Are prophylactic oral antibiotics indicated for the treatment of intraoral wounds?

Patients with intraoral and oral-cutaneous wounds commonly present to emergency departments (EDs), usually after sustaining blunt facial trauma. Many of these wounds are minor, small (<1 cm), hemostatic on presentation, and confined to the oral mucosa, requiring no specific intervention. Some of these injuries, however, do require wound repair, in particular large mucosal wounds (1 to 2 cm) and those that communicate with the overlying facial skin ("through-and-through" wounds). Most emergency medicine textbooks consider these larger wounds to be at significant risk for infection because of oral bacterial flora and thus recommend that a course of prophylactic antibiotics be prescribed when primary repair of these wounds is performed in the ED, in addition to routine oral and local wound care. However, studies have shown that other wounds commonly considered to be at significant risk for secondary infection, such as simple lacerations of the hand, do not appear to conclusively benefit from prophylactic antibiotic therapy when careful wound preparation is performed before primary repair. We therefore reviewed the available literature to determine the strength of evidence supporting the use of prophylactic oral antibiotics for intraoral wounds treated and repaired in the ED.