Question: Good morning,

I am very concerned because I had three wisdom teeth extracted yesterday and I am afraid that the standards of care were not followed. One of them was impacted and required a surgical approach and they used bone graft on both lower sites following the extractions. I am afraid that the DDS who did the procedure did not take all the measures to prevent infections and I am very scared that this can cause me a lot of issues in the future. Right before the surgery I asked the team what they would use to clean my mouth. The assistant said that they would not use anything. Then, when the surgeon came in, I asked him the same question and he looked at me like I was crazy and said that they, in fact, would not use anything. I asked again, so you don't clean with iodine or anything at all? He said no. I frowned and was trying to make sense of his answer. Then I thought to myself: well, maybe it is because the mouth is so dirty that there is no point. While that was happening they were already starting the laughing gas and he pushed the midazolam in my IV. Next thing I know, the procedure is done and I am going home.

This morning, with a little more mental clarity, I started reading about the protocols for oral surgery and bone grafting and they all say that chlorhexidine is usually used as a rinse or iodine swabs can substitute but it is critical that asepsis be done prior to a procedure like the one I had, mostly because bone grafts were used.

I am freaking out now and I am extremely mad for not advocating for myself; yesterday, I was scared to death as it was the first time that I had any sort of surgery and anesthesia and I did not even have enough time to think and challenge the DDS's answer. As a nurse, I have read a lot about clean VS sterile procedures but I have no experience whatsoever in oral surgery protocols. Also, I am very concerned because, despite all the contact isolation measures used in hospitals, I could have been exposed to MRSA the night before the procedure given that both of my patients were positive for it.

So, I have three questions for the forum:

1) What is the current evidence-based practice accepted by the dentist community on this matter? Should the DDS have at least rinsed my mouth prior to the procedure?
2) What can I do in order to prevent complications such as osteomyelitis. Should I ask him for a prescription for additional antibiotics that are known to be effective against MRSA. I am currently taking amoxicillin only.
3) Unfortunately, I cannot go back and stop the procedure. When can I stop worrying about this? How long after the surgery an infection is still likely?