A comparison of the effect of phenoxymethylpenicillin and azidocillin on postoperative complications after surgical removal of impacted mandibular third molars.

Postoperative complications after surgical removal of mandibular third molars are still a clinical problem. Sixty patients undergoing operations for removal of an impacted third mandibular molar, were included in a double blind study. Phenoxymethylpenicillin 800 mg, azidocillin 750 mg, or placebo were given to the patients pre-operatively and then twice per day for the following seven days. The concentrations of phenoxymethylpenicillin and azidocillin in serum and alveolar serum were measured and the postoperative courses - pain, trismus, swelling and wound-healing - were recorded. The 40 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 20 patients in the placebo group, and there were no differences between phenoxymethylpenicillin and azidocillin. Antibiotics significantly reduced pain on day 7 postoperatively. There were no differences between antibiotic groups and placebo with respect to trismus and swelling. When the dental alveolar serum concentrations of phenoxymethylpenicillin 3.0 microgram/ml and azidocillin 7.9 microgram/ml were related to their range of inhibitory concentrations for microorganisms isolated from orofacial infections, it was noticed that the two drugs achieved levels sufficient to inhibit most strains. The effect of phenoxymethylpenicillin and azidocillin on postoperative infections can be of value after traumatic oral surgery or after operations on patients especially susceptible to infections.