The effect of a topical combined anti-inflammatory antibiotic preparation on the outcome of third molar surgery

Abstract

Third molar surgery may be associated with a number of complications the most common of which are postoperative pain, swelling and trismus, and dry socket formation. The appearance of these post-operative sequelae is intimately related to the manifestations of inflammation in response to tissue injury. There is significant post-operative morbidity associated with these complications and it was thus the objective of this study to - investigate the effect of a combined antibiotic/anti-inflammatory intrasocket medication on post-operative pain, swelling and dry socket formation. The medication chosen for the study was Covomycin D®. Covomycin D® is a commercially prepared opthalmological preparation - each 1 millilitre contains 2 mg chloramphenicol, 5 mg neomycin sulphate and 0,5 mg dexamethasone. Nineteen subjects were included in the study after fullfilling certain criteria. All subjects were operated under general anaesthesia by the same surgeon. The patients were blinded to the side of the medication and were asked to complete a pain visual analogue scale and note the side of the worst swelling in the post¬operative period. All patients were followed up in the first week following surgery by an independent oral and maxillofacial surgeon who was also blinded to the side on which the medication was placed. The results showed a significant difference (p<0.6) in the pain experienced on the non-medicated compared to the medicated side on day one in eleven of the nineteen patients (57.9%). When the data was analysed over the six day postoperative period sixteen of the nineteen patients (84.2%) had significantly less pain on the medicated side compared to the non-medicated side (p<0.6). The swelling was reported as being worse on the non-medicated side in fourteen out of the nineteen patients (73.7%). Dry socket occurred in three out of nineteen patients or three out of thirty eight surgical extraction sites; an overall incidence of 7.9% or an incidence of 0% for the medicated side and an incidence of 15.8% on the non-medicated side i.e. all the dry sockets occurred on the non-medicated side. In conclusion, this double-blinded prospectve study, showed that the use of a combined antibiotic/anti-inflammatory intrasocket medication favourably influences the common adverse post-operative sequelae following the removal of lower third molars.