use of antibiotics after mandibular third molar surgery-is it useful in preventing post extraction complications?

To determine whether the administration of postoperative antibiotics following extraction of a asymptomatic soft tissue impacted lower wisdom teeth is necessary to reduce the incidence of dry socket, and post operative morbidity such as pain, swelling and trismus. This study including 441 patients [208 males, 233 females] who required surgical extraction of lower wisdom teeth. Patients were divided into three groups; [Gl] patients received Metronidazole, [G2] patients received Amoxicillin, and [G3] patients did not receive antibiotics at all. All patients received the same analgesic regimen. The incidence of dry socket, swelling, and the intensity of pain was recorded. The chi-squared test was employed to compare the results in the three treated groups No significant difference was found between the three groups regarding the evaluated parameters in the postoperative sequelae, i.e. pain, swelling and alveolar osteitis [dry socket]. This study showed that prescribing postoperative oral prophylactic antibiotic treatment following the removal of soft tissue impacted lower third molars does not contribute to less pain, less swelling, increased mouth opening or a lower incidence of dry socket, therefore it is not recommended for routine use

Dental management of patients on warfarin therapy

The aim of this study was to investigate whether patients who were taking warfarin and had an International Normalized Ratio [INR] within the normal therapeutic range require cessation of their anticoagulation drugs before dental extractions or not. Patients were divided into three groups: One, consisting of 48 patients had their warfarin treatment stopped for 2-3 days prior dental extractions. Two, consisting of 49 patients who did not have their anticoagulant treatment altered before extractions, and had an average preoperative INR of 2.5. Three, consisting of 45 patients with average preoperative INR of 2.6, their warfarin was stopped and switched to the Low-molecular-weight [LMWHs]. The incidence of postoperative bleeding was recorded. The incidence of bleeding complications in the control group was [5/48, 10%], in the group 2 [6/ 49, 12%] and in group 3 it was [4/45, 8%]. No statistical significance was found between the three tested groups.This study supports the consensus in the medical literature that dental extractions in patients whose INR is within the therapeutic range can be done without modification of oral anticoagulant treatment

efficay of pre-emptive analgesia in controlling postoperative pain in lower third molar surgery: a cinical trial

The aim of this study was to evaluate the analgesic efficacy of preoperative versus postoperative administration of diclofenac sodium in the prevention of the postoperative pain following a lower third molar surgery. A prospective randomized clinical trial was conducted on 73 patients who underwent surgical extraction of bilateral fully impacted lower third molars. Patients were randomised into two groups: group I were started on diclofenac sodium postoperatively, and group II were started on diclofenac sodium preoperatively, both groups were then prescribed a diclofenac sodium regimen for three days postoperatively and were advised to resort to an additional analgesic [paracetamol/codeine tablets] as a rescue medication when adequate relief from pain was not achieved. The analgesic efficacy of both regimens was tested. Results showed a significant difference between the two groups in terms of the analgesic efficacy in the first postoperative day. Significantly less pain and less need for additional analgesia was recorded in group II [<0.05]. Preoperative treatment with diclofenac sodium provides effective relief from acute mild to moderate pain following third molar surgery compared to its postoperative administration

Retrograde facial nerve dissection in superficial parotidectomy versus standard approach: a comparative study

This study was conducted to determine whether the retrograde approach in parotidectomy is more efficient than standard anterograde parotidectomy without compromise of surgical effectiveness. A prospective analysis of 48 patients undergoing superficial parotidectomy was conducted. Cases were divided into those undergoing retrograde facial nerve dissection and those undergoing standard anterograde facial nerve dissection. The following had been monitored: surgical time, estimated blood loss, and incidence of either temporary or permanent facial nerve injury. Statistical comparisons were conducted for the two approaches comparing the three different mentioned variables. The average patient age was 48.5 years with a female preponderance [71%]. There were 23 standard superficial parotidectomies and 25 retrograde approaches. Compared to standard superficial parotidectomy, retrograde superficial parotidectomy consumed less operative time [1.80 versus 2.10 hours], decreased intraoperative blood loss [88.00 ml versus 50.00 ml]. No significant difference in incidence of either temporary or permanent facial nerve injury was observed. In appropriately selected cases, compared with standard anterograde parotidectomy, retrograde parotidectomy is more efficient in terms of lower operative time and less blood loss, with no added risk to facial nerve injury