The document discusses the long-standing debate around extracting teeth in the setting of acute oral infection. Early studies from the 1930s-1960s supported immediate extraction, but later work found higher risks of complications like osteomyelitis and life-threatening infections. More recent reviews recommend first treating the infection medically with antibiotics or drainage before extracting, as this reduces complications and leads to faster recovery without increased risks. While immediate extraction may be necessary in some urgent cases, resolving the infection first is generally the safer approach.

2. AN INFECTION THAT APPEARS SUDDENLY AND MAY BE OF BRIEF OR
PROLONGED DURATION
MEDICAL DICTIONARY 2009 FARLEX & PARTNERS
ACUTE ORAL INFECTION?
ORAL INFECTIONS ARE MOSTLY CHRONIC IN NATURE AND RARELY
HAVE ACUTE OR DRAMATIC CONSEQUENCES.MEDICALLY COMPROMISED
PERSON,HOWEVER,MAY BE AT RISK FOR ACUTE OR CHRONIC ORAL
CONDITION,ESPECIALLY IF THEY HAVE A WEAKENED IMMUNE SYSTEM.
OLSEN I,VAN WINKELHOFF AJ: ACUTE FOCAL INFECTION OF DENTAL ORIGIN

3. DO WE EXTRACT IMMEDIATELY OR WE TREAT THE ACUTE INFECTION
THAN EXTRACT?
IT HAS BEEN ONE OF THE OLDEST CONTROVERSIAL TOPIC IN THE FIELD OF OR
AND MAXILLOFACIAL SURGERY.
STUDIES HAVE BEEN MADE AND PUBLISHED SINCE THE YEAR 1937 TILL TODAY
DEBATE ON THIS ISSUE.
THUS THIS IS A PRESENTATION BASED ON REVIEW IN THE LITERATURE AND
PROVIDE THE CLINICIAN BASED EVIDENCE RECOMMENDATIONS ON
EXTRACTION OF TEETH IN THE SETTING OF AN ACUTE INFECTION.

4. FREW 1937
GLUCK 1939
WAINWRIGHT 1940
HAYMAKER 1945
FELDMAN 1951
KROGH 1951
KAY 1965 & 1966
HOLLIN AND COLLEAGUES 1967
HALL AND COLLEAGUES 1968
RUD 1970
MARTIS & KARAKAKIS 1975 & 1978
JOHN WILEY AND SONS NOV 2012
CAREFREE DENTAL MARCH 2016

5. -BASED ON HIS PERSONAL CLINICAL EXPERIENCE
-STATES THAT WHEN INDICATED FOR WISDOM TOOTH EXTRACTION,SUBSID
THE INFECTION FIRST
EG:-OPERCULACTOMY
DRAINAGE
COVER WITH ANTIBIOTIC
THAN PROCEDE WITH EXTRACTION
-THIS IS TO PREVENT OSTEOMYELITIS ,CELLULITIS AND SEVERE
LIFE-THREATENING INFECTION

6. -BASED ON APPROX 600 PATIENT FOUND THAT IMMEDIATE TOOTH
EXTRACTION IN THE FACE OF ACUTE INFECTION IS BENEFICIAL
-HE STATES NONE OF HIS PATIENT SUFFERED FROM CELLULITIS OR SEVERE
LIFE THREATENING INFETION POST OPERATIVELY
-HIS CONCEPT EXTRACT AND DRAIN PUS FROM SOCKET,THUS INFECTION
REDUCUSES FASTER AND PATIENT HAVE RELIEF IN PAIN AND NO DISTURB
IN SLEEP.

7. -SUPPORTS IMMEDIATE EXTRACTION
-HE STRESSED THAT A NECROTIC TOTH,DEVOID OF BLOOD SUPPLY AND
GANGRENOUS PULP ACTS AS FORGEIN BODY AND ACTS AS A CULTURE MEDIA
-FOR TOOTH RE-ESTABLISHED BLOOD SUPPLY MUST BE EXTRACTED AND
PROVIDED WITH DRAINAGE TO RELIEF PAIN AND PRESSURE

8. -125000 PATIENTS UNDERGONE EXTRACTION ON AVUTE INFECTION AND
28 PATIENTS WERE REPORTED OF CNS INFECTION AFTER TOOTH EXTRACTIO
-DATA WAS 12-BRAIN ABSCESS
2-LEPOMENINGITIS
1-ENCEPHALITIS
11-CAVERNOUS SINUS THROMBOSIS
1-MYELITIS
1-SUBDURAL EMPYEMA
17-DIRECT EXTENSION INTO INTRACRANIAL CAVITY
11-HEMATOGENOUS SPREAD
-UPPER EXTRACTION LEADS DIRECT EXTENSION WHILE
LOWER EXTRACTION LEADS HEMATOGENOUS SPREAD
-STAPHYLOCOCCUS MAINLY IN DIRECT SPREAD
AND STREPTOCOCCUS FOR HEMATOGENOUS SPREAD

