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Question
I spent some time as an Oral Maxillo-facial Surgeon's Assistant in the USAF.  While practicing I noted a high instance of post-operative infection, especially as expected in tissue and bony-impacted Mandibular 3rd molars.  Is it standard practice to issue oral antibiotics as a preventative measure against post-op infections in these indicated cases?  What has your expertise taught you about this practice?  What are the possible alternatives to the widespread use of antibiotics?  What are the alternatives to extraction of bony/tissue impacted, painful wisdom teeth?

Answer
Dennis -  I personally believe and was always taught that the use of a prophylactic antibiotic after the extraction of especially lower wisdom teeth is important.  The main reason is that these extractions produce some bleeding and even though the gum tissue is closed with sutures, there is often a small hematoma, blood collection, in the tissues.  This collection that is usually also exposed to some saliva, that always contains bacteria, is more prone to developing an infection.  For that reason alone, antibiotics with wisdom tooth extractions is an appropriate treatment after wisdom tooth extractions.  

As an alternative, the use of warm salt water rinses after the extractions to help drain any contained blood and bacteria could help.  The problem with this is that no warm salt water rinses should begin for 48 hours after the extractions.  Those 48 hours is enough for an infection to develop.  So in my opinion, antibiotics are appropriate.

Alternatives to not extracting the wisdom teeth depends on the anatomy of the area around the teeth.  If painful - extract!!  If infected - extract.  If no symptoms and the position of the tooth appears as a possible future problem, then extract to prevent future problems.  If the position of the wisdom tooth is good and no evidence of potential future problems and there is not crowding in the area -leave the tooth alone.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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