Should we use antibiotics to prevent complications from the removal of third molars?


The use of antibiotics to prevent complications from the removal of third molars is a cause of debate. The aim of this review was to assess the efficacy of antibiotics in preventing infectious complications after third molar surgery

What did they do

The Medline Embase, ,and Cochrane databases were searched together with the references in retrieved reports and review articles.  Only randomised controlled trials (RCTs) that compared antibiotic prophylaxis with placebo or no treatment in preventing infection or inflammation in patients undergoing surgical removal of the lower third molar were included. Only studies written in English were included. Studies were independently assessed for quality by two authors using the Delphi List and Jadad Scale.

What did they find

27 studies met their inclusion criteria, 15 were judged to be of ‘low-quality’ and 8 of ‘high-quality’ and a qualitative summary of the findings presented because of differences in treatment approaches and study designs.

They concluded

There is limited evidence supporting the efficacy of commonly used antibiotics in preventing complications after lower third molar removal. Well designed and well reported high-quality randomized trials considering known risk factors and taking clinical outcomes into account are needed to reach final consensus on the efficacy of antibiotic prophylaxis to allow evidence-based recommendations.

Antibiotic prophylaxis in third molar surgery: a review Marjolijn A. E. Oomens, MD, and Tymour Forouzanfar, MD, DDS, PhD.  Oral Surg Oral Med Oral Pathol Oral Radiol. Article in press


While three major databases were searched for this review restricting inclusions to English only studies could have resulted in some trials being missed.  The use of scales and checklists to assess study quality  can be problematic as many contain items that are not directly related to internal validity and the Cochrane Collaboration now recommends a domain based evaluation. The authors note a previous systematic review by Ren et al 2007 . That review included 16 RCTs and did include a meta-analysis, Interestingly a number of the studies included in the Ren review were not included in this new review, although their search strategy was not restricted to English only studies.

Ren concluded

 Systemic antibiotics given before the surgery were effective in reducing the frequencies of alveolar osteitis and wound infection after third molar surgery.

So while this new review includes 5 studies published since Ren’s review the authors only consider 2 of them to be of high quality and there remains the possibility that there could additional non-English studies available. This would suggest that a more exhaustive systematic review may be helpful prior to more high quality trials.

Ren YF, Malmstrom HS. Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials. J Oral Maxillofac Surg 2007;65:1909-21.





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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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