Antibiotic prophylaxis and postoperative complications after tooth extraction and implant placement: A review of the literature

Objectives: To assess published evidence regarding the use of preoperative antibiotic prophylaxis among children and adults undergoing dental extraction or implant placement. Data: Research published between 12/31/97 and 6/30/07 in English. Sources: MEDLINE, PUBMED, EMBASE, EBM Reviews, and Cochrane Central Register for Controlled Trials using the following search terms linked with Boolean AND logic: prophylactic antibiotics, dentistry, tooth, third molar, extraction, implant, endosseous, prophylaxis, prophylactic, infective endocarditis, bacterial, infection, and bacteremia. Study selection: Eight randomized clinical trials and one retrospective study was found involving preoperative use of antibiotics before tooth extraction. Four additional non-randomized intervention studies among patients undergoing implant placement were found. These 13 studies comprised all of the published research found that met our inclusion criteria. Overall, this body of literature was limited and of poor quality. In general, sample sizes were small and provided insufficient statistical power to avoid type II, or false-negative errors. In some studies no comparison group was included and/or it was difficult to determine the extent to which the intervention had actually been implemented. Conclusion: With the recent improvements in the current standards of antibiotic prophylaxis in dentistry, further monitoring of antibiotic use among dental practitioners as well as continuing education for practitioners concerning the public health risks related to the over-prescription of antibiotics are needed. (C) 2007 Elsevier Ltd. All rights reserved.