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Chapter 474impact regarding wound healing delay. An animal study however, showed that gelfoam packing impregnated with medication enhanced early socket healing.53 The use of antibiotics to prevent AO and postoperative infection is still controversial, but recent studies and systematic reviews have demonstrated that systematic antibiotics significantly reduce the risk of dry socket and infection in third molar surgery.17,18,54 In a recent meta-analysis combining the results from 21 trials, the use of antibiotics reduced the risk of infection by 57% (RR=.43; 95% CI .33-.56). The efficacy of penicillin’s was slightly greater than the efficacy of nitroimidazoles.17 In a study of 1877 patients having 5631 third molars removed, the overall complication frequency in the group receiving postoperative antibiotics was 4.3% versus 7.5% in the group not receiving antibiotics.18However, the use of antibiotics puts patients at risk of adverse reactions, such as allergies or diarrhea, and contributes to the development of antibiotic resistance.55 Sekhar et al estimated that 6-7% of patients receiving antibiotics have adverse reactions.56 In the present study, no infections were found in the tampon sites. Therefore, the use of a tampon may be a good alternative for antibiotic prophylaxis in mandibular third molar surgery requiring bone removal. In the present study, all patients received an ice pack immediately after surgery. They were instructed to use the packs with a 10-min interval during the day of surgery until bedtime. However, Van der Westhuijzen et al. did not find any significant difference in postoperative swelling between the postoperative application of an ice pack and no ice application.57 The difference with the present study was that patients in the previous study received continuous ice packs for up to 21 h. The patient’s perception was that the control of postoperative pain and discomfort over the first 24 h was better with the ice packs.57Despite the strength of the methodology chosen for this study, there are still some limitations that must be considered when interpreting the results. The data acquired from the patients were all self-reported. The disadvantage of using subjective data is that it cannot be controlled and, therefore, involves a risk