Dry Socket

What is Dry Socket? 

Dry socket or alveolar osteitis is delayed healing but is not associated with an infection.

What is the alternative name of Dry Socket? 

Fibrinolytic Alveolitis or alveolar osteitis.

How can we describe Dry Socket?

Appearance of the tooth extraction socket when the pain begins.

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When does it occur after Tooth Extraction? 

In the usual clinical course, pain develops on the third or
fourth day after removal of the tooth.

Dry Socket is Most commonly Associated with which teeth? 

Lower molars.

Findings on Examination:

On examination, the tooth socket appears to be empty, with a partially or completely lost blood clot, and some bony surfaces of the socket are exposed. The exposed bone is sensitive and is the source of the pain. The dull, aching pain is moderate to severe, usually throbbing in nature, and frequently radiates to the patient’s ear. The area of the socket has a bad odor, and the patient frequently complains of a foul taste.

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Cause of Dry Socket:

The cause of alveolar osteitis is not fully clear, but it appears to result from high levels of fibrinolytic activity in and around the tooth extraction socket. This fibrinolytic activity results in lysis of the blood clot and subsequent exposure of bone. The fibrinolytic activity may result from subclinical infections, inflammation of the marrow space of the bone, or other factors. The occurrence of a dry socket after a routine tooth extraction is rare (2% of extractions), but it is frequent after the removal of impacted mandibular third molars and other lower molars (20% of extractions in some series).

Prevention of Dry Socket: 

Prevention of the dry socket syndrome requires that the surgeon
minimize trauma and bacterial contamination in the area of surgery.
The surgeon should perform atraumatic surgery with clean incisions
and soft tissue reflection. After the surgical procedure, the wound
should be irrigated thoroughly with large quantities of saline delivered under pressure, such as from a plastic syringe. Small amounts of antibiotics (e.g., tetracycline) placed in the socket alone or on a gelatin sponge have been shown to substantially decrease the incidence of dry socket in mandibular third molars and other lower molar sockets. The incidence of dry socket can also be decreased by preoperative and postoperative rinses with antimicrobial mouth rinses such as chlorhexidine. Well-controlled studies indicate that the incidence of dry socket after impacted mandibular third molar surgery can be reduced by 50% or more with these measures.

Main goal of treating Dry Socket: 

The treatment of alveolar osteitis is dictated by the single therapeutic goal of relieving the patient’s pain during the period of healing. If the patient receives no treatment, no sequela other than continued pain exists (treatment does not hasten healing).

Treatment of Dry Socket :

Treatment is straightforward and consists of irrigation and insertion
of a medicated dressing. First, the tooth socket is gently irrigated
with sterile saline. The socket should not be curetted down to bare
bone because this increases the amount of exposed bone and the
pain. Usually, the entire blood clot is not lysed, and the part that is intact should be retained. The socket is gently suctioned of all excess saline, and a small strip of iodoform gauze soaked in or coated with the medication is inserted into the socket with a small tag of gauze left trailing out of the wound. The medication contains the following principal ingredients: eugenol, which obtunds the pain from the bone tissue; a topical anesthetic such as benzocaine; and a carrying vehicle such as balsam of Peru. The medication can be made by the surgeon’s pharmacist or can be obtained as a commercial preparation from dental supply houses.

Use of Medicated Gauze in Dry Socket: 

The medicated gauze is gently inserted into the socket, and the
patient usually experiences profound relief from pain within 5
minutes. The dressing is changed every other day for the next 3 to 6
days, depending on the severity of pain. The socket is gently irrigated with saline at each dressing change. Once the patient’s pain decreases, the dressing should not be replaced because it acts as a foreign body and further prolongs wound healing.

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