When should I take antibiotics?
There are two variants of how an antibiotic is used in a tooth removal. Either it is used preoperatively, before the procedure as a single dose to prevent infection. However, most procedures do not require this prophylaxis, as tooth extraction is a routine procedure.
Only in case of complications during or after the procedure, the dentist will initiate an antibiotic therapy by taking one tablet two or three times a day for 5 days. This antibiotic therapy can be prescribed in cases of severe inflammation of alveolitis sicca or a formed abscess. The practitioner decides in each individual case which preparation is to be prescribed in which dosage. The classic antibiotic is the aminopenicillin amoxicillin. A long intake of the antibiotic is necessary to avoid the development of resistance.
Complications/risks
As with any procedure, complications can arise when extracting a tooth. In addition, as with any procedure, there is a certain risk. The probability of serious complications is negligible!
For example, the root of the tooth can fracture and then has to be laboriously removed piece by piece. If not all parts are caught, a cyst can form around this one part even after years, which then has to be surgically opened and treated. Such remaining parts can also be completely harmless and never develop symptoms.
After a tooth extraction, a wound healing disorder can also occur if the wound cannot be sufficiently closed by a “blood clot”, as would be the case with healthy wound healing. The wound healing disorder can have various causes, such as poor oral hygiene or smoking. If the formed blood clot disintegrates too quickly, the jawbone becomes inflamed because it lacks a protective layer and is completely exposed to the bacteria in the oral cavity.
Hard food, for example, can destroy the blood coagulum. This clinical picture is called dry alveolus or alveolitis sicca. The opening of the mouth can be made more difficult if a nerve in the lower jaw was unfavorably hit during conduction anesthesia.
In most cases, however, this disappears of its own accord after two to three days. There is also a risk of hematoma formation due to bleeding into the surrounding tissue. This hematoma formation is often accompanied by an unsightly swelling in the face.
Although this may not look very aesthetic, it is only in very few cases dangerous or in need of treatment. Pain is completely normal in moderation, only if the pain persists for days or if no improvement is noticeable at all, a dentist should be consulted again. If a molar in the upper jaw (cheek tooth in the upper jaw) is removed, it can happen that the maxillary sinus is opened.
The wall between the tip of the root and the maxillary sinus is very thin and can therefore break easily, this is not a fault on the part of the dentist. After the extraction it is therefore necessary to check whether an opening has taken place. If this is the case, this opening must be closed again by the oral surgeon, because otherwise bacteria and germs will get from the oral cavity into the maxillary sinus and cause maxillary sinusitis there.
An opening of the maxillary sinus is always rather an exception! After tooth extractions there are some things that should be followed to ensure rapid wound healing. Pus is always a sign of infection, as it consists of dead white blood cells.In the case of pus formation, it is important to drain it through a relief incision so that the accumulation of pus does not increase and develop into a manifest abscess.
In the case of already formed abscesses with severe swelling, a drainage system consisting of tubes through which the pus can constantly drain is inserted next to an incision for drainage. An additional antibiotic therapy is additionally arranged to get the bacteria out of the body as fast as possible and to avoid an intrusion into the bloodstream, as sepsis. It may be that the patient is ordered close meshed at the beginning daily to drain the pus completely and to rinse the infected wound.
Post-bleeding is usually the result of incorrect behaviour after extraction. Due to its blood-thinning effect, the active ingredient acetylsalicylic acid in many painkillers is the most common cause of self-produced post-bleeding. For this reason, the treating dentist always explicitly advises not to take any painkillers such as Aspirin® or Tomapirin®.
Furthermore, the consumption of alcohol after the procedure can also dilute the blood in such a way that secondary bleeding occurs. If post-operative bleeding is detected, the patient should roll a handkerchief and bite on it with pressure for ten minutes to stop the bleeding. If this does not stop the bleeding, the dentist or emergency service must be contacted immediately, who will close the wound with a flap and tightly meshed sutures to stop the bleeding.
Bad breath after a tooth extraction is in the majority of cases a sign of infection. Dead white blood cells form pus, which causes an unpleasant odor in the oral cavity. This odor disappears only after the entire pus has been drained and the inflammatory cells disappear.
Furthermore, an unpleasant odor can also be caused by food residue that remains in the wound and cannot be cleaned. This results in a decomposition odor, which can be alleviated by rinsing solutions and wound cleansing. Even an alveolitis sicca, in which the blood has been removed from the tooth socket, can produce unpleasant odors and taste disorders.
The odor only disappears when the wound is closed and the inflammation subsides. Dental procedures should generally be avoided during pregnancy and tooth extractions are only performed in an extreme emergency. Care must be taken that a local anaesthetic with a high protein binding rate is used so that as little of it as possible reaches the unborn child.
Since the procedure is always associated with stress for mother and child, it should be considered beforehand whether a trepanation, the removal of the nerve tissue of the tooth is not sufficient to relieve the pain and the tooth extraction is connected after birth. Patients with heart disease are often discontinued through long-term therapy with anticoagulants such as Marcumar®. Marcumar® dilutes the blood, which causes bleeding during a tooth extraction that can hardly be stopped.
Therefore, in consultation with the family doctor or internist, the medication is discontinued for the procedure and the patient is bridged with a substitute preparation, usually heparin. On the morning of the operation, the value of Marcumar® in the blood, the so-called Quickwert, is checked. From a Quickwert > 35%, tooth extraction is possible; if the value is not reached, the patient waits until the blood is “thicker” again. Marcumar® is taken again on the day after the procedure or on the day itself, which is why a tight suture around the wound edges is essential to prevent secondary bleeding.