Mikrobiol. Z. 2021; 83(6):41-48.
doi: https://doi.org/10.15407/microbiolj83.06.041

Species Composition and Susceptibility to Antibiotics of Microorganisms Isolated from
Tooth Sockets of Extracted Teeth in Cases of Alveolar Osteitis

V.O. Malanchuk1, A. Javadiasl1, A.V. Rybachuk1, M.V. Oblap1, V.V. Potochilova2

1Bogomolets National Medical University
1 Zoologichna Str., Kyiv, 03057, Ukraine

2Kyiv Regional Clinical Hospital
1 Baggovutivska Str., Kyiv, 04106, Ukraine

Alveolar osteitis (AO) is one of the most common infectious complications after dental extractions. The data on the species composition of AO pathogens and their susceptibility to antimicrobial drugs can be the basis for their empirical use in case of inflammatory process aggravation. Objective. To determine  the species composition and susceptibility to the antimicrobial agents of microorganisms, which were detected in patients with AO, who sought medical help in the oral surgery department of the dental medical center of Bogomolets National Medical University. Methods. Throughout 2018–2021, microbiological examination of tooth sockets from 30 patients with AO and 20 patients without AO was performed. The studied biological material was plated on appropriate nutrient media for isolation of aerobic, facultative and obligate-anaerobic microorganisms. Anaerobic conditions were achieved in GENbox 7.0 L and GENbox 2.5 L aerostats using GENbox anaerobic packages (“Biomerieux”, France). The genus and species identity of the bacteria were determined according to Bergey. Antibiotic susceptibility of the isolated strains was determined by disk diffusion method. Results. It was found that most commonly microorganisms from tooth sockets in case of AO are: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Escherichia coli, Bacteroides spp., Clostridium spp., and Candida species, as well as their mixed cultures of 3–5 species of microorganisms. These aerobic and facultative anaerobic bacteria were susceptible to amoxicillin, ceftriaxone and ciprofloxacin in 92.6–100% of cases. The growth of anaerobic bacteria in 100% of cases was inhibited by colistin and meropenem. Conclusions. AO developing is caused by pathological colonization of socket of the extracted tooth by representatives of endogenous microbiota, namely Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Escherichia coli, which are present mainly in the mixed cultures with Candida albicans. For empirical antibiotic therapy of complicated forms of AO, amoxicillin or ceftriaxone or ciprofloxacin in complex with colistin or meropenem should be used, since these drugs suppress the growth of 92.6–100% of strains of aerobic, facultative and obligate anaerobic microorganisms, which are potential pathogens of the purulent forms of AO.

Keywords: alveolar osteitis, alveolar osteitis pathogens, complication after tooth extraction, susceptibility to antimicrobial drugs.

