Rational utilization of antibiotic prophylaxis in oral and maxillofacial surgery: a large scope review of recent data

Surgical site infections raise the risk of serious health issues following oral and maxillofacial surgeries. There is full consensus that using systemic antibiotics as a prophylactic measure can reduce infection risk in oral and maxillofacial surgical procedures, but the optimal duration and effective usage of these antibiotics remains debated. In light of growing antibiotic resistance, prophylactic use of antibiotics should be evaluated carefully and limited to certain scenarios. Thus, the aim of this scoping review was to summarize the available data regarding the prudent and evidence-based application of prophylactic antibiotics in the realm of oral and maxillofacial surgical interventions. A comprehensive literature search was conducted using published studies from 2000 to 2025 across the Ovid MEDLINE, PubMed, Web of Science, Embase, and Google Scholar databases. We included 25 randomized controlled trials, 60 cohort studies, and 40 systematic reviews. According to the included articles, infection rates ranged from 0% to 62% depending on surgery type. Moreover, various antibiotic types and regimens were used, and in most studies, the follow-up period was short, and the outcomes were not clearly defined. The choice of prophylactic antibiotics depends on the specific surgical procedure and the level of contamination involved. The use of prophylactic antibiotics is advised for surgical extractions of third molars, temporomandibular joint replacements, and clean-contaminated tumor removal surgeries. In compound fractures of the mandible, maxillofacial fractures, and those communicating with paranasal sinuses, prescribing a postoperative course of antibiotics for at least 24 h is necessary, but extended use doesn’t lower infection rates. For dental implants, the evidence supporting prophylaxis in healthy individuals is weak. Prophylactic antibiotics are not routinely advised for fractures of the upper or midfacial thirds. The included studies exhibited substantial differences in design and objectives, making direct comparisons challenging. The findings underscore the importance of short-course, targeted prophylaxis over prolonged empirical regimens to curb resistance. Attention to antimicrobial stewardship and strict adherence to guidelines for antibiotic prophylaxis in oral and maxillofacial surgery are essential to reduce antibiotic misuse and improve the quality of study. More studies are required to provide recommendations for maxillofacial surgical interventions in immunocompromised patients.