Preoperative Dose of Co-amoxiclav for Prevention of Postoperative Complications in Dentoalveolar Surgery
Preoperative Dose of Co-amoxiclav for Prevention of Postoperative Complications in Dentoalveolar Surgery
There was no evidence to judge the effects of preventative antibiotics for extractions of
 severely decayed teeth, teeth in diseased gums, or extractions in patients who are sick or
 have low immunity to infection. Undertaking research in these groups of people may not be
 possible or ethical. However, it is likely that in situations where patients are at a higher
 risk of infection that preventative antibiotics may be beneficial, because infections in this
 group are likely to be more frequent and more difficult to treat To the best of knowledge, no
 adult study has compared the effects of single dose of Co-Amoxiclave and full oral course
 before or after dentoalveolar surgery. The current study has formally considered this
 comparison as a potential valuable trail for reducing the postoperative complications in
 adult patients who have had surgical removal of teeth under LA.
A comparison of single preoperative dose of Co-amoxiclav versus postoperative full course of
 Amoxicillin/ Co-amoxiclav in prevention of postoperative complications in dentoalveolar
 surgery: a randomized controlled trial

 Background considerations Prophylactic antibiotics and corticoid in a single dose regimen did
 not bring any benefit on mandibular third molar surgeries.

 Tooth extraction is a surgical treatment to remove teeth that are affected by decay or gum
 disease or impacted wisdom teeth or those causing pain or inflammation.

 The risk of infection after extracting wisdom teeth from healthy young people is about 10%;
 however, it may be up to 25% in patients who are already sick or have low immunity.
 Infectious complications include swelling, pain, pus drainage, fever, and also dry socket.
 Treatment of these infections is generally simple and involves patients receiving antibiotics
 and drainage of infection from the wound.

 A review study was carried out to investigate the effectiveness of Antibiotics to prevent
 complications following tooth extractions. The findings revealed that there is evidence that
 prophylactic antibiotics reduce the risk of infection, dry socket and pain following third
 molar extraction and result in an increase in mild and transient adverse effects. However,
 patients at a higher risk of infection are more likely to benefit from prophylactic
 antibiotics, because infections in this group are likely to be more frequent, associated with
 complications and be more difficult to treat.

 Dry socket is a complication that occurs frequently after tooth extraction, causing
 discomfort to the patient, pain, and a fetid odor. Another study was carried out to
 investigatethe incidence and risk factors which played the main role in dry socket following
 surgical removal of impacted third molar in an Iranian population. The outcome of this study
 revealed that the incidence of dry socket was 19.14%. Age, gender, systemic disorder, and
 antibiotics use prior to surgery revealed no significant associations with dry socket.
 However, incidence of dry socket was significantly relevant to smoking, oral contraceptive
 use, menstruation cycle, difficulty of the surgery according to pre-surgery radiograph
 evaluation and perception of surgeon post-surgery, length of surgery, and number of carpules
 used to reach anesthesia. Tolstunov's study demonstrated that the post-extraction socket
 bleeding is very important for the proper uncomplicated socket healing. If the irrigation
 solution has not used at the end of extraction, the normal blood clot has a higher likelihood
 to form, and therefore, can potentially lead to an uncomplicated socket healing without
 development of alveolar osteitis. Socket bleeding at the extraction site creates a favorable
 environment for the formation of a blood clot - a protective dressing - necessary for a
 favorable osseous healing of the socket.

 There was no evidence to judge the effects of preventative antibiotics for extractions of
 severely decayed teeth, teeth in diseased gums, or extractions in patients who are sick or
 have low immunity to infection. Undertaking research in these groups of people may not be
 possible or ethical. However, it is likely that in situations where patients are at a higher
 risk of infection that preventative antibiotics may be beneficial, because infections in this
 group are likely to be more frequent and more difficult to treat.

 To the best of knowledge, no adult study has compared the effects of single dose of
 Co-Amoxiclave and full oral course before or after dentoalveolar surgery. The current study
 has formally considered this comparison as a potential valuable trail for reducing the
 postoperative complications in adult patients who have had surgical removal of teeth under
 LA.

 Primary aim The aim of this study was to assess the efficacy of a single prophylactic dose of
 Co-Amoxiclave and full oral course in preventing postoperative complications (PC) after a
 surgical removal of upper and lower teeth.

