Prevention & Management of Dry Socket

[DrAnil]

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.

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.

        

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