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  1. Dym H, Orrett EO. Oral surgery for the general dentist, an issue of dental clinics. Elsevier Health Sciences. 2011; 56(1):82.
  2. Poeschl PW, Eckel D, Poeschl E. Prophylactic antibiotic treatment in third molar surgery — a necessity. J. Oral Maxillofac Surg. 2004; 62(1):3–8. https://doi.org/10.1016/j.joms.2003.05.004
  3. Bragger U, Schild U, Lang NP. Radiographic parameters. J Clin Periodontol. 1994; 21(6):422–30. https://doi.org/10.1111/j.1600-051X.1994.tb00740.x
  4. Noroozi AR, Philbert RF. Modern concepts in understanding and management of the “dry socket” syndrome: comprehensive review of the literature. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2009; 107(1):30–5. https://doi.org/10.1016/j.tripleo.2008.05.043
  5. Fernandes GJ, Hatton MN. Prevention of Alveolar Osteitis: A Case Report and Review of Literature. Journal of the Michigan Dental Association. 2017; 82(1):21–5.
  6. Noneva NO. [Rationale for the use of new antiseptic agents for the prevention and treatment of alveolar osteitis, candidate dissertation]. 2009:44. Russian.
  7. Potochilova V, Samarin D, Yukhimenko O. [Method of isolation of anaerobic pathogens from cranial cavity in patients with acute necrotizing pancreatitis]. Patent of Ukraine 128512, N u 2018 020236; statement 05.03.2018; published: 25.09.2019, ballot N 18. Ukrainian.
  8. Bergey’s Manual of Systematic Bacteriology–Springer–Verlag: New York; 2012.
  9. Kirby-Bauer disk diffusion susceptibility test protocol. Washington: American Society for Microbiology; 2009.
  10. Kulaeva E. [Treatment of alveolar osteitis using low-intensity laser radiation and modern pharmacological agents]. Tver: Tver state medical university; 2019. Russian.
  11. Borodulina I, Lantsova ES, Zheleznova EA, Solovyeva TL. [Microbiocenosis of a tooth socket in the development of alveolar osteitis]. Medico-pharmaceutical journal Pulase. 2008; 4:614. Russian.
  12. Belanov GN. [Comprehensive treatment of patients with alveolitis using biogenic materials with antimicrobial effects]. Samara: Samara state medical university; 2009. Russian.
  13. Torres-Lagares D, Serrera-Figallo MA, Romero-Ru´ız MM, Infante-Cossío P, García-Calderón M, Gutiérrez-Pérez JL. Update on dry socket: a review of the literature. Medicina Oral, Patologia Oral y Cirugia Bucal. 2005; 10(1):77–85.
  14. Tarasenko IV, Volozhin AI, Barer GM, Tarasenko SV, Tsarev VN, Zuyrjv YA , et al. [Experimental justification and clinical application of ER, CR: YSGG laser in the complex treatment of chronic generalized periodontitis]. Russian stomatological journal. 2009; 1:15–8. Russian.
  15. Yaromenko AI. [Some aspects of etiotropic therapy of infectious and inflammatory diseases of the maxillofacial region in elderly and old people]. In: Thesis of 5th international conference maxillofacial surgeons and dentists; 2000 May 21–22, Saint Petersburg, Russia. 2000. p. 208–9. Russian.
  16. Hedstrom L, Sjogren P. Effect estimates and methodological quality of randomized controlled trials about prevention of alveolar osteitis following tooth extraction: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont. 2007; 103(1):8–15. https://doi.org/10.1016/j.tripleo.2006.01.007
  17. Freudenthal N, SternuddM, Jansson L, Wannfors K. A double-blind randomized study evaluating the effect of intra-alveolar chlorhexidine gel on alveolar osteitis after removal of mandibular third molars. J Oral Maxillofac Surg. 2015; 73:600–5. https://doi.org/10.1016/j.joms.2014.08.035
  18. Sokolova EA, Sherbovskikh AE. Treatment of alveolar osteitis with osteoplastic materials taking into account the spectrum of antibacterial activity of antiseptic drugs. Student Science and Medicine of the XXI Century: Traditions, Innovations and Priorities. 2010:299–300.
  19. Nathani DB, Sequeira J, Sripathi Rao BH. Comparison of platelet rich plasma and synthetic graft material for bone regeneration after third molar extraction. Annals of maxillofacial surgery. 2015; 5(2):213. https://doi.org/10.4103/2231-0746.175762
  20. Dutta SR, Passi D, Singh P,Sharma S, Mahinder Singh, Srivastava D. A randomized comparative prospective study of platelet-rich plasma, platelet-rich fibrin, and hydroxyapatite as a graft material for mandibular third molar extraction socket healing. National journal of maxillofacial surgery. 2016; 7(1):45. https://doi.org/10.4103/0975-5950.196124
  21. Nebu GT, Sanil GP, Rajmohan G, Prabhakaran JV, Panda AK. Fabrication and anti-microbial evaluation of drug loaded polylactide space filler intended for ridge preservation following tooth extraction. Journal of Indian Society of Periodontology. 2011; 15(3):260. https://doi.org/10.4103/0972-124X.85671