| Exodontia.Info |
Dry Socket, also known as dento-alveolar osteitis,
alveolar osteitis, alveolitis, focal osteomyelitis without
suppuration, alveolalgia, alveolitis sicca dolorosa and
alveolar periostitis, is a well-recognised complication
of tooth extraction.
It is characterised by increasingly severe pain in and around
the extraction site usually starting on the 2 – 4 post-
operative day and can last for 10 – 40 days.
The pain radiates typically to the ear. The normal post-
extraction blood clot is absent from the tooth socket; the
bony walls of the socket are bare and exquisitely sensitive
to even gentle probing. Bad breath and an unpleasant
taste in the mouth are invariably present.
The condition probably arises as a result of a complex
interaction between surgical trauma, local bacterial infection
and various systemic factors.
The incidence rate probably lies somewhere between 3 -
20% of all extractions with lower pre-molar and molar
sockets most commonly involved.
alveolar osteitis, alveolitis, focal osteomyelitis without
suppuration, alveolalgia, alveolitis sicca dolorosa and
alveolar periostitis, is a well-recognised complication
of tooth extraction.
It is characterised by increasingly severe pain in and around
the extraction site usually starting on the 2 – 4 post-
operative day and can last for 10 – 40 days.
The pain radiates typically to the ear. The normal post-
extraction blood clot is absent from the tooth socket; the
bony walls of the socket are bare and exquisitely sensitive
to even gentle probing. Bad breath and an unpleasant
taste in the mouth are invariably present.
The condition probably arises as a result of a complex
interaction between surgical trauma, local bacterial infection
and various systemic factors.
The incidence rate probably lies somewhere between 3 -
20% of all extractions with lower pre-molar and molar
sockets most commonly involved.
| Prevention & Management of Dry Socket |
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| Photograph of Dry Socket in the socket of the Upper Left 2nd Molar |
- Extraction of ‘wisdom teeth’ especially impacted
lower ‘wisdom teeth’. - Traumatic & difficult extractions.
- Oral / depot contraception.
- Immunosuppressant drugs such as steroids,
cyclosporine & methotrexate. - Active / recent history of Acute Ulcerative Gingivitis
(‘Trench Mouth’) or Pericoronitis (infection /
inflammation around the crown of a tooth)
associated with the tooth to be extracted. - Smoking (> 20 cigarettes per day).
- Increased bone density either locally or generally
(eg. Paget’s Disease & Osteopetrosis). - Previous history of ‘dry sockets’ following extractions.
PREVENTIVE MEASURES FOR THE PATIENT
- Wherever possible pre-operative oral hygiene
measures to reduce plaque levels to a minimum
should be instituted, such as using an antiseptic
mouthwash. - Patients who smoke should stop before the tooth
extraction and for at least two weeks post-extraction
whilst the socket(s) heals. - Patients should avoid vigorous mouth rinsing for the
first 24 hours post extraction and to use gentle tooth
brushing and mouth rinses for 7 days post-extraction. - Patients should return to the Oral Surgeon / Dentist
immediately they develop increasing pain from the
extraction socket, awful taste in the mouth or bad
breath.
DRY SOCKET TREATMENT
- The infected socket is gently irrigated with an
antiseptic mouthwash. - The socket is packed with a dressing that contains
sedative and antiseptic ingredients. The dressing
prevents the accumulation of food debris in the
extraction socket, protects the exposed bone from
local irritation and calms down the inflammation-
infection within the extraction socket walls. - Antibiotics may be prescribed or changed (if already
on Painkillers will still need to be taken until the
effects of the sedative dressing become apparent
and the infection has started to clear. - If the pain does not settle within 48 hours, then get
back in contact with the Oral Surgeon / Dentist.
Useful Website & Articles:
Management and Prevention of Dry Socket
Anesth Prog 1990. Clinical Reports. Alveolar Osteitis
Following Surgical Removal of Mandibular Third Molars
Medicina Oral S 2005. Intra-alveolar chlorhexidine gel for
the prevention of dry socket in mandibular third molar
surgery. A pilot study
Evidence-Based Dentistry 2008. Chlorhexidine Gel
reduces Incidence of Alveolar Osteitis after Extraction of
the Mandibular 3rd Molars
Pakistan Oral & Dental Journal 2009. Alveolar Osteitis -
Incidence & Risk Factors Following Third Molar Surgery
In Jordan
University of Toronto, Faculty of Dentistry 2009. Alveolar
Osteitis Prevention Strategies in Third Molar Extractions.
An Evidence-Based Review.
J Oral Maxillofac Surg 2010. Clinical Concepts of Dry
Socket
J Oral Maxillofac Surg 2011. Factors Affecting Incidence
of Dry Socket. A Prospective Community-Based Study
J Oral Maxillofac Surg 2011. Comparison of Alvogyl,
SaliCept Patch & Low-Level Laser Therapy in the
Management of Alveolar Osteitis
| Last Updated 10th February 2012 |