Effect of Antimicrobial Drug Regimens in Mandibular Third Molar Extraction: A Narrative Review

Abstract

Surgical extraction of impacted mandibular third molars is one of the most common procedures in oral and maxillofacial surgery, often associated with postoperative complications such as pain, swelling, trismus, alveolar osteitis, and infection. The use of antimicrobial regimens to prevent these complications remains controversial, particularly in healthy patients undergoing uncomplicated extractions. This narrative review aims to critically evaluate the effectiveness, indications, timing, and duration of antimicrobial therapy in mandibular third molar extraction, while emphasizing evidence-based prescribing and antimicrobial stewardship. A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science databases for studies published between 2010 and 2025. Studies evaluating antimicrobial regimens in mandibular third molar extraction, including randomized controlled trials, cohort studies, and systematic reviews, were included. Clinical outcomes such as postoperative infection, alveolar osteitis, pain, swelling, wound healing, and adverse drug reactions were analyzed. A total of 67 relevant articles were selected following screening and eligibility assessment. The findings suggest that postoperative infection rates are generally low in healthy individuals when appropriate surgical techniques are followed. Prophylactic antibiotics provide only modest benefits, with evidence supporting single-dose preoperative administration as effective as extended postoperative regimens in most cases. Multi-day antibiotic use does not significantly improve outcomes but increases the risk of adverse effects and antimicrobial resistance. Therapeutic antibiotics are justified in cases of active infection or high-risk patients. Routine antibiotic use in uncomplicated mandibular third molar extraction is not recommended. Rational prescribing, guided by patient-specific risk assessment and evidence-based protocols, is essential to optimize clinical outcomes while minimizing antimicrobial resistance.