Evaluation of the oral microbiota in surgical extraction of symptomless third molar enclosed: Oral hygiene instructions associated with chlorhexidine without antibiotic therapy

Background: Surgical site plaque accumulation is one of the problems that leads to bad healing. Of clinical rele-vance is the fact that the structure of the plaque biofilm might restrict the penetration of antimicrobial agents, while bacteria grows on the surface; only with mechanical therapy we can to destroy it. Antibiotic Prophylaxis (AP) represents a common but often misused procedure in dental practice, thus aggravating the risk for antimicrobial resistance and adverse effects occurrence. Aim of the study is to prove that on healthy individuals a good oral hygiene associated to an antiseptic is enough in order to prevent from infections. Methods: Randomly selecting healthy individuals for the extraction of the impacted symptomless mandibular third molar. We take a sample of dental plaque before the extraction and another one after 7 days, that will be subjected to microbiological analysis. To half of the selected patients (that for convenience we will call the "educated patients") we provide an accurate oral hygiene lesson using models and brushes in order to show the correct movements to be implemented; in addition, to that half of sample, we will prescribe Chlorhexidine (CHX) mouthwash and toothpaste and we will recommende to use them for the following 7 days twice a day (every 12 hours). Each patient will fill out a questionnaire in order to be divided into 3 groups: educated patients who didn't have AP and post-operative antibiotic therapy but used CHX; uneducated patients who didn't have AP and post-operative antibiotic therapy but used CHX; uneducated patients who didn't have AP and post-operative antibiotic therapy and didn't use CHX. Results: An efficient oral hygiene and the use every 12 hours of CHX gives hope for a faster and better healing of the treated gingival tissue and m a lower and less aggressive presence of bacterial plaque compared to patients who don't follow these measures. Conclusions: The plaque biofilm is the main cause of postoperative complications in the extraction of the third molar, and since we are not able to destroy it if not through the brushing, an exclusively antibiotic therapy would not pre-vent the infection. Providing a good education to oral health instructions is essential for oral cavity health. A mechanical therapy associated with the use of an antiseptic is sufficient to avoid an infection.