In people undergoing dentoalveolar surgery, the pre-emptive use of co-amoxiclav along with postoperative amoxicillin or metronidazole was efficient to reduce pain and extenuated the severity and incidence of the post-surgical extraction infection and dry socket.

A randomized controlled study was held to compare the efficacy of various oral antibiotics to avoid infection and dry sockets in adults after surgical extraction of teeth under local anesthesia.

A total of 46 patients were randomly segregated into 3 groups: (a) Postoperative co-amoxiclav (625 mg) group (n=16), (b) Preoperative co-amoxiclav (625 mg) + postoperative metronidazole (500 mg) group (n=15), and (c) Preoperative co-amoxiclav (625 mg) + postoperative amoxicillin (500 mg) group (n=15).

The postoperative signs of infection and alveolar osteitis were estimated by a dental surgeon after 5 days of surgery. With the utilization of standard 100 mm visual analogue scales (VAS), the post-surgical extraction pain was assessed by the patients immediately and after 5 days of the surgery. With the aid of VAS, the difficulty of surgery was also documented for all patients just after the surgery.

All the antibiotics employed in the trial were found to be efficient. Notably, 2% of the patients showed  oral infections and 15% showed painful alveolar osteitis. Compared to the co-amoxiclav group at 5 days post-surgery, no substantial reduction in the number of patients with infection or alveolar osteitis for co-amoxiclav + metronidazole and co-amoxiclav + amoxicillin groups was observed.

In comparison with co-amoxiclav and amoxicillin, metronidazole was more clinically efficient to protect the extracted tooth socket from alveolar osteitis. Additionally, compared with the pain levels immediately after surgery, the mean pain scores reduced profoundly 5 days following the operation. Participants in the metronidazole group exhibited minimized incidence of dry socket.

To reduce the occurrence of infection and alveolar osteitis post-surgery, the administration of a single preoperative dose of co-amoxiclav with a full postoperative dose of metronidazole or amoxicillin seems to be more efficient than conventional treatment with postoperative co-amoxiclav.