***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Abstract The use of systemic prophylactic antibiotics in third molar surgery is still a controversial issue . A double-blind study has been conducted with 75 selected patients r and omized into two groups . After exclusions , 68 patients requiring removal of 133 bone impacted m and ibular third molars remained . Surgery was carried out under general anesthesia and a St and ard operative technique used . Postoperative raorbidity was assessed by recording trismus , swelling , pain , and the incidence of infection . In the group given an antibiotic 15.1 % of patients and 7.8 % of sockets became infected ; in the control group the incidence was 14.3 % and 8.7 % , respectively . Difficult extraction s were more likely to give rise to postoperative infection , but neither the state of eruption nor the occurrence of previous pericoronitis appeared to predispose to dry socket . Trismus and swelling were associated with increased difficulty of extraction , but increased pain did not usually occur unless a socket became infected , Differences of overall morbidity between the groups were slight and not statistically significant . The main conclusion from the study is that the use of prophylactic antibiotics in third molar surgery is unnecessary unless specific systemic factors are present Treatment of osteitis after surgical removal of the third molar of the m and ible is still a clinical problem . A total of 140 patients undergoing operations for removal of an impacted third molar of the m and ible , were included in a double-blind study . Placebo or antibiotics - azidocillin , erythromycin , clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days . The concentrations in serum , alveolar serum and m and ibular bone were measured and the postoperative courses - pain , trismus , swelling and wound-healing - were recorded . No correlation was obtained between the antibiotic concentration and the postoperative complaints , except in the azidocillin group on day 2 , in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations . The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups . Only 15 operations lasted more than 15 min and the three of them which subsequently result ed in alveolitis were in the placebo groups . Antibiotics significantly reduced pain on day 7 postoperatively . In general , no statistically significant differences in trismus and swelling could be demonstrated between the patient groups . However , there was a significant difference between the placebo and doxycycline groups with respect to swelling ( day 2 postoperative , P < 0.01 ; day 5 postoperative , P < 0.05 ) . Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third m and ibular molars , but could decrease the rate of infections after traumatic operations PURPOSE This study evaluated the influence of antibiotic prophylaxis on postoperative complications after inferior third molar removal in young patients . PATIENTS AND METHODS We extracted 59 m and ibular third molars from 59 patients with a mean age of 15 years ( range , 12 - 19 years ) . The patients were included in the study when radiographs at the time of surgery showed that only the crown of the tooth germ was formed . Patients were r and omized into 2 groups , the test group and the control group . The test group received 2-g amoxicillin tablets 1 hour before surgery , and the control group received no antibiotic therapy .  The test group included 32 patients , 20 of whom were female and 12 were male ; the mean age was 15 years . The control group included 27 patients , 12 of whom were female and 15 were male ; the mean age was 15 years . Postoperative complications such as pain , swelling , wound infection , and fever were recorded by use of a question naire completed by the patient for the week after the extraction . Suture removal and question naire evaluation were performed by a surgeon who did not know the preoperative regimen . RESULTS The mean operating time was 34 minutes in the control group and 31 minutes in the test group . This difference was not significant . In the test group there was a statistically significant reduction of postoperative pain in the 7 days after the extraction , and the patients had a consistent minor consumption of analgesics . Swelling was always present in the control and test groups in the postoperative week , but in the test group it was a minor sequela and was absent in 2 patients . Wound infection was a sequela reported in 4 patients in the control group and in 1 patient in the test group ; this difference was statistically significant ( P < .01 ) . Fever was present in 2 patients in the control group and in 1 patient in the test group ; this difference was not statistically significant . CONCLUSIONS A statistically significant difference was found between patients receiving preoperative amoxicillin and the control group in the incidence of postoperative pain , fever , and wound infection . Another important finding was the statistically minor consumption of analgesics in the test group in the postoperative week AIM To test the efficacy of two dosing regimens of antimicrobial prophylaxis during the removal of impacted lower third molars . DESIGN Double blind , prospect i ve , placebo-controlled trial . SETTING Teaching hospital , India . SUBJECTS 151 patients aged 19 - 36 having impacted lower third molars removed . METHODS R and om allocation into three groups : placebo ( n= 34 ) , metronidazole 1 g orally , 1 hour preoperatively ( n= 44 ) , or metronidazole 400 mg orally eight hourly for 5 days postoperatively ( n= 47 ) . Patients were recalled on the sixth postoperative day for assessment of pain scores on the second and sixth days , swelling , differences in mouth opening between preoperative and the sixth postoperative day , and the state of the wound . RESULTS There were no significant differences in the outcome between the three groups ( P= 0.09 ) . CONCLUSION Antimicrobial prophylaxis does not seem to reduce morbidity after removal of lower third molars PURPOSE We sought to compare recovery for clinical and health-related quality of life ( HRQOL ) outcomes after third molar surgery in patients treated with or without intravenous antibiotics at surgery . PATIENTS AND METHODS Fifty-six patients at least 18 years of age and with all 4 third molars below the occlusal plane , treated at 3 clinical centers , were given intravenous antibiotics just before third molar surgery .  Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group ( n = 60 patients ) who did not receive antibiotics .  The control group was selected using the same criteria and treated under the same surgical protocol as the antibiotic group . Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics . RESULTS The incidence of delayed clinical recovery defined as a postsurgery visit with treatment was higher in the control group compared with the antibiotic group . In the antibiotic group , 4 % had 1 postsurgery visit with treatment ; no patient had 2 visits . In the control group without antibiotics , 28 % had at least 1 postsurgery visit with treatment ( P < .0001 ) and 13 % had at least 2 postsurgery visits with treatment . No statistically significant differences in HRQOL outcomes were found between the 2 groups . CONCLUSIONS Administration of intravenous antibiotics before third molar surgery may improve clinical recovery in healthy adult patients with all 4 third molars below the occlusal plane , a presenting characteristic that has been suggested as a risk factor for delayed recovery . The findings from this exploratory trial indicate that evaluation of the effectiveness of systemic antibiotic administration with third molar surgery in a r and omized , multi-intervention , explanatory clinical trial is warranted A double blind trial , was design ed , in which 118 patients undergoing the removal of impacted wisdom teeth were r and omly divided into the following groups ; 41 patients received Metronidazole , 39 patients received Arnica Montana , 38 patients received the placebo . Metronidazole was more effective in pain control than Arnica ( p less than 0.001 ) and placebo ( p less than 0.01 ) . It prevented swelling better than Arnica ( p less than 0.01 ) and placebo ( p less than 0.05 ) and was more effective in promoting healing than Arnica ( p less than 0.01 ) and placebo ( p greater than 0.02 ) . Arnica Montana appeared to give rise to greater pain than placebo ( p less than 0.05 ) and caused more swelling than the placebo ( p less than 0.01 ) Objective The purpose of the study was to determine if the intra-alveolar application of topical metronidazole gel could reduce the incidence of alveolar osteitis ( dry socket ) following routine tooth extraction in molar and premolar extraction sites . Design This was a multicentre , double blind , r and omised , placebo-controlled clinical trial . A total of 302 patients took part , of which 23 returned with alveolar osteitis . Of these , eight had received the metronidazole gel  and 15 the placebo . Setting The study was carried out in three general dental practice s by general dental practitioners working in Engl and over the period 2000 - 2003.Main outcome measures Following extraction of either a molar or premolar tooth , either a 25 % metronidazole gel or KY Jelly was syringed gently into the socket . A painful post operative complication was recorded if either a dry socket was present or the patient returned with pain . Results and conclusions The difference in the incidence of alveolar osteitis between the placebo and the active gel groups was not significant and it was concluded that 25 % topical metronidazole gel was not effective in reducing the incidence of alveolar osteitis . It was found that the incidence of alveolar osteitis reduced with increasing age and was more likely to occur in a patient with a previous history of the condition OBJECTIVES The purpose of this study was to examine the relationships between patient characteristics and reasons for extraction of permanent teeth .  METHODS 5131 dentists were selected from the list of the membership directory of the Japan Dental Association by systematic r and om selection . The dentists were asked to record the reason for each extraction of permanent teeth during a period from February 1 to 7 , 2005 . Reasons for tooth extraction were assigned to five groups : caries , fracture of teeth weakened by caries or endodontics , periodontal diseases , orthodontics and other reasons . We used cross tabulation and multiple logistic regression analysis to estimate the relationships between patient characteristics and reasons for tooth extraction . RESULTS 2001 dentists ( response rate of 39.0 % ) returned the forms , and complete information on 7333 patients was obtained . A total of 3,196 ( 43.6 % ) patients underwent tooth extraction due to caries and its sequela , and 2721 ( 37.1 % ) patients underwent tooth extraction due to periodontal disease . Multiple logistic regression analysis showed that denture wearers were more likely to undergo  tooth extraction  due to periodontal disease in all age groups ( p < 0.05 ) . Males tended to undergo  tooth extraction  due to periodontal disease than did females in all age groups ( p < 0.05 ) except for age group 30 - 49 . Subjects with 19 or less teeth were more likely to undergo  tooth extraction  due to periodontal disease in the age groups 30 - 49 ( p < 0.001 ) and 50 - 69 ( p < 0.001 ) . In the age group of 50 years or older , female ( p<0.01 ) and the possession of 20 or more natural teeth ( p < 0.05 ) were related to caries extraction . However , there was no clear relationship between caries extraction and patient characteristics under 50 years old . CONCLUSION There was a significant relationship between denture wearing and periodontal extraction .  In the middle aged population , patients with 19 or less teeth lost their teeth mainly due to periodontal disease The most common complications after surgical extraction of the third m and ibular molar are trismus , oedema or swelling , local pain , dysphagia and infection . The aim of this comparative , double-blind , r and omized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after third molar extractive surgery . A total of 225 patients were r and omized into three equal groups : placebo , prophylaxis with single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5 mg , and pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate 1000/62.5 mg BID for 5 days . A higher rate of infection ( P=0.006 ) was found among patients receiving placebo ( 16 % ) than those receiving single-dose prophylaxis ( 5.3 % ) or 5-day pre-emptive therapy ( 2.7 % ) . A relationship between both the duration ( 13.8 % for long versus 7.4 % for medium versus 1.6 % for short ) and difficulty ( 12.7 % with ostectomy versus 3.5 % without ostectomy ; P=0.011 ) of surgical procedure and incidence of subsequent infection was also observed . Both prophylactic and therapeutic regimens versus placebo achieved greater reduction of pain after surgery on day 3 ( P=0.001 ) . Logistic regression analysis 
    Output:
    
There is evidence that prophylactic antibiotics reduce the risk of infection , dry socket and pain following third molar extraction and result in an increase in mild and transient adverse effects .
However , patients at a higher risk of infection are more likely to benefit from prophylactic antibiotics , because infections in this group are likely to be more frequent , associated with complications and be more difficult to treat .
Due to the increasing prevalence of bacteria which are resistant to treatment by currently available antibiotics , clinicians should consider carefully whether treating 12 healthy patients with antibiotics to prevent one infection is likely to do more harm than good