Pre-treatment Antibiotic Prophylaxis for Dental Extractions

In healthy adults receiving extraction of non-periodontally involved teeth, the use of amoxicillin and moxifloxacin pre-operatively has been associated with decreased detection of post-extraction bacteremia, while preoperative clindamycin prophylaxis conferred no such benefit.⁶⁷ Similarly, post-operative infection rates were reduced in individuals receiving dental extraction therapy who receive antibiotic prophylaxis v. placebo. Infection rates were also associated with procedural length and complex bone removal procedures (alveolplasty, ostectomy, etc.).⁶⁸ Other investigations have not shown a benefit of prophylactic antibiotic use in a third molar extraction model.^69,70 Given the low level of conclusive evidence to suggest a benefit for the use of prophylactic antibiotic therapy prior to extractions not associated with infections in healthy patients, the routine use of antibiotics in these cases is not recommended.⁶⁴ Careful evaluation of the patient, any underlying clinical conditions, and surgical treatment rendered is necessary to optimize decision-making for antibiotic use and limit promiscuous prescribing practices.