A comparative study of delayed and immediate tooth extraction in the presence of acute infection

Background: Odontogenic infections are commonly encountered in the dental hospital. One of the oldest controversies in the field of Oral and Maxillofacial Surgery is whether or not to extract teeth immediately in the presence of acute infection. Many dentists and physicians still believe that extraction of teeth in the presence of an acute infection may cause the organism to seed into the fascial spaces and cause spread of infection in the host. Objectives: The purpose of this study is to compare immediate and delayed extraction in the presence of acute infection and to provide the clinician evidence based recommendations on the extraction of teeth in the presence of acute infection. Patients & Methods: Fifty patients fulfilling the inclusion criteria were selected. Extraction was performed in Group 1 at the first visit itself and postoperative antimicrobial coverage was given. Extraction was performed in Group 2 after antimicrobial coverage and continued the postoperative medication. All patients in both the groups were given same type of antibiotic and analgesic. Two groups were evaluated for pain, mouth opening, duration of treatment and medication, cost of the treatment and no. of visits. Results: Significant differences were not observed for pre and postoperative pain and mouth opening between the groups. Early extraction of teeth reduced the duration of treatment, duration of antibiotic and analgesic therapy, cost of the treatment and number of hospital visits and hence increased overall patient comfort. Conclusion: Extraction of acutely infected or abscessed teeth as early as possible prevents the spread of infection in to the fascial spaces and thus reduces the patient discomfort. The belief that the extraction of an infected tooth might spread the infection is unsubstantiated.