{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T02:15:07Z","timestamp":1780539307225,"version":"3.54.1"},"reference-count":43,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Anecdotal evidence suggested variation in practices for antibiotic prescribing around dental procedures including route of administration of antibiotics, timing of the course prescribed (before, after or both), length of course prescribed, narrow vs. broad spectrum agents prescribed, use of single or combination of antibiotics, and the use of loading doses. This review aims to investigate this disparity of practices and the absence of global and local recent consensus on the most appropriate antibiotic interventions around invasive dental procedures. Material and methods: Following PRISMA-P\u00a9 methodology, a systematic review of randomised controlled clinical trials was designed, reviewed, and entered on the PROSPERO\u00a9 website prior to commencement. Ethics approval was gained from the University of Wolverhampton Committee. Searches were performed using PubMed\u00a9, Science Direct\u2122, and the Cochrane Database, plus the bibliographies of studies identified. They investigated studies examining the efficacy and safety of any antibiotic regimen tested, independent of regimen used, versus a placebo, control, or no therapy, on outcomes in post third molar extraction. Results: The primary outcome of interest was postoperative infection and secondary outcomes were other post-surgical related complications of infectious nature and antibiotic adverse events. Sixteen RCTs were identified that met the selection criteria. Antibiotic use was reported to be safe, causing few adverse events. Meta-analysis of infection events showed antibiotics reduced the risk of an infection by 69%, but routine use for prophylaxis in uncomplicated procedures was not supported, and their role in patients with comorbidities or impaired immunity remains controversial. The effect on the incidence of dry socket showed no difference based upon regimen used. No significant benefit was found with respect to reduction of intraoral inflammation, wound dehiscence, haematoma, and lymphadenopathy. Conclusion: The effect on postoperative pain reduction was inconclusive. Routine use of antibiotics around M3 extraction procedures is not supported, but their use in the presence of co-morbidities and or immunosuppression remains controversial to be confirmed by future studies.<\/jats:p>","DOI":"10.3390\/medicina59030422","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T02:57:38Z","timestamp":1677034658000},"page":"422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The Role of Antibiotic Use in Third Molar Tooth Extractions: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"59","author":[{"given":"Elham","family":"Torof","sequence":"first","affiliation":[{"name":"School of Pharmacy, University of Wolverhampton, Wolverhampton WV1 1LY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9752-537X","authenticated-orcid":false,"given":"Hana","family":"Morrissey","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Wolverhampton, Wolverhampton WV1 1LY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8918-2119","authenticated-orcid":false,"given":"Patrick A.","family":"Ball","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Wolverhampton, Wolverhampton WV1 1LY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/j.1600-0528.1991.tb00124.x","article-title":"Prevalence of impacted teeth and associated pathology in middle-aged and older Swedish women","volume":"19","author":"Ahlqwist","year":"1991","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2147\/TCRM.S298147","article-title":"Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar","volume":"17","author":"Zhang","year":"2021","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_3","first-page":"e497","article-title":"Unerupted mandibular third molars: Symptoms, associated pathologies, and indications for removal in a Turkish population","volume":"38","author":"Orhan","year":"2007","journal-title":"Quintessence Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1016\/j.joms.2012.04.040","article-title":"What has been the United Kingdom\u2019s experience with retention of third molars?","volume":"70","author":"Renton","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1016\/j.tripleo.2009.05.036","article-title":"Assessment of the associated symptoms, pathologies, positions and angulations of bilateral occurring mandibular third molars: Is there any similarity?","volume":"108","author":"Akarslan","year":"2009","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_6","unstructured":"NICE UK (2022, January 28). Guidance on the Extraction of Wisdom Teeth. Available online: https:\/\/www.nice.org.uk\/guidance\/ta1."