Acutely infected teeth: to extract or not to extract?

Abstract: Not only laymen but also dentists generally believe that extraction of acutely infected teeth should be avoided until the infection subdues by using systemic antibiotics. The aim of this study was to compare perioperative complications in routine extractions of acutely infected teeth with extractions of asymptomatic teeth. This prospective study was performed with 82 patients. Severe pain on percussion of the relevant tooth was considered as basic criteria for acute infection. The acutely infected teeth were labeled as the study group (n = 35) and the asymptomatic teeth as the control group (n = 47). The extractions were done using standard procedures. The amount of anesthetic solution used and duration of extractions were recorded. Postoperative severe pain and exposed bone with no granulation tissue in the extraction socket were indications of alveolar osteitis (AO). The level of statistical significance was accepted as 0.05. Symptoms that could indicate systemic response, including fever, fatigue, and shivering were not found. There was no statistically significant difference between groups in terms of AO, amount of anesthetic solution used, and duration of extraction. The presence of an acute infection characterized by severe percussion pain is not a contraindication for tooth extraction. Infected teeth should be extracted as soon as possible and the procedure should not be postponed by giving antibiotics.

摘要：不仅普通民众，多数牙医亦普遍认为，在通过全身应用抗生素控制感染前，应避免拔除急性感染患牙。本研究旨在对比急性感染患牙常规拔除术与无症状患牙拔除术的围手术期并发症情况。本前瞻性研究共纳入82例患者，将患牙叩击剧痛作为急性感染的基本判定标准。急性感染患牙纳入研究组（n=35），无症状患牙纳入对照组（n=47）。所有拔牙操作均采用标准流程进行，记录所用麻醉药液用量及手术时长。术后剧痛、拔牙窝内无肉芽组织覆盖的暴露骨面被认定为牙槽骨干燥症（alveolar osteitis, AO）的诊断指征。本研究设定统计学显著性阈值为0.05。本研究未观察到发热、乏力、寒战等提示全身反应的症状。两组患者在牙槽骨干燥症发生率、麻醉药液用量及手术时长方面均无统计学显著差异。以叩击剧痛为特征的急性感染并非患牙拔除的禁忌证。感染患牙应尽早拔除，不应通过使用抗生素推迟手术时机。