Effect of Antibiotic Premedication on Postoperative Complications Following Dental Extractions

The efficacy of antibiotic premedication prior to tooth extraction for the prevention of postoperative complications has long been debated. Multiple studies have reviewed the literature, which includes but is not limited to Cochrane reviews, Medline searches, and formal professional society recommendations for antibiotic prophylaxis, such as those from the American Heart Association, the American Academy of Orthopedic Surgeons, and the American Dental Society. This article utilized the extensive database stored in the Veterans Health Administration (VHA) Corporate Data Warehouse to draw upon for the analysis. This is a national, real-time data repository that stores both clinical and administrative data from several VHA systems.

The cohort consisted of patients undergoing tooth extractions (excluding third molars) from 2015 to 2019. This retrospective cohort study looked at postextraction complications occurring within the first 7 postsurgical days and the association between the occurrence and the presence or absence of prophylactic antibiotic use. Prophylactic antibiotics were prescribed and either mailed or dispensed to the patient prior to or on the date of the extraction.

Outcomes

Prophylactic antibiotics were given at approximately one-third of the 385,880 visits. The overall postoperative complication rate was low (<1%), which is in line with that published in other studies. A multivariate analysis was performed to evaluate not only the percentage of postoperative complications but also to include the systemic disease variables in this population. None of these variables, including those known to cause immunosuppression, were found to be a significant predictor of postextraction complications. Diabetes was included, as it is significantly higher in the veteran population; however, surprisingly, the results showed that patients with diabetes who received a prophylactic antibiotic were more likely to have a postoperative complication than those who were not given a prophylactic antibiotic. In the larger cohort, antibiotic prophylaxis was not shown to be associated with a lower risk of postoperative infection or dry socket (two of the most common postoperative complications).

Direct evidence for the use of prophylactic antibiotics prior to tooth extraction and other invasive dental procedures for the prevention of postoperative complications, including but not limited to surgical site infection and prosthetic joint/cardiac valve infection, has always been elusive. This is due to the low incidence of these complications and the lack of randomized controlled trials. The rationale for the use of prophylactic antibiotics has often been attributed to the morbidity and mortality incurred when these rare events happen. Studies such as this one help support evidence against the widespread use of antibiotics solely for prophylactic purposes, as it is not effective for the intended purpose. This is important to promote better antibiotic stewardship and decrease the promotion of antibiotic resistance.