Basic and patient-oriented research
Treatment of Delayed-Onset Infections After Impacted Lower Third Molar Extraction

https://doi.org/10.1016/j.joms.2008.01.045Get rights and content

Purpose

To describe the treatment of delayed-onset infections after lower third molar removal.

Patients and Methods

A retrospective study was made of 33 delayed-onset infections after impacted lower third molar extraction diagnosed between 2001 and 2005 in the Oral Surgery and Implantology Department of the School of Dentistry of the University of Barcelona, Spain.

Results

Antibiotic treatment was effective in 22 patients, whereas the remaining 11 needed an additional surgical procedure to resolve this postoperative complication. Patients with prolonged use of antibiotics after the onset of the infection were more likely to require surgical intervention.

Conclusions

Patients with delayed-onset infections should be treated initially with antibiotics for 7 days. If the infection does not respond favorably within that time, surgical debridement of the extraction site should be done.

Section snippets

Patients and Methods

A retrospective study was made of 33 delayed-onset infections that had occurred after impacted lower third molar extractions done between 2001 and 2005 in the Oral Surgery and Implantology Department of the School of Dentistry of the University of Barcelona, Spain. The inclusion criterion was an inflammatory swelling of the operated area accompanied by pain or the presence of suppuration that began at any time subsequent to suture removal 1 week postoperatively.

All patients had 1 lower third

Results

The mean age of the patients was 26.3 ± 8.9 years (SD). Twenty-two were females and 11 were males. The median time elapsed from extraction to the delayed-onset infection was 29 days (range, 11 to 210 days) (Fig 1). The duration of postinfection antibiotic treatment ranged from 4 to 28 days (median = 7 days) (Table 1). Twenty-two of the 33 infections resolved with antibiotics alone (Table 1). Nineteen of 22 patients were managed with a single antibiotic (amoxicillin-3, amoxicillin plus

Discussion

Several reports have established the main features of delayed-onset infections.10, 11, 12, 15 Some large sample studies report that 1.5% of lower third molar extractions develop this complication.10, 11, 15 A recent case-controlled study in our department concluded that total soft tissue coverage, a lack of distal space, and a vertical or mesioangular tilt are significant risk factors for the development of delayed-onset infections.13 Furthermore, it also identified an important relationship to

Acknowledgment

The authors thank Maria Eugenia De-Castro-Avellaner, DDS, for help in the data sampling.

References (22)

  • R. Figueiredo et al.

    Incidence and clinical features of delayed-onset infections after extraction of lower third molars

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (2005)
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      However, this antibacterial drug should be associated with another antibiotic, mainly because it has a reduced effect over gram-positive aerobic bacteria.27 The microbial sensitivity test results of this article seem to support the clinical data published in 2008, where amoxicillin/clavulanate showed disappointing success rates, with 33% of patients needing surgical debridement of the extraction site.8 The microbiology outcomes of the present study seem to support the use of clindamycin in the treatment of delayed-onset infections after lower third molar extraction.

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