Alveolar osteitis (

[Anonymous]

Alveolar osteitis (dry socket) is the most common painful complication of tooth extraction that can arise within two to five days postoperatively without any apparent causative agent in most cases. The symptoms include local tenderness, bad breath, severe, persistent pain at the area of extraction that is typically radiates to the adjacent areas and do not easily relieved by analgesics. The extraction socket may contain necrotic debris with the absence of blood clot and obviously denuded alveolar bone .
The exact etiology of this condition is not firmly established , however, a presumed causative factors include severe trauma (attained during difficult extractions), cigarette smoking, poor oral hygiene, inadequate irrigation during surgical procedure, excessive use of local anesthesia (containing vasoconstrictor) and the experience of the dental surgeon. The condition may further be influenced by systemic illnesses such as diabetes mellitus, nutritional deficiencies or the use of oral contraceptives . The pathogenesis of this condition evolves around local disturbances of blood supply and local infection .

        

[Anonymous]

Risk factors: What causes dry sockets?

Dental research has not yet been able to determine the exact chain of events that causes dry sockets. It has, however, been able to identify a number of factors that seem to place a person at greater risk for having one.
A) Patients who don’t follow their dentist’s postoperative instructions have a greater incidence of dry sockets.

We’ve listed this factor first because this is absolutely something that every dental patient has a great amount of control over.
Dentists give instructions for a reason.

It’s a fact. People who follow their dentist’s instructions after having a tooth extracted (especially those instructions involving blood clot formation and protection) will have fewer postoperative complications.
You can help to prevent a dry socket by helping a proper blood clot form.
1) Proper blood clot formation helps to prevent dry sockets.

Most dentists will advise their patients that:

* After having their tooth pulled they should place firm biting pressure on the gauze packing that has been placed over their extraction site for the next 30, and preferably, 60 minutes.
* Doing so will help to insure that a proper blood clot has a chance to form in the tooth socket.

2) Protecting the blood clot that has formed will help to prevent a dry socket.

Once a blood clot has formed, a patient must be careful not to disrupt it.

* During the first 24 hours after an extraction a dental patient should avoid vigorous rinsing, refrain from actions like sucking on a straw or cigarette, avoid alcohol and tobacco use in general, minimize physical stress and exercise, and avoid hot liquids such as coffee and soup.

Of course, all of the instructions given on this page are generalized. Your dentist should provide you with those postoperative instructions that they feel are important for your specific situation. If they don’t, just ask.
B) Dental patients who have had a dry socket before are at greater risk for developing a dry socket with future extractions.

If you’ve had a dry socket before, you should consider yourself to be at somewhat greater risk for experiencing one again.

There can be a number of factors involved in this type of situation, many of which you don’t have any control over. However, it’s also quite possible that your previous dry socket experience was simply due to the fact that you didn’t follow your dentist’s postoperative instructions as closely as you should have.

Whatever the circumstances or cause, be smart. Help to minimize your potential for having a dry socket this time around by strictly adhering to proper post-extraction protocol.
C) Difficult tooth extractions are more likely to result in dry socket formation.

All dentists know that there seems to be a correlation between the amount of tissue trauma created during the tooth extraction process and the potential for the patient to develop a dry socket. For example, surgical tooth extractions generally have a tenfold higher incidence rate of dry socket formation that routine extractions.
Why does this relationship exist?

The general hypothesis is that the traumatized bone in the area of the extraction site releases compounds (tissue activators) that then diffuse into the socket’s blood clot. These tissue activators cause the blood clot to disintegrate, thus leading to the formation of a dry socket.

As a side note: It’s also thought that some of the compounds released during this process (kinins) stimulate pain receptors, and therefore are responsible for much of the pain associated with having a dry socket.
Your dentist may or may not know how much surgical trauma will take place during your extraction.

The amount of trauma caused by a tooth extraction might be planned or unplanned.
1) The "planned" traumatic extraction.

With some tooth extractions the dentist may know beforehand that it’s likely that a fair amount of tissue trauma will be created.

As an example, some impacted wisdom teeth are entirely encased in the jawbone. If so, the dentist will first need to make an incision through gum tissue and then remove that bone that lies over the impacted tooth, before they can even gain access to the tooth itself.

In comparison, when an erupted tooth having a normal positioning is extracted, the dentist already has direct access to the tooth and therefore no gum incision or bone tissue removal is needed.
2) The "unplanned" traumatic extraction.

A dentist may begin an extraction with the expectation that it will be an easy one and instead find out that it’s really going to be quite difficult. (This is why having a less experienced dentist perform your tooth extraction may place you at greater potential for having a dry socket.)

With a relatively more difficult extraction, the tissues surrounding the tooth will need to be manipulated more so and over a longer period of time. Both of these factors will result in comparatively more trauma to the area where the extraction has taken place. Due to this increased amount of trauma, the patient will be at greater risk for having a dry socket

        

[Anonymous]

Treatments of Dry Socket

Treatment of dry socket is mainly geared toward reducing its symptoms, particularly pain. Dry socket treatment includes:

*
Medicated dressings. This is the main way to treat dry socket. Your dentist or oral surgeon generally packs the socket with medicated dressings. You may need to have the dressings changed several times in the days after treatment starts. The severity of your pain and other symptoms determines how often you need to return for dressing changes or other treatment.
*
Flushing out the socket. Your dentist or oral surgeon flushes the socket to remove any food particles or other debris that has collected in the socket and that contributes to pain or infection.
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Pain medication. Talk to your doctor about which pain medications are best for your situation. If over-the-counter pain relievers aren’t effective, you may need a stronger prescription pain medication.
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Self-care. You may be instructed how to flush your socket at home to promote healing and eliminate debris. To do this, you’ll be given a plastic syringe with a curved tip to squirt water, salt water, mouthwash or a prescription rinse into the socket. You may need to continue to do this daily for three or four weeks.

Once treatment is started, you may begin to feel some relief in just a few hours. Pain and other symptoms should continue to improve over the next few days. Complete healing typically goes smoothly and generally takes about 10 to 14 days.

        

[Anonymous]

ACTION OF ZOE

The pain from alveolar osteitis usually lasts for 24–72 hours. There is no real treatment for dry socket — it is a self-limiting condition that will improve and disappear with time — but certain interventions can significantly decrease pain during an episode of dry socket. These interventions usually consist of a gentle rinsing of the inflamed socket followed by the direct placement within the socket of some type of sedative dressing, which soothes the inflamed bone for a period of time and promotes tissue growth. This is usually done without anesthesia.[7] The active ingredients in these sedative dressings usually include substances like soluble aspirin, zinc oxide, eugenol, and oil of cloves. It is usually necessary to have this done for two or three consecutive days, although occasionally it can take longer. Because true dry socket pain is so intense, additional analgesics are sometimes prescribed.
A fresh Zinc oxide eugenol mix is then wrapped in the cotton pellet and the impregnated cotton gauze/pellet is then placed in the dry extraction socket site

* Metronidazole/Doxicycline (powdered/gel form) can also be added to the dressing to enhance antibiotic action
* Anesthetic gel, like lignocaine gel can also be added to provide additional pain relief.

Antibiotics like Amoxicillin may be prescribed to prevent any infections in and around the extraction site.

        

[Author]

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