15 July 2023

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Wisdom teeth extraction: what drugs to give after surgery?

By Arianna Bianchi

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The extraction of wisdom teeth sometimes presents a challenge for dentists and patients, especially in the case of complex interventions and due to the anatomy that these dental elements have with the inferior alveolar nerve (NAI).

For this reason, therefore, correct preoperative planning is essential, observing the picture not only from a clinical point of view, but also using three-dimensional imaging methods (i.e., CBCT), if the situation requires it. However, a correct approach from a pharmacological point of view is also essential, to improve the management of post-operative pain and any discomfort of the patient after the extraction.

First, using the most effective anesthesia plays a key role. Since most dental operations take place in an outpatient setting, regional anesthesia is the most common method for anesthetizing the patient. 

Blocking the inferior alveolar nerve is used to obtain the correct anesthesia, then assisted by infiltrations of anesthetic via the plexus, usually with anesthetics also containing a vasoconstrictor, which has the purpose of prolonging the effect of the anesthetic molecule and to reduce bleeding due to the operation.

After the extraction, the thing that most worries patients is the management of post-operative pain, together with infectious complications. Regarding this second aspect, antibiotic prophylaxis is a very widespread, but also controversial and debated practice and essentially linked to the possible emergence of new bacterial resistance. However, several studies have shown that antibiotics — especially penicillin — taken for prophylactic purposes after extractions or complex operations are effective in preventing infectious complications and dry sockets.

As far as the management of post-operative discomfort is concerned, recent studies have shown that the administration of dexamethasone, especially submucosal, seems to be effective in reducing post-operative sequelae. It is possible to use anti-inflammatory drugs non-steroidal drugs (NSAIDs - such as ibuprofen), which can also be associated with paracetamol. It’s important to pay attention to your patient’s existing medications, especially in patients who are already taking antiplatelet or anticoagulant therapy.

Finally, even a local antiseptic treatment can be useful after tooth extractions, above all because the patient will have to pay attention to brushing the area that has undergone surgery. The most used antiseptic is chlorhexidine, at a concentration of 0.20%, which can be used to rinse starting from the day after the operation.