Pre-op antibiotics, yay or nay?

August 19, 2010 9:37 AM

I'm getting all four of my impacted wisdom teeth out tomorrow. In a study done in 2007, one dose of pre-op antibiotics has been shown to lower infection rates by 50%, and might do more good than several days of antibiotics post-op. My oral surgeon's office apparently does not follow that practice. Is there any danger in me taking one of the doses of amoxicillin that has already been prescribed for this procedure the night before?

I'm in good health, have no drug allergies, and am on no other medication. The amoxicillin is already prescribed in my name for this specific surgery by this dentist, I would just be taking one dose pre-surgery and the rest by the schedule after. I can't think of any reason to not go ahead and pre-dose myself since my DDS apparently doesn't subscribe to that 2007 study (if they even know about it), but I want to make sure there's nothing glaring I'm missing. (I just called the dentist to check, and the person who answered the phone, possibly a nurse, said there were no instructions to take anything beforehand unless I had a heart murmur, which I don't.)

I know YANAD and all consequences are on my own head, but, logically, is there some major reason I'm missing to not go ahead and do this? 50% is a pretty big number, and I can't think of any danger in taking one dose early.

posted by wending my way to health & fitness (16 answers total)

Call your dentist. Tell them about your research. See what they say. Turning to an internet forum for something like this is ridiculous, especially when no one here knows your medical history.

Besides, amoxicillin can potentially cause bleeding issues, and that's not something you want to have during a surgical procedure.
posted by Cat Pie Hurts at 9:46 AM on August 19, 2010 [4 favorites]

Can you provide a link to this study, so that we have access to the same information you do?
posted by altolinguistic at 9:58 AM on August 19, 2010

My totally uninformed random guess is that a single dose of Amoxicillin is not enough to have any effect, bad or good, so you might as well take it if it will make you feel better.
posted by Mid at 10:02 AM on August 19, 2010

50% is a pretty big number

It's not necessarily - imagine that infection rates were 0.002%. Now imagine that they increase to 0.003%. That's a 50% increase in infection rates, but both rates are still extremely low.
posted by altolinguistic at 10:06 AM on August 19, 2010 [3 favorites]

Do what your oral surgeon says.

And yeah, 50% of 2% infection rates isn't much to worry about, especially if those 2% are all smokers or some other non-random subgroup.
posted by benzenedream at 10:15 AM on August 19, 2010

Actually, I'm having a hard time finding one that's not a pay link. It's in the Journal of Oral and Maxillofacial Surgery from 10/2007, "Effectiveness of Antibiotic Prophylaxis in Third Molar Surgery: A Meta-Analysis of Randomized Controlled Clinical Trials." (Yes, I know that's not actually a study, it's a study of studies.) But in attempting to find a link to that, I found a new study from 2010 (possibly done by a coworker of the original author) that says their difference was not statistically significant, so this whole question might be moot.

The reason I'm skeptical of my oral surgeon keeping up on new research is that his office (even some of the medical equipment) is from around 1970 and he has no computer or internet. He just comes highly recommended for this one specific procedure. Exposed to the same material, I would definitely trust his judgment more than my own, but from he says, he may not be 100% up to date on current research. Also, I recall in the past having to do this for teeth extractions (I've had about 13 done), so evidently it varies by surgeon.

But, yeah, I probably shouldn't be reading up on this when I'm already mildly nervous. Point taken. I'll stick with the plan.
posted by wending my way at 10:22 AM on August 19, 2010

I see nothing wrong with your logic assuming the study was reasonable. It is not going to hurt you; just might not help.
posted by JohnnyGunn at 10:22 AM on August 19, 2010

Can you provide a link to this study, so that we have access to the same information you do?

This is the study in question. There is no free full text version on the Internet.

It's not necessarily - imagine that infection rates were 0.002%. Now imagine that they increase to 0.003%. That's a 50% increase in infection rates, but both rates are still extremely low.

In this case it was more like 6.2% and 14.4% for alveolar osteitis (commonly called dry socket) and 4% and 6.1% for wound infection. These are apparently clinically significant figures.

