Suppurative infections after lower third molar surgery: a systematic review

Background: After lower third molar surgery, suppurative infections can occur. They can spread into adjacent tissues, toward superficial mucosal or skin planes or toward deep facial and neck fascial spaces. Material and Methods: The 2020 PRISMA guidelines for systematic reviews were followed. A literature search was conducted, without initial time limit, in the Medline database, via Pubmed (MEDLINE), and SCOPUS. For the analysis of statistical significance, the hypothesis test on the difference between means with unknown variances was used. Results: Eleven articles met the inclusion criteria. The total number of extractions taken from the articles included in the review is 7363, with a 5.35% total incidence of purulent infections. The incidence of purulent infections was found significantly higher in cases in which antibiotic prophylaxis was not performed. Conclusions: Although lower third molar extraction is the most frequently performed oral surgical procedure, little has been written about post-operative purulent infections, in relation to risk factors, involved spaces, and performed therapies, so to be able to identify preventive and therapeutic behaviors based on scientific evidence. Antibiotic prophylaxis is the only variable which resulted in determining a significative statistical reduction in the incidence of purulent infection after lower third molar surgery.