Abstract:

Objective

To evaluate the effect of nitroimidazole antibiotics （NIAs）on the prevention of infection after the extraction of the bone embedded mandibular impacted third molars（M3Ms）.

Methods

Patients（390 patients and 439 M3Ms）who received the extraction of bone embedded M3Ms in the Department of Oral and Maxillofacial Surgery，Hospital of Stomatology，Sun Yat-sen University from May 2023 to April 2024 were enrolled and divided into two groups in a prospective，randomized controlled，single-blind design.In the experimental group，223（195 patients）bone embedded M3Ms were given cefuroxime axetil tablets（0.25 g orally，bis in die for 3 days）and tinidazole tablets（1.0 g orally，quaque die for 3 days，double the first dose）after extraction.In the control group，216（195 patients）bone embedded M3Ms were extracted and given cefuroxime axxime tablets.For those who were allergic to cefuroxime axetil tablets，the antibiotics were replaced with clindamycin palmitate hydrochloride dispersed tablets（150 mg orally，quater in die for 3 days）.Only one bone embedded M3M was extracted in each patient，and the postoperative infection（wound suppurative infection，anterior buccal infection and anterior isthmic space infection），postoperative reactions（pain，swelling and trismus）and adverse drug reactions（central nervous system reaction and gastrointestinal reaction）were recorded on the 7th day after surgery.SPSS 26.0 software package was used for statistical analysis of the data.

Results

The incidence of postoperative infection was 4.0%（9/223）in the experimental group and 6.5%（14/216）in the control group，with no significant difference between the two groups（χ²=1.322，P=0.250）.There were no significant difference between the two groups in postoperative reactions，including pain（Z=-0.426，P=0.670），swelling（Z=-0.961，P=0.336）and trismus（Z=-0.170，P=0.865）.The incidence of adverse drug reactions in the experimental group was higher than that in the control group，including central nervous system reactions：9.9%（22/223）in the experimental group and 3.2%（7/216）in the control group（χ²=7.805，P=0.005）；gastrointestinal reactions：14.3%（32/223）in the experimental group and 6.0%（13/216）in the control group（χ²=8.278，P=0.004）.

Conclusions

The combination of NIAs could not further reduce the incidence of infection after the extraction of bone embedded M3Ms，but the incidence of adverse drug reactions was high，so that the combined use of NIAs should be of caution.

Key words: Nitroimidazoles, Anti-bacterial agents, Molar,third, Tooth extraction, Infections