 Material and methods This randomized double-blind clinical trial included 50 patients
 diagnosed with dentoalveolar surgery. Patients received either preoperative single dose of
 625mg Co-Amoxiclav and 1g paracetamol associated with 0.2% chlorhexidine mouthwash or
 postoperative full course of Co-Amoxiclav for 5 days with 0.9% normal saline irrigation or
 postoperative full course of amoxicillin 500 mg for five days with 0.9% normal saline
 irrigation. Patients were reviewed 5 days following the surgery and evaluated if they had
 alveolar infection, alveolar osteitis, trismus, edema and pain. Difficulty of surgery was
 reported by the surgeon by using (VAS).

 Forty five patients who satisfy the inclusion criteria will be involved in the study and
 undergo surgical removal of their teeth. . Patients refusing the preoperative dose of oral
 co-amoxiclav, and unwilling to take part were excluded. Patients who are allergic either to
 co-amoxiclve or amoxicillin were also excluded. To be included in the study, the tooth must
 need surgery and require an osteotomy for extraction with use of a motorised drill. Patients
 will be divided in 3 groups according to the follow up protocol. Patients will be randomly
 allocated to one of three groups. Patients and assessor will not be aware of the exact
 treatment which will carry out.

 -  Treatment 1: 0.9% normal saline irrigation immediately after the surgery with course of
 Co-Amoxiclav 625 mg 0.2% chlorhexidine mouthwash following the surgery for 5 days
 (control group)

 -  Treatment 2: 625 mg Co-Amoxiclav and 1g Paracetamol preoperatively and 0.2%
 chlorhexidine mouthwash immediately before the surgery with course of Metronidazole 500
 mg and 0.2% chlorhexidine mouthwash following the surgery for 5 days

 -  Treatment 3: 625 mg Co-Amoxiclav and 1g Paracetamol preoperatively and 0.2%
 chlorhexidine mouthwash immediately before the surgery with course of amoxicillin 500 mg
 and 0.2% chlorhexidine mouthwash following the surgery for 5 days

 All surgeries will be done under local anaesthesia. A standard extraction technique of
 surgery will be employed for the patient in first group. This include a buccal full-thickness
 flap, buccal trough (osteotomy) and extraction of the tooth), followed by a traditional
 end-of-surgery debridement protocol consisting of a gentle curettage, socket irrigation with
 approximately 5 ml of sterile normal saline solution , socket suctioning and placement of
 stitches.

 -  Signs of alveolar osteitis may include:

 1. An empty socket, which is partially or totally devoid of blood clot.

 2. Exposed bone may be visible or the clot may be filled with food debris which
 reveals the exposed bone once it is removed. The exposed bone is extremely painful
 to touch.

 3. Surrounding inflamed soft tissues may overlie the socket and hide the dry socket
 from casual examination (Daly et al., 2012)

 -  Symptomsof alveolar osteitis may include:

 1. Dull, aching, throbbing pain in the area of the socket, which is moderate to severe
 and may radiate to other parts of the head such as the ear, temple and neck. The
 pain normally starts on the second to fourth day after the extraction,[ and may
 last 10-40 days.The pain may be so strong that even strong analgesics do not
 relieve it.

 2. Intraoral halitosis

 3. Bad taste in the mouth (Fragiskos, 2007)

 -  Signs and symptoms of oral infection

 1. Oral swelling

 2. Tenderness with touch

 3. Pus drainage

 4. Difficulty fully opening your mouth or swallowing. Power calculation A study with
 45 subjects was reported to have 90% power to detect a difference in success rate
 of 21% (Bortoluzzi et al, 2013) in a continuous outcome measure assuming a
 significance level of 5% and a correlation of 0.5 between responses from the
 different subjects.
Inclusion Criteria:

 -  Patient age from 16 to 70 yrs old

 -  Patient needs surgical teeth extraction (subject tooth will be removed using osteotomy
 by motorised drill).

 Exclusion Criteria:

 -  Patients refusing the preoperative dose of oral co-amoxiclav, and unwilling to take
 part .

 -  Patients who are allergic to co-amoxiclve, amoxicillin or metronidazole

 -  Patient are on warfarin medication