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internal validity of the study rather than alter the protocol Formula).The patients in the age groups over 60
specifically for the study. The final year students and interns were more likely to be medically compromised and
were routinely allotted patients on a rotation basis and the firm teeth were a rarity in this age group.)
procedure was carried out under supervision by the faculty
members. The purpose of the study was to evaluate whether 3. Patients with teeth that could not be salvaged or
there was any difference in the healing process post those who preferred extraction only.
extraction among the two groups. In order to promote patient
compliance and eliminate bias, both the groups were Exclusion Criteria:
administered an across the counter multivitamin (Vitamin B
1. Chronic oral infections.
complex) table. The usual time taken for extraction was about
20 minutes and there were no reported complications. 2. Immune compromised patients.
In order to evaluate the healing process, pain and 3. Patients on specific drugs.
discomfort post extraction among the two groups, it was
imperative that the patient returns for evaluation after a 4. Tobacco users in any form.
week. In an effort to improve patient compliance and to
make sure all the cases were evaluated, a single suture was 5. Chronic alcoholics
placed after extraction and specific instructions given to
the patient to return after a week to get the suture removed. 6. Pregnant and lactating mothers.
88
Controlled Clinical Trial To Understand The Need For Antibiotics During Routine Dental Extractions www.ejournalofdentistry.com
DISCUSSION
The choice of antibiotic is empirical because no definitive molar extraction in young patients. J Oral Maxillofac Surg. 2009 Jul;67(7):1467-
72.
information on the causative pathogenic microorganisms
is available. However, it is known that oral infections are 6. Al-Asfour A. Postoperative infection after surgical removal of impacted
mandibular third molars: an analysis of 110 consecutive procedures. Med Princ
usually of mixed bacteria with a predominance of obligate Pract. 2009;18(1):48-52. Epub 2008 Dec 4.
anaerobes19-22. It has been theorized that this diffuse
infection is mediated by streptococci, which elicit factors 7. I. R. Blum: Contemporary views on dry socket (alveolar osteitis): a clinical
appraisal of standardization, aetiopathogenesis and management: a critical review.
that facilitate the rapid spread of bacteria and the infection Int. J. Oral Maxillofac. Surg. 2002; 31: 309–317.
through the tissues.23 The antibiotic of choice is penicillin,
8. Thomas J. Pallasch, DDS, MS.Global Antibiotic Resistance and Its Impact on
administered orally and with aggressive dosages24. the Dental Community, J Calif Dent Assoc. 2000 Mar;28(3):215-33.
Contrary to the common expectation that patients 9. Kunin CA, Editorial response: Antibiotic armageddon. Clin Infect Dis, 1997,
25(2):240-241.
on antibiotics will have event free healing, this study
showed that maximum patients with dry sockets were on 10. Pallasch TJ, Gill CJ, Microbial resistance to antibiotics. J Cal Dent Assoc
1986,14(5):25-7.
antibiotic cover (80%). However, no attempt was made to
validate whether the intervention group completed the 11. Pallasch TJ, Slots J, Antibiotic prophylaxis and the medically compromised
course of antibiotics. The results are an eye opener for patient. Periodontol 1996, 10:107-38.
general dentists to shun the rampant use of antibiotics for 12. Pallasch TJ, Pharmacokinetic principles of antimicrobial therapy. Periodontol
routine procedures and be selective in prescribing based 1996, 10:5-11.
on need. Nature can help heal in most cases without having 13. Pallasch TJ, How to use antibiotics effectively. J Cal Dent Assoc 1993,
to resort to the use of antibiotics. 21(2):46-50.
21. Brook I, Frazier EH, Gher ME. Aerobic and anaerobic microbiology of periapical
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