9. -IMMEDIATE EXRACTION WITH I&D
-3127 PATIENTS 0VER 5 YEARS
-CRITERIA WAS TYPICAL S&S PREOPERATIVELY WERE ACHING TOOTH,
EXTRAORAL SWELLING,TRISMUS,AND PUS IN TOOTH SOCKET
-EXTRACTION WAS DONE DISPITE OF CORMORBITS
-91% WAS DONE UNDER GA
-I&D DONE WITH DRAINS PLACED WHEREVER NECESSARY
-COMPLICATION 3%-MINOR
-DRY SOCKET
-POSTOPERAVITE ABSCESSES REQUIRING I&D

10. -EXTRACTION OF TEETH IN A SETTING OF ACUTE INFECTION WAS
SAFE(BEFORE STUDY)
-BUT AFTER HIS STUDY HE NOTED TO RESOLVE THE INFECTION BEFORE
EXTRACTION
-THIS STUDY WAS BASED ON STANDART TREATMENT FOR SUBACUTE
PERICORONITIS:-WARM SALINE IRRIGATION
-INSERTION OF 50% TRICHLOACETIC ACID
-NEUTRALIZATION WITH GYYCERIN
-WARM SALINE MOUTH RINSE EVERY 2 HOURS
-THIS ALWAYS ENSURED IMMEDIATE PAIN RELIEF THUS HE CHANGED THE ACI
FOR NORMAL SALINE FOR 152 PATIENT AND NOTED NONE HAD RAPID RELIEF
-ANOTHER TEST WAS TO DO EXTRACTION ON OPPOSED TOOTH THUS WAS
DONE ON 106 PATIENT AND WHEN THE INFECTION WAS SEVERE HE
RECOMMENDED PENICILLIN WHICH WAS SATISFACTORY FOR MOST PATIENT
-HE NOTED THE PERCENTAGE OF DRY SOCKETS WAS ALMOST THE SAME
WHETHER THE TEETH WERE REMOVED IMMEDIATELY OR DELAYED
(MANY THOUGHT AT THIS TIME WAS EARLY EXTRACTION=DRY SOCKET)

11. -ANOTHER STUDIES WAS DONE ON ACTION OF PENICILLIN ON
DEVELOPMENT
OF ALVEOLAR OSTEITIS
-28 PATIENTS WITH PERICORONITIS WHOM IMMEDIATE EXTRACTION WAS
PERFORMED,20 SUFFERED DRY SOCKET(71%)
-NEXT 25 PATIENT GIVEN PREOP ANTIBIOTIC PENICILLIN G IM 0.5 HR
BEFORE EXTRACTION,2 SUFFERED DRY SOCKET(8%)
-ANOTHER STUDY WAS MADE ON 3RD MOLAR EXTRACTION AND 3 GROUP
MADE:- 1-EXTRACTION UNDER LA WITHOUT ANTIBIOTICS-24% DEVELOP
AO
2-EXTRACTION UNDER LA WITH SINGLE DOSE PREOP
ANTIBIOTICS- . 3.6% DEVELOP AO
3-EXTRACTION UNDER GA WITH 3 DAYS PREOP ANTIBIOTIC-2.6%
. DEVELOP AO

12. -THEY REPORTED 5 CASE OF CNS INFECTION OF DENTAL ORIGIN WHERE
3 RECOVERED AND 2 DIED
-2 CASE OF BRAIN ABCESS AND 3 CASE OF SUBDURAL EMPYEMA
-4 DEVELOPED SYMPTOM S AFTER TOOTH EXTRACTION ,THE SYMPTOMS
VARIED FROM 4DAYS TP 4 WEEKS
-SYMPTOMS ARE HEADCHES,CONCULSION,HEMIPARESIS OR HEMISENSORY
DEFICITS
-IN 3 CASES TH E SUPPURATION WAS STERILE
-IN 1 CASE MICROCOCCUS FOETIDUS WAS CULTURED
-IN ANOTHER CASE STREPTOCOCCUS VIRIDANS AND
HAEMOPHILUS PARAINFLUENZAE WERE CULTURED
-POSTERIOR TOOTH WAS LIKELY TO CONTRIBUTE TO INTRACRANIAL
INFECTION
-EVEN THOUGH INTRACRANIAL COMPLICATION ARE RARE BUT MORTILITY
RATES ARE HIGH
-THUS EARLY DETECTION OF INTRACRANIAL COMPLICATION ARE CRUCIAL

