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Extracted Immediately
i n t h e P re s e n c e of
Acute Infection?
Ankur Johri, DDS, MD, Joseph F. Piecuch, DMD, MD*
KEYWORDS
oralmaxsurgery.theclinics.com
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SUMMARY
As seen in this review of the topic, the controversy has been settled for several decades, yet
the purpose of the article is to review the
evidence on both sides of this question, because
concerns arise from time to time, particularly from
general dentists and physicians unfamiliar with
the oral and maxillofacial surgery literature. The
earliest literaturearticles before the antibiotic
eraconsidered immediate (at the time of initial
diagnosis) extraction to be dangerous. These articles presented primarily the lowest level (level IV)
evidence, expert opinion based on personal
experience. Later articles suggesting that early
extraction did not lead to serious infection or to
CNS spread also had lower levels of evidence
(level III), retrospective uncontrolled case series.
Only the article by Hall and colleagues10 provided
strong evidence (level Ib) in the form of a prospective randomized controlled trial, finding that delaying extraction led to more severe infection, which
required more extensive surgery. Currently, most
surgeons understand that a combination of surgical extraction and antibiotics can be curative
and that watchful waiting, even with antibiotics,
is no longer acceptable.
Based on this review of the literature, the recommendation is to extract infected teeth as soon as
safely possible, given a patients overall medical
condition. The longer a necrotic tooth remains,
the more likely it is to cause a fascial space infection, with greater morbidity and possible mortality.
Early extraction, along with incision and drainage,
and antibiotics as indicated, hastens recovery.
Reports of serious CNS spread of infection after
tooth extraction are rare, and a causal relationship
REFERENCES
1. Frew AL. Acute oral infectionswhen not to extract
teeth. J Am Dent Assoc 1937;24:440.
2. Kay LW. Investigations into the nature of pericoronitisII. Br J Oral Surg 1966;4:5278.
3. Gluck B. The advisability of immediate extraction in
cases of swellings. Dental Items Interest 1939;61:225.
4. Wainwright J. Anesthesia and immediate extraction
in the presence of swellings of the jaws. Dental
Items Interest 1940;62:849.
5. Haymaker W. Fatal infections of the central nervous
system and meninges after tooth extraction, with
analysis of 28 cases. Am J Orthod (Oral Surg
Section) 1945;31:117.
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