Effect of the suture technique on postoperative pain, swelling and trismus after removal of lower third molars: A randomized clinical trial.

BACKGROUND: To evaluate the intensity of pain, swelling and trismus after the removal of impacted lower third molars comparing two different suture techniques of the triangular flap: the complete suture of the distal incision and relieving incision and the partial suture with only one suture knot for closure of the corner of the flap and the closure of the distal incision, without suturing the relieving incision. MATERIAL AND METHODS: A prospective, randomized, cross-over clinical trial was conducted in 40 patients aged from 18 to 45 years who underwent surgical extraction of impacted lower third molars at the Department of Oral Surgery in the Odontological Hospital of the University of Barcelona during the year 2011. Patients were randomly divided in 2 groups. Two different techniques (hermetical closure and partial closure of the wound) were performed separated by a one month washout period in each patient. Postoperative pain, swelling and trismus were evaluated prior to the surgical procedure and also at 2 and 7 days postoperatively. RESULTS: No statistically significant differences were observed for pain (p<0.06), trismus (p<0.71) and swelling (p<0.05) between the test and the control group. However, the values of the three parameters related to the test group were lower than those for the control group. CONCLUSIONS: Partial closure of the flap without suturing the relieving incision after surgical extraction of lower third molars reduces operating time and it does not produce any postoperative complications compared with complete closure of the wound.

Antibiotic prescription in the treatment of odontogenic infection by health professionals: a factor to consensus.

OBJECTIVE: To observe the attitude of dentists and family doctors in prescribing antibiotics for the treatment of dental infections. STUDY DESIGN: A poll was performed to determine the differences in the prescription of antibiotics for the treatment of odontogenic infection by dentists and family doctors of the primary care department of the Catalan Health Care Service. RESULTS: A hundred polls were distributed among family doctors, and another 100 ones among primary care dentists assigned to the Catalan Health Care Service of the Generalitat de Catalunya. Of the total of questionnaires distributed, 63 were retuned and answered from dentists and 71 from family doctors. Eighty-one percent of dentists included in the opinion poll considered amoxicillin as the first antibiotic choice for the treatment of odontogenic infections, while 73.2% of family doctors preferred the combination of amoxicillin and clavulanic acid. With regard to antibiotics of choice in patients allergic to penicillin, 67.7% of family doctors preferred macrolides (25.4% opted for clarithromycin, 25.4% for erythromycin and 16.9% for spiramycin). However, clindamycin was the antibiotic most frequently prescribed by dentists (66.7%), followed by erythromycin (28.6%). CONCLUSIONS: The results of this study show a large discrepancy in the criteria for the treatment of odontogenic infections on the part of leading professionals involved in the management of this condition. Although the most common prescription involved beta-lactam antibiotics in both groups, several significant differences have been detected with regard to the second antibiotic choice.

Antibiotic prophylaxis to prevent local infection in Oral Surgery: use or abuse?

Antibiotics have a well-documented efficacy in the treatment of established infections and as prophylactic agents in medically compromised patients. However, the systematic administration of antibiotics to prevent local infections in fit patients is much more controversial. The aim of this paper is to reflect on the justification for prophylactic usage of antibiotics to prevent wound infection and to reason out the most appropriate antibiotic guidelines taking into account available scientific data and studies by other authors. Numerous clinical trials question the efficacy of antibiotics in preventing wound infection. While some studies establish that antibiotics reduce the incidence of postoperative infections, others compare their efficacy to that of placebo. Thus, scientific literature suggests that every oral surgical intervention is not tributary of systematic antibiotic prophylaxis to prevent local infections. Intrinsic surgical risk factors and the patient's individual circumstances must be taken into account. Even though the efficacy of other antibiotics cannot be ruled out due to our limited comprehension of the bacteriologic interrelations intervening in the pathogenesis of postextraction local infection, the amoxicillin-clavulanic acid combination theoretically covers the complete odontogenic bacterial spectrum in Spain. When the prophylactic use of antibiotics is indicated, this should be performed preoperatively, at high doses, and its extent should not exceed 24 hours. Special attention should be paid to antiinfectious local measures that can minimize infection risk during the wound's healing period.

Analysis of the antibiotic prophylaxis prescribed by Spanish Oral Surgeons.

AIM: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. METHOD: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. RESULTS: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. CONCLUSIONS: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infection.