13. -350 PATIENT WITH DENTAL CELLULITIS WERE RANDOMLY ASSIGNED TO
2 TREATMENT GROUP:- A-EXRACTION ON THE SAME DAY
B-EXTRACTION AFTER 4 DAYS OF ANTIBIOTICS
-ALL PROCEDURE DONE UNDER LA EXCEPT 6% DONE UNDER GA AND
I&D DONE WHENEVER NEEDED
-CONCLUSION WAS PATIENT WITH IMMEDIATE EXTRACTION HAD BETTER
PAIN RELIEF,ORAL TEMPERATURE CONTROL,SWELLING RESOLVED AND
PATIENT WITH DELAYED EXTRACTION HAD TWICE THE NEED FOR
I&D(EXTRAORAL AND INTRAORAL)
-EITHER GROUP EXHIBITED CNS OR LIFE THREATENING COMPLICATION.

14. -REMOVAL OF IMPACTED LOWER 3RD MOLAR REMOVAL IN 988 PATIENTS
WITH ACUTE PERICORONITIS
-94% DONE UNDER LA,85% PE.88% NO ANTIBIOTICS
-2% DEVELOP POST OP ABCESS WHICH NEEDED I&D AND 98% NO POST OP
COMPLICATIONS
-HIS CONCLUSION DELAYED EXTRACTION CAN LEAD TO SEPTECEMIA,
OSTEOMYELITIS,CELLULITIS OR PARAPHARYNGEAL ABCESS.
-IF SYSTEMIC SYMPTOMS PRESENTS START SYSTEMIC ANTIBIOTICS

15. 1975
-EXTRACTION DONE IN 1376 INFECTED TEETH,327 HAD FASCIAL
SPACE INFECTION
-NO SERIOUS COMPLICATION WAS NOTED IN THIS STUDY
-1 PATIENT HAD MILD OSTEMYELITIS WHICH RESOLVE ON ANTIBIOTICS
1978
-720 PATIENT WITH LOWER 3RD MOLAR WITH ACUTE PERICORONITIS WITH
CLASIC IFLAMMATORY SYMPTOM (5 S&S)
-72% WAS PE,95% DONE UNDER LA,19% NEEDED I&D
-NO SUTURE(SOCKET) OR ANTIBIOTICS USED
-SELECTED PATIENT WITH FACIAL SPACE INFECTION GIVEN
SYSTEMIC ANTIBIOTICS POST OP
-NO SERIOUS CNS OR LIFE THREATENING COMPLICATIN
-1.67%(6 PATIENT) DEVELOPED POST OP FACIAL INFECTION
5(SUBMANDIBULAR SPACE INFECTION),1(PARAPHYRANGEAL SPACE INFECTION
THE INVESTIGATORS ATTRIBUTED THESE COMPLICATION DUE TO DELAYED
SURGICAL INTERVENTION AND NOT DUE TO SURGICAL INTERVENTION ITSELF

16. -18 STUDIES DONE ON 2456 PATIENT WHO RECIVED ANTIBIOTICS
IMMEDIATELY BEFORE AND/OR JUST AFTER TOOTH EXTRACTION
-CONSLUSION THE ANTIBIOTICS REDUCE THE RISK OF INFECTION,DRY SOCKE
AND PAIN FOLLOWING THID MOLAR EXTRACTION
-STATES TO RELIEF THE INFECTION BY USING ANTIBIOTICS THAN DO THE
EXTRACTION

17. CONCLUSION
THOSE TIME EXTRACTION WAS DONE IMMEDIATELY DUE TO LACK OF
UNDERSTANDING AND DEVELOPMENT OF ANTIBIOTICS,THUS THE
CONTROVERSIAL OR EXTRACTION CAME TO A RISE
THE NEWER ARTICLE NOTES ON RELIEF OF INFECTION THAN TO UNDERGO
EXTRACTION
AS SEEN MULTIPLE COMPLICATION DOES ARISE FROM IMMEDIATE
EXTRACTION ,ITS COMPLICATION CAN EVEN LEAD TO DEATH
MEDICAL ISSUES SHOULD ALSO BE NOTED AS THIS MAY EFFECT THE
PATHOLOGY OF HEALING THUS TREATMENT PLAN ALSO SHOULD BE
MODIFFIED FOLLOWING EACH MEDICAL ISSUE
A TREATMENT SHOULD BE DELAYED(ANTIBIOTICS OR I&D),BUT AN
EXTRACTION CAN BE DELAYED