Also known as alveolar osteitis, alveolitis sicca dolorosa, infected socket.
• It occurs after about 3% of routine extractions.
• It is recognized by aching or throbbing type of pain at the site of extraction.
• The pain is remarkably constant in severity (including during night).
• It usually starts within a day or two after tooth extraction.
• The pain is often resistant to common analgesics.
• O/E it reveals a socket partly or totally devoid of blood clot with exposed, rough, painful bone.
• Grayish remnants of clot may be present.
• The surrounding mucosa and the whole alveolus may be red, swollen and tender.
• Inflammation spreads through the alveolus mesiodistally, as a result of which the adjacent teeth exhibit tenderness to percussion. As a result, the patient may believe that a wrong tooth has been extracted.
• The mouth smells and tastes foul (a smell of anaerobic bacterial activity or rotting meat).
• Local lymphadenitis may occur.
Precautions to reduce the occurrence of dry socket:
• By irrigating of the gingival crevice with chlorhexidine before extraction.
• Prophylactic administration of metronidazole prior to extraction may also reduce the incidence of dry socket, but it should be noted that routine prophylactic administration of antibiotics before extraction is not justified.
Common causes of dry socket:
• More frequent in smokers.
• There is possible relationship to female sex hormones.
• Most prevalent in patients in their 4th decade.
• More common after extractions of posterior and difficult teeth.
• More common in lower jaw than upper.
• More likely to occur after extraction under LA than under GA.
• Less frequent after multiple extractions.
• It is the outcome of a mixture of disease processes in which trauma, local fibrinolysis and bacterial clot degradation all play a part.
Diagnosis:
• Diagnosis can be done confidently on clinical grounds.
• IOPA is valuable as a baseline against which to check bone change and also to convince the patient that no root has been left behind.
Treatment:
• Treatment is primarily symptomatic.
• The socket should be irrigated with warm saline to remove the debris.
• A variety of antiseptic dressings is available to cover the exposed bone.
• A proprietary eugenol containing, soft, fibrous paste can be tucked into the coronal part of the socket to cover the bone. It can be left insitu and is usually shed spontaneously from the socket over a few days.
• Alternative dressings (each of which must be removed about a week later) include whitehead’s varnish on ribbon gauze, Bismuth Iodoform and paraffin paste on gauze (which may have lidocaine paste added to it).
Complication:
• In untreated cases of dry socket the infection may progress through the bone – marrow to result into osteomyelitis.
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