Effect of the suture technique on postoperative pain, swelling and trismus after removal of lower third molars: a randomized clinical trial

BACKGROUND: To evaluate the intensity of pain, swelling and trismus after the removal of impacted lower third molars comparing two different suture techniques of the triangular flap: the complete suture of the distal incision and relieving incision and the partial suture with only one suture knot for closure of the corner of the flap and the closure of the distal incision, without suturing the relieving incision. MATERIAL AND METHODS:A prospective, randomized, cross-over clinical trial was conducted in 40 patients aged from 18 to 45 years who underwent surgical extraction of impacted lower third molars at the Department of Oral Surgery in the Odontological Hospital of the University of Barcelona during the year 2011. Patients were randomly divided in 2 groups. Two different techniques (hermetical closure and partial closure of the wound) were performed separated by a one month washout period in each patient. Postoperative pain, swelling and trismus were evaluated prior to the surgical procedure and also at 2 and 7 days postoperatively. RESULTS: No statistically significant differences were observed for pain (p<0.06), trismus (p<0.71) and swelling (p<0.05) between the test and the control group. However, the values of the three parameters related to the test group were lower than those for the control group. CONCLUSIONS: Partial closure of the flap without suturing the relieving incision after surgical extraction of lower third molars reduces operating time and it does not produce any postoperative complications compared with complete closure of the wound

Antibiotic prescription in the treatment of odontogenic infection by health professionals: A factor to consensus

Objective: To observe the attitude of dentists and family doctors in prescribing antibiotics for the treatment of dental infections. Study Design: A poll was performed to determine the differences in the prescription of antibiotics for the treatment of odontogenic infection by dentists and family doctors of the primary care department of the Catalan Health Care Service.Results: A hundred polls were distributed among family doctors, and another 100 ones among primary care dentists assigned to the Catalan Health Care Service of the Generalitat de Catalunya. Of the total of questionnaires distributed, 63 were retuned and answered from dentists and 71 from family doctors. Eighty-one percent of dentists included in the opinion poll considered amoxicillin as the first antibiotic choice for the treatment of odontogenic infections, while 73.2% of family doctors preferred the combination of amoxicillin and clavulanic acid. With regard to antibiotics of choice in patients allergic to penicillin, 67.7% of family doctors preferred macrolides (25.4% opted for clarithromycin, 25.4% for erythromycin and 16.9% for spiramycin). However, clindamycin was the antibiotic most frequently prescribed by dentists (66.7%), followed by erythromycin (28.6%).Conclusions: The results of this study show a large discrepancy in the criteria for the treatment of odontogenic infections on the part of leading professionals involved in the management of this condition. Although the most common prescription involved beta-lactam antibiotics in both groups, several significant differences have been detected with regard to the second antibiotic choice (AU)

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Analysis of the antibiotic prophylaxis prescribed by Spanish Oral Surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedicationto Oral Surgery in different types of tooth extraction surgeries.Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 differenttooth extraction modalities scaled according to their surgical invasiveness.Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyedsurgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventionaltooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, thepercentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap waselevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis.Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participantswould prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days.Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infectionis not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drugreactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibioticsin the prevention of postsurgical wound infection (AU)

Antibiotic prophylaxis to prevent local infection in Oral Surgery: Use or abuse?

Antibiotics have a well-documented efficacy in the treatment of established infections and as prophylactic agents in medicallycompromised patients. However, the systematic administration of antibiotics to prevent local infections in fit patientsis much more controversial. The aim of this paper is to reflect on the justification for prophylactic usage of antibiotics toprevent wound infection and to reason out the most appropriate antibiotic guidelines taking into account available scientificdata and studies by other authors. Numerous clinical trials question the efficacy of antibiotics in preventing woundinfection. While some studies establish that antibiotics reduce the incidence of postoperative infections, others comparetheir efficacy to that of placebo. Thus, scientific literature suggests that every oral surgical intervention is not tributaryof systematic antibiotic prophylaxis to prevent local infections. Intrinsic surgical risk factors and the patient’s individualcircumstances must be taken into account. Even though the efficacy of other antibiotics cannot be ruled out due to ourlimited comprehension of the bacteriologic interrelations intervening in the pathogenesis of postextraction local infection,the amoxicillin-clavulanic acid combination theoretically covers the complete odontogenic bacterial spectrum in Spain.When the prophylactic use of antibiotics is indicated, this should be performed preoperatively, at high doses, and its extentshould not exceed 24 hours. Special attention should be paid to antiinfectious local measures that can minimize infectionrisk during the wound’s healing period (AU)