Impacted mandibular third molars:

Introduction: There are dissenting opinions regarding the efficacy of prophylactic antimicrobial agents in third molar surgery. Objective: To determine: 1) The efficacy of a prophylactic antibiotic regimen compared with a chlorhexidine mouthwash in reducing postoperative infections in mandibular third molar surgery. 2) The pattern of presentation and the indications for extraction of mandibular third molars. Design: 100 surgical patients were randomly assigned to two groups (group 1: 15 ml of chlorhexidine rinse for one minute preoperatively. group 2: 2g amoxicillin orally one hour preoperatively). Methods: Postoperative complications and surgical site infections were assessed seven days postoperatively. The patients’ age, gender, type of impaction and indications for extraction were also recorded. Data was analyzed using the statistical package STATA 13.1. results: The infection rate was 8% and 6% for groups 1 and 2 respectively. No statistically significant difference in surgical wound infection was found between the two groups. Mesioangular impaction was the most common type of impaction, and pericoronitis was the most prevalent indication for extraction. conclusion: Amoxicillin and chlorhexidine prophylaxis are equally effective in reducing postoperative infections in third molar surgery. Hence, antibiotic prophylaxis is not indicated for routine administration in non-immunocompromised patients for such procedures. INTrODUCTION Removal of impacted teeth is a very common surgical procedure performed by Oral and Maxillofacial Surgeons as well as general dentists in the South African Public Health sector.1 Owing to the complexity of this surgical procedure, extensive skills and training are required in order to reduce the risk of complications that may arise during or after surgery.1 In addition, adequate knowledge regarding the diagnostic and treatment modalities is essential in order to achieve optimum results for the patients. Complications associated with third molar surgery can be classified as either infection or non-infection related.2 Non-infection related complications usually feature pain, swelling and erythema due to the normal inflammatory process following surgical trauma, while complications that occur with infection include alveolar osteitis, osteomyelitis, lymphadenopathy (localized/generalized) and fascial space involvement.2 Traditionally, antibiotic therapy has been used to reduce bacterial contamination and subsequent infection at the surgical site. A plethora of studies exists in the literature regarding the efficacy of antibiotic therapy in reducing postoperative infection in third molar surgery.3,4 Other studies have however demonstrated that prophylactic antibiotics may not be of any value in reducing the incidence of infection.5-9 The absence of broad-based consensus on the efficacy of antibiotic prophylaxis in third molar surgery has resulted in the proliferation of haphazard and unsystematic prescribing of antibiotics among dental practitioners; despite the low risk of complication associated with this surgery. 1. Pooshan Gopee: BDS, MSc Dent (Wits). Dentist, Ermelo Provincial Hospital, Ermelo. 2. ephraim rikhotso: BDS, MDent (MFOS), FCMFOS. Head of Department, Maxillofacial and Oral Surgery, University of the Witwatersrand. corresponding author Pooshan Gopee: Ermelo Provincial Hospital, Private Bag, X9005, Ermelo, 2350. Cell: 076 470 3139. Email: [email protected] saDJ June 2017, Vol 72 no 5 p213 p218 P Gopee,1 e rikhotso2 Impacted mandibular third molars: the efficacy of prophylactic antibiotics and chlorhexidine mouthwash in preventing postoperative infections