The biggest problem with the study is that it was a meta-analysis of other studies. Without the full text (particularly the methodology section), it's impossible to say whether the results are believable.
posted by jedicus at 10:23 AM on August 19, 2010

Oh, and what started this was I could have sworn he, himself, said to me a few months ago when I was there for my consultation to start taking the antibiotics the morning of. But it never got written down. Hence me calling the office this morning to check, getting the nurse instead, who apparently knew nothing about this instruction, and me turning to Google in confusion. I normally find researching medical procedures too much very bad for my mental health.
posted by wending my way at 10:27 AM on August 19, 2010

I do believe "cat pie hurts" response was a bit harsh--asking medical questions is par for the course. I did 15 minutes of research and noted that a one hour preoperative dose of amoxicillin does appear to have some positive benefits in reducing post operative infections. Given that you are having significant oral surgery I would call your dentist and state that you would like to take a preoperative dose--does he/she have a problem with that. I did see that bleeding was listed as an unusual adverse consequence of amoxicillin but did not find the incidence. As a layman, I believe the bleeding is secondary to possible anemia(s) and not damage to the clotting factors. Personally, I can't see any harm in a 1 hour preoperative dose--but hey, IANAD.
posted by rmhsinc at 10:30 AM on August 19, 2010

It's not necessarily - imagine that infection rates were 0.002%. Now imagine that they increase to 0.003%. That's a 50% increase in infection rates, but both rates are still extremely low.

In this case it was more like 6.2% and 14.4% for alveolar osteitis (commonly called dry socket) and 4% and 6.1% for wound infection. These are apparently clinically significant figures.

Sure, but the 6.2% and 14.4% are figures for those who received antibiotics, and those who received *no antibiotics at all*. My point about a 50% increase in risk not necessarily involving large numbers is still relevant.

OP, from that study it does look as though preoperative antibiotics are recommended above postoperative antibiotics. It might be worth phoning the dentist's office again and trying to get clearer instructions, perhaps mentioning your research.
posted by altolinguistic at 10:42 AM on August 19, 2010 [1 favorite]

What about mouthwash? When I had a gum infection and I had to have my wisdom teeth out the dentist prescribed a toxic mouthwash (that no one should use everyday), but he insisted I use it or no surgery.

So I don't know about the antibiotics but if I were as worried as you are I would ask my pharmacist about that mouthwash. You should ask your pharmacist the antibiotic question also.
posted by cda at 11:31 AM on August 19, 2010

You know, this community is traditionally very hostile to people making health choices without getting a doctors note first, so that culture is going to impact the answers you get here.

Some things a good doctor or dentist would consider before prescribing medications:

- What is the purpose of the medication? In this case, you want broad-spectrum protection against a range of possible pathogens - rather than a narrow spectrum antibiotic that treats a specific pathogen after you have the infection.
- Is this the most effective, affordable, and readily accessible medication for this purpose?
- Do you have any history with this particular medication - especially any history of allergy?
- What is the appropriate dose for you considering your weight and age?
- Is there any resistance to this medication for the purpose you intend to use it for? Drug resistance happens regionally, so there can be more resistance to a certain antibiotic among, say, people living in LA compared to people living in rural Kansas.

These are the questions I would consider before medicating myself.

My memory of getting my wisdom teeth out is that not every dentist even provides prophylactic antibiotics, so another option is not taking antibiotics at all (unless you become symptomatic).
posted by serazin at 12:57 PM on August 19, 2010

I am having an implantation done, in a two-stage process. First, the dental surgeon put a screw in my jaw, and then a few months down the road, he's going to put in the fake tooth. For the first procedure, I was prescribed amoxicillin, and was told to start taking it the day before. I also got the crazy mouthwash and had to swish with it three times a day for about ten days following the procedure.

So there you go. Not a wisdom tooth extraction, but there was a chance of infection that my dental surgeon felt might be reduced by taking the amoxicillin before the surgery.
posted by sillymama at 1:05 PM on August 19, 2010

Not answering your question but somewhat related - it is not a bad idea to take a dose of ibuprofin before your surgery. Ibuprofin reduces swelling which could make the work easier for your dentist. Plus, you would have at least a mild painkiller on board before the

The reason I suggest it: I am neither a doctor nor a dentist and my non-impacted wisdom teeth came out in less than 5 minutes each. However, I recently had a root canal. I had to go in three times because the novocaine didn't take the first two. Taking ibuprofin before the third appt reduces the swelling enough to let the dentist get a better shot at giving the novocaine and all went well from there.
posted by maryr at 2:01 PM on August 19, 2010

Beginning a seven day course of antibiotics one day before your surgery will not harm the procedure, the outcome, or the healing. But if you begin, follow the directions, don't just take one pill and hold the next dose until after the surgery. If the directions are for one dose 4 times a day then follow this as soon as you begin the first dose. There are no contraindications to using amox alone due to bleeding issues, as cat pie contends. Good luck.
posted by OHenryPacey at 9:46 PM on August 21, 2010 [1 favorite]