Single Dose Preoperative Intravenous Antibiotic versus 5 Days Postoperative Per Oral Antibiotic Therapy in Third Molar Surgery- A Randomised Clinical Trial

Abstract

Introduction: Surgical extraction of third molars is carried out in dentistry worldwide and is mostly performed under local anaesthesia on an outpatient basis. In minor oral surgery, various antibiotic regimens have been used. Antibiotic medication can be given immediately after surgery and continued for several days or as single or multiple doses several days before surgery as a preventative measure. Antibiotics can also be given prior to surgery and continued after surgery. Aim: To evaluate the effectiveness of single dose preoperative injectionamoxicillin1gmadministered1hourbeforetheprocedure, over routine 5 days postoperative peroral antibiotic therapy in decreasing the frequency of postoperative complications after third molar surgery. Materials and Methods: This randomised clinical trial was conducted at JSS Dental College and Hospital, Mysuru, Karnataka, India, during the period of August 2020 to April 2021, among 30 patients with bilaterally impacted mandibular third molars. Each subject underwent removal of impacted tooth on one side with oral amoxicillin 500 mg thrice daily for 5 days postsurgically (Group A) and that on the other side was removed after two weeks with a single dose intravenous (i.v.) 1 gram Inj. amoxicillin 1 hour preoperatively (Group B). Postoperatively each patient was evaluated on the 3rd, 7th and 14th postoperative day for variables like surgical site infection and alveolar osteitis. Oedema, erythema and Purulent Discharge (PD) were the parameters assessed to diagnose surgical site infection. Pain greater than 36 hours, Loss of Blood Clot (LOBC) and Evidence of Exposed Bone (EEB) were the parameters to diagnose alveolar osteitis. Chi-square test was used for statistical analysis. Results: Amongst 30 patients selected for this study, 14 (46.7%) were females and 16 (53.3%) were males with a mean age of 25.17±5.74 years. In 30 subjects, oedema, erythema and pain more than 36 hours were evident by the (p-value=0.559, 0.80, 0.436 respectively on 3rd day) which resolved completely by 14th postoperative day. There was no occurrence of alveolar osteitis and surgical site infection among both groups. Conclusion: Inj. amoxicillin 1 gm administered 1 hour prior surgery was found to be equally effective as compared to capsule amoxicillin 500 mg administered per orally thrice daily for 5 days. Hence, Inj. amoxicillin 1 gm an hour prior surgery was found to be a viable option.