differences among antibiotics, though preoperative clindamycin was ranked as the best option. Also, antibiotics significantly reduced SSI risk (OR, 0.36; 95% CI, 0.22 to 0.57; p < 0.001; I² = 4%) with an NNT of 18. Postoperative amoxicillin was ranked the most effective treatment, and adverse event rates were similar between antibiotic and control groups (OR, 1.08; 95% CI, 0.60 to 1.94; p = 0.79; I² = 63%), Majid wrote.
Nevertheless, the study had limitations. DS diagnosis varied across studies, often based on pain symptoms, leading to potential assessment bias, Majid added.
"Given that antimicrobial resistance is a significant global health threat, dentists should assess the necessity of prescribing antibiotics for each patient, considering factors such as systemic conditions and the specific risk of DS or SSI following LM3 extraction," Majid concluded.
