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British Journal of Oral and Maxillofacial Surgery 46 (2008) 133–135

Short communication
Routine antibiotic prophylaxis is not necessary during
operations to remove third molars
Hanife Ataoğlu ∗ , Gülsün Yildirim Öz, Celal Çandirli, Dilek Kiziloğlu
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Selçuk, Konya, Turkiye

Accepted 8 November 2006

Available online 22 December 2006

Abstract

The purpose of this study was to evaluate the efficacy of antibiotic prophylaxis during removal of impacted third molars. We studied 150
patients with impacted mandibular or maxillary third molars who were divided randomly into three groups. The first was given amoxicillin
2 g combined with clavulanic acid, orally daily for 5 days postoperatively; starting at the end of the operation. The second group was given
the same drugs but the regimen started 5 days before the operation. The third was given no antibiotics. Pain, infection, swelling, alveolar
osteitis, and interincisal mouth opening (mm) were evaluated. There were no significant differences among the groups in the incidence of
these complications. We cannot recommend routine oral antibiotic prophylaxis in third molar surgery.
© 2006 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Keywords: Impacted third molars; Antibiotic prophylaxis; Postoperative complication

Patients and methods
A total of 150 healthy patients who had taken no antibiotics
or anti-inflammatory drugs within 30 days before opera-
tion were selected for extraction of impacted maxillary or
mandibular third molars. They were divided randomly into
three groups (n = 50 in each). The first group was given
amoxicillin 1 g with clavulanic acid orally twice daily start-
ing directly after operation for 5 days. The second group
had the same regimen but starting 5 days before operation.
The third group (controls) was given no prophylaxis. Each
patient was given naproxen sodium 275 mg (Kapnax Fort,
İlsan Hexal, Turkey), and clorhexidine gluconate with ben-
zydamine hydrochloride as a mouth rinse (Andorex, Delta
Vital, Turkey) orally twice a day for 5 days starting at the end
of the operation.
∗ Corresponding author at: Selçuk Üniversitesi, Dişhekimliği Fakültesi,
Ağız, Diş, Çene Hastalıkları ve Cerrahisi Bölümü, Selçuklu- 42079,
Kampüs/Konya, Turkiye. Tel.: +90 332 223 11 55;
fax: +90 332 241 00 62.
E-mail address: hataoglu@selcuk.edu.tr (H. Ataoğlu).
All operations were done under local anaesthesia (2% arti-
caine with adrenaline 1:100000) in the same operating theatre
with the same type of instruments by two oral surgeons with
more than 2 years’ experience, and under similar conditions.
Immediately before operation all patients rinsed for 1 min
with a 0.12% clorhexidine mouthwash. The technique was
standardised. All wounds were closed primarily using 3.0
silk sutures, and no dressings or haemostatic agents were
used. The postoperative course was checked clinically on
the second and seventh days postoperatively by the surgeon
who had done the operation, and the postoperative symptoms
were scored according to the evaluation criteria. Sutures were
removed on day 7.
The following details were recorded on the second and
seventh postoperative days: swelling, infection, alveolar
osteitis scores using two grades (presence or absence), and
interincisal mouth opening (mm). Pain was evaluated for 7
days using a visual analogue scale. Maximum interincisal
distance was measured with a caliper micrometer (always by
the same person). The patient was asked to open the mouth
as wide as possible and the distance between the upper and
lower central incisors was measured.

0266-4356/$ – see front matter © 2006 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2006.11.005
134 H. Ataoğlu et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) 133–135

Table 1
Details of patients
Group Sex Mean (S.D.) Site of teeth
Women Men Age (years) Mandible Maxilla
Postoperative antibiotic 44 6 23 (5) 43 7
Preoperative antibiotic 40 10 23 (4) 41 9
Control 40 10 21 (4) 35 15

Table 2 use of antimicrobials can result in adverse outcomes, and

Mean (S.D.) maximum interincisal distance (mm) there is a general trend to overprescribe antimicrobials.6
Group Before Postoperative Postoperative The risks of indiscriminate prescribing include the develop-
operation day 2 day 7 ment of resistant organisms, secondary infection, toxicity,
Postoperative antibiotic 45 (6) 33 (9) 42 (6) and the development of allergic reactions.7 It is estimated
Preoperative antibiotic 41 (5) 33 (8) 39 (6) that 6–7% of patients who are given antibiotics have some
Control 44 (5) 35 (10) 41 (6)
kind of adverse reaction.8 The estimated rate of infection
after removal of an impacted third molar is less than 1%, so
the efficacy of such drugs is questionable.9,10
Table 3 An important point in the debate about prophylactic antibi-
Complications (n = 50 in each group)
otics is their timing. There is evidence that giving antibiotics
Complication Antibiotic Control preoperatively may reduce the incidence of postoperative
Preoperative Postoperative wound infections.11 In our study, the antibiotic was pre-
Pain (VAS 40 or more) 3 2 3 scribed postoperatively for the first group and preoperatively
Swelling that limited 3 4 3 for the second group, and there were neither clinical nor
chewing or speaking statistical differences.
Alveolar osteitis 0 1 0 There is growing concern about the misuse of antibiotics
Wound infection
Early 6 8 7
during removal of impacted third molars. We found no sig-
Late 1 1 2 nificant difference between the three groups regarding the
variables evaluated, and our results show that routine antibi-
otic prophylaxis is unwarranted for routine operations to
remove third molars in healthy patients.
Results

There were 26 men and 124 women; their details are given
in Table 1. There were 69 vertically impacted third molars
(46%), 61 mesioangular (41%), 14 horizontal (9%), 5 dis-
toangular (3%), and 1 buccolingual. Interincisal distances are
shown in Table 2.
Postoperative pain was evaluated for 7 days after extrac-
tion on a 100 mm horizontal visual analogue scale (VAS),
where the end points were marked “no pain” and “unbear-
able pain.” Extractions were considered painful when they
scored 40 or more.1,2 This score for 3 days or more during
the week after the extraction was the variable that defined
“pain.” Pain and other complications are shown in Table 3.
There were no significant differences among the groups.
Discussion
Operations to extract third molars are considered clean-
contaminated operations and we decided to test the validity
of antibiotic prophylaxis in a prospective study.3,4
Some authors think that the incidence of postoperative
infections after the removal of third molars (between 1 and
5%) is too low to justify routine antibiotics.5 The blind
Acknowledgements
This study was supported by Selcuk University Scientific
Research Fund with the project number of 05701106.
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