Antibiotic prophylaxis in oral healthcare - the agreement between Swedish recommendations and evidence.

BACKGROUND: Almost all (17/20) Swedish counties have pharmaceutical committees that establish recommendations for the use of antibiotic prophylaxis in oral healthcare.Objective To evaluate the evidence for the use of antibiotic prophylaxis in oral healthcare and the agreement between Swedish recommendations and evidence. MATERIAL AND METHODS: We conducted a systematic literature search in PubMed and the Cochrane Controlled Trials Register. The MeSH terms 'antibiotic prophylaxis' and 'dentistry' were used in the database search. Abstracts were reviewed according to specific inclusion and exclusion criteria. A total of 186 articles were read in full text by the four authors independently. Data extraction and interpretation of data was carried out using a pre-defined protocol. In the end, one case-control study was included for evaluation of evidence. RESULTS: The case-control study included patients with specific cardiac conditions. The study reported a 49% protective efficacy (odds ratio: 0.51) of antibiotic prophylaxis for first-time episodes of endocarditis within 30 days of procedure. This result was not statistically significant. The quality of the evidence was low. No studies were evaluated on patients with other medical conditions. The recommendations included several cardiac and other medical conditions for which there is a lack of evidence or no evidence to support the use of antibiotic prophylaxis. CONCLUSIONS: There is a lack of evidence to support the use of antibiotic prophylaxis. To avoid the risk of adverse events from antibiotics and the risk of developing resistant bacterial strains, the use of antibiotic prophylaxis should be minimised and recommendations in Sweden should be revised to be more evidence-based.

Dentists' decisions on prophylactic removal of mandibular third molars: a 10-year follow-up study.

OBJECTIVES: In recent years, several critical outcome studies concerning the prophylactic removal of mandibular third molars have been published. These would appear to motivate a more restrictive approach today as compared with 10 years ago. The aim of the present study was to examine dentists' decisions on the prophylactic removal of impacted mandibular third molars over a 10-year period. METHODS: Thirty-six cases were selected so as to represent an equal distribution of males and females, ages, angular position and degree of impaction of the molar. Twenty-six general dental practitioners (GDPs) and 10 oral surgeons judged the same cases on two occasions 10 years apart. RESULTS: Calculated for each category of dentists, there was no significant difference in the mean number of molars designated for removal between the two occasions. Two GDPs and three oral surgeons presented a higher removal rate, whereas five GDPs presented a lower removal rate on the second occasion as compared to the first one. The dentists presented a considerable interindividual variation in removal rate, between 0 and 22 molars on the first occasion and between 0 and 25 molars on the second occasion. CONCLUSION: In the decisions on prophylactic removal of mandibular third molars, there has been no change over the last 10 years towards a more noninterventionist attitude. Thus, the dentists seem not to have been influenced by the evidence that this intervention is not cost-effective.

Mandibular third molars: oral surgeons' assessment of the indications for removal.

The aim was to examine oral surgeons' assessment of the indications for removal of mandibular third molars. Questionnaires were distributed to seven oral and maxillofacial surgery clinics. The oral surgeons were asked to record whether or not there was associated disease. Three other factors were recorded: patient's age, and angular position and extent of eruption of the molars. The strength of the indication for removal was rated on a visual analogue scale (VAS) where 0= weakest and 100= strongest indication for removal. The results were based on data from 666 molars: 118 (18%) had no disease, 465 (70%) had one associated disease, 77 (11%) had two and 6 (1%) had three. The indication for removal as expressed by the mean VAS for molars with no disease was assessed to be weaker (P<0.05) than that for molars with one, two, or three diseases. The only factor that influenced the indication for removal in molars with no disease was the patient's age.