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e230","DOI":"10.18295\/squmj.2019.19.03.009","article-title":"Complications of Third Molar Extraction: A retrospective study from a tertiary healthcare centre in Oman","volume":"19","author":"Sayed","year":"2019","journal-title":"Sultan Qaboos Univ. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"156","DOI":"10.15171\/joddd.2017.028","article-title":"Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars: A randomized prospective study","volume":"11","author":"Mobilio","year":"2017","journal-title":"J. Dent. Res. Dent. Clin. Dent. Prospect."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Jaro\u0144, A., and Trybek, G. (2021). The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18116016"},{"key":"ref_10","first-page":"63","article-title":"Principles of Exodontia as Applied to the Impacted Mandibular Third Molar","volume":"1","author":"Pigott","year":"1928","journal-title":"Yale J. Biol. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1038\/sj.bdj.2010.581","article-title":"Experience in third molar surgery: An update","volume":"209","author":"Jerjes","year":"2010","journal-title":"Br. Dent. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/sj.bdj.4812412","article-title":"Paraesthesia of the lip and chin area resolved by endodontic treatment: A case report and review of literature","volume":"198","author":"Jerjes","year":"2005","journal-title":"Br. Dent. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5002","DOI":"10.1128\/JB.00542-10","article-title":"The human oral microbiome","volume":"192","author":"Dewhirst","year":"2010","journal-title":"J. Bacteriol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1046\/j.0902-0055.2001.00098.x","article-title":"Bacteriology and antimicrobial susceptibility of gram-positive cocci isolated from pus specimens of orofacial odontogenic infections","volume":"17","author":"Kuriyama","year":"2002","journal-title":"Oral Microbiol. Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1177\/2042098614554919","article-title":"Antimicrobial resistance: Risk associated with antibiotic overuse and initiatives to reduce the problem","volume":"5","author":"Llor","year":"2014","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.jhsa.2013.05.020","article-title":"Identifying and measuring heterogeneity across the studies in meta-analysis","volume":"38","author":"Zhao","year":"2013","journal-title":"J. Hand Surg. Am."},{"key":"ref_18","unstructured":"Higgins, J.P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2022). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3, Cochrane Collaboration."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/j.1524-475X.2004.04006.x","article-title":"A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions","volume":"1","author":"Thomas","year":"2004","journal-title":"Worldviews Evid. Based Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1128\/AAC.01550-05","article-title":"Comparative efficacies of amoxicillin, clindamycin, and moxifloxacin in prevention of bacteremia following dental extractions","volume":"50","year":"2006","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"81","DOI":"10.5005\/jp-journals-10024-2215","article-title":"Effectiveness of Antimicrobial Therapy after Extraction of Impacted Mandibular Third Molar: A Randomized Clinical Trial","volume":"19","author":"Rabi","year":"2018","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s10006-015-0521-6","article-title":"Antibiotic therapy in fully impacted lower third molar surgery: Randomized three-arm, double-blind, controlled trial","volume":"19","author":"Milani","year":"2015","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1054\/bjom.2000.0557","article-title":"Role of antimicrobials in third molar surgery: Prospective, double blind, randomized, placebo-controlled clinical study","volume":"39","author":"Sekhar","year":"2001","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ijom.2009.12.014","article-title":"Antibiotic prophylaxis in third molar surgery: A randomized double-blind placebo-controlled clinical trial using split-mouth technique","volume":"39","author":"Siddiqi","year":"2010","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e333","DOI":"10.1016\/j.joms.2011.03.055","article-title":"Prophylaxis versus placebo treatment for infective and inflammatory complications of surgical third molar removal: A split-mouth, double-blind, controlled, clinical trial with amoxicillin (500 mg)","volume":"69","author":"Bezerra","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.ijom.2006.12.003","article-title":"Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery","volume":"36","author":"Kaczmarzyk","year":"2007","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.bjoms.2015.02.001","article-title":"Efficacy of antibiotic prophylaxis on postoperative