I was pleased to see this article in the JOMS looking at post-op antibiotic use for third molar treatment on a meaningful group of patients. (J Oral Maxillofac Surg 76:700-708, 2018) There is a big push by national and world medical authorities to try to get clinicians to prescribe less or no antibiotics for routine procedures such as the removal of third molars/wisdom teeth. The problem is that the mouth is a naturally dirty place and the gingival pockets of the teeth are particularly dirty (they contain many and varied microorganisms/germs). When we make an incision in these areas it contaminates the wound/surgical site.

Now technically, our bodies have multiple natural defenses and natural immunity which, in most cases, effectively fight off these infections and in the majority of patients you would not have a problem with infective complications. What is at issue is that even though the incidence of problems such as infection would be low with no antibiotics – there is a cost, inconvenience, and possible sequale such as pain, and need for additional treatment such as surgical drainage – which makes the antibiotic usage a reasonable “risk” after such treatment. Frankly, my patient population are generally intolerant of complications and expect me to do everything reasonably possible to give them the best, least complicated, experience.

Because of this, I use postoperative antibiotic treatment for most of my procedures. The last point would be “how much is enough?”. I have found that a minimal dose of 4 days of penicillin 500 mg qid is effective. We will often use a one week course of Amoxicillin 875 mg bid in cases where we feel the risk may be greater. Appropriate substitutes are used for allergies and of course more broad spectrum antibiotics are considered when there is a more serious infection suspected or diagnosed.