Do antibiotics prior to dental extractions reduce adverse post-operative outcomes?

Design: This retrospective cohort study aimed to investigate whether antibiotic prophylaxis reduced or increased post-operative complications following dental extractions.

Sample selection: The cohort included 269,003 patients. In terms of participants, this sample consisted of Veteran Affairs Dental patients, who attended for a dental extraction between 01/01/2015- 31/12/2019. The intervention and comparator was whether or not patients had received an antibiotic prescription prior to their extraction, with the primary outcome a specified post-extraction complication (oral infection, dry socket or fever within 7 days of the extraction). Data was collected on patient demographics, medical history, and details regarding the extraction.

Data analysis: Multivariable logistic regression models were used to determine the association between antibiotic prescription prior to extraction and outcomes, alongside a sensitivity analysis that excluded antibiotics prescribed by a medical provider.

Results: The cohort included 269003 patients, who attended 385,880 dental visits. During 122,810 visits (31.8%), patients received antibiotics prior to extraction, with amoxicillin the most frequently prescribed. Antibiotics were more commonly prescribed in those who received a surgical extraction. In total, 3387 patients experienced a complication. Of these patients, 1272 had received antibiotics, compared with 2115 who had not. The regression analysis determined that diabetes was a statistically significant modifier of an association. For patients without diabetes, receiving antibiotics increased the odds of a post-extraction complication.

Conclusions: In this sample of older people, there was no association between being prescribed antibiotics and post-extraction complications.