inflammatory complications in Chinese patients having impacted mandibular third molars removed: A split-mouth, double-blind, self-controlled, clinical trial","volume":"53","author":"Xue","year":"2015","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_28","first-page":"e633","article-title":"Efficacy and safety comparison of two amoxicillin administration schedules after third molar removal. A randomized, double-blind and controlled clinical trial","volume":"15","year":"2010","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.oooo.2014.08.014","article-title":"Amoxicillin\/clavulanic acid 2000\/125 mg to prevent complications due to infection following completely bone-impacted lower third molar removal: A clinical trial","volume":"119","author":"Arteagoitia","year":"2015","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/j.joms.2011.01.019","article-title":"Efficacy of amoxicillin treatment in preventing postoperative complications in patients undergoing third molar surgery: A prospective, randomized, double-blind controlled study","volume":"69","author":"Pijoan","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.oooo.2020.08.034","article-title":"Do perioperative antibiotics reduce complications of mandibular third molar removal? A double-blind randomized controlled clinical trial","volume":"131","year":"2021","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.bjoms.2006.11.005","article-title":"Routine antibiotic prophylaxis is not necessary during operations to remove third molars","volume":"46","author":"Oz","year":"2008","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0266-4356(04)00136-6","article-title":"Metronidazole for the prevention of dry socket after removal of partially impacted mandibular third molar: A randomised controlled trial","volume":"42","author":"Bergdahl","year":"2004","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1016\/j.tripleo.2005.03.025","article-title":"Efficacy of amoxicillin\/clavulanic acid in preventing infectious and inflammatory complications following impacted mandibular third molar extraction","volume":"100","author":"Arteagoitia","year":"2005","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.ijom.2006.11.007","article-title":"Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: A randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin\/clavulanic acid (1000\/62.5 mg)","volume":"36","author":"Lacasa","year":"2007","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/j.1472-8206.2004.00234.x","article-title":"Assessment of patient-reported outcomes in clinical trials: The example of health-related quality of life","volume":"18","author":"Wiklund","year":"2004","journal-title":"Fundam. Clin. Pharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/S0895-4356(01)00377-8","article-title":"Funnel plots for detecting bias in meta-analysis: Guidelines on choice of axis","volume":"54","author":"Sterne","year":"2001","journal-title":"J. Clin. Epidemiol."},{"key":"ref_38","first-page":"Cd003811","article-title":"Antibiotics to prevent complications following tooth extractions","volume":"2","author":"Lodi","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1016\/j.joms.2007.03.004","article-title":"Effectiveness of Antibiotic Prophylaxis in Third Molar Surgery: A Meta-Analysis of Randomized Controlled Clinical Trials","volume":"65","author":"Ren","year":"2007","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_40","unstructured":"FoPH, UK (2023, January 21). Numbers Needed to Treat (NNT)\u2014Calculation, Interpretation, Advantages and Disadvantages. Available online: https:\/\/www.healthknowledge.org.uk\/public-health-textbook\/research-methods\/1a-epidemiology\/nnts."},{"key":"ref_41","unstructured":"CEBM, UK (2023, January 23). Number Needed to Treat. Available online: https:\/\/www.cebm.ox.ac.uk\/resources\/ebm-tools\/number-needed-to-treat-nnt."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.oooo.2016.04.016","article-title":"Do systemic antibiotics prevent dry socket and infection after third molar extraction? A systematic review and meta-analysis","volume":"122","author":"Ramos","year":"2016","journal-title":"Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Singh Gill, A., Morrissey, H., and Rahman, A. (2018). A Systematic Review and Meta-Analysis Evaluating Antibiotic Prophylaxis in Dental Implants and Extraction Procedures. Medicina, 54.","DOI":"10.3390\/medicina54060095"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/3\/422\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:38:33Z","timestamp":1760121513000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/3\/422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["medicina59030422"],"URL":"https:\/\/doi.org\/10.3390\/medicina59030422","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]}}}