ALVEOLAR OSTEITIS ( DRY SOCKET )

ALVEOLAR OSTEITIS ( DRY SOCKET)

ALVEOLAR OSTEITIS  as we commonly know as DRY SOCKET is a painful condition following a extraction in which patient experiences a severe, throbbing pain at the extraction site because of a exposed bone. We all know blood clot is formed after a extraction at the extraction site but if it fails to form or gets dislodged or lysed because of any reason it leaves a denuded bone where nerves are exposed, that leads to severe pain.

• SIGNS AND SYMPTOMS - 

• severe pain
• radiating pain may reach upto preauricular area
• usually felt after 3-5 days of extraction
• sometimes even not gets relieved by pain killers.
• pain may last upto 2-3 weeks post extraction

•  HOW TO DIAGNOSE? 

o   A definite diagnosis can be made based on following symptoms :-

§  Bone exposure

§  Absence of facial swelling or swelling of the lymph nodes

§  Pain when the extraction site is irrigated/flushed with fluids.

o    One should rule out local pathologies by performing an intra oral and extra oral examination:

§  Check if  there is any remaining root tip that may cause pain.

§  Check for the infection source at the extraction site like accumulation of food debris.

§  Check for any adjacent tooth pathology.

§  Check for trismus.

·        HOW IT CAN BE PREVENTED?

1.    A traumatic extraction can help.

2.    Rinsing with chlorhexidine (0.12% or 0.2%) or placing chlorhexidine gel (0.2%) in the sockets.

3.    prophylactic antibiotics reduce the risk of dry socket.

4.    Antifibrinolytic agents applied to the socket after the extraction may reduce the risk of dry socket.

5.    One should routinely debride the bony walls of the socket to encourage hemorrhage (bleeding).

6.    Dental extractions in females taking oral contraceptives be scheduled on days without estrogen supplementation (typically days 23–28 of the menstrual cycle).

7.    Teeth to be extracted should be scaled prior to the procedure.

·         CAUSES:-

o   Mouth rinsing:- Excessive mouth rinsing can also dislodge the clot and can cause dry socket.

o   Extraction site:- Posteriors usually mandibular are more prone to dry socket because of difficulty in cleaning.

o   Infection:- Infection already present in the form of pericoronitis or calculus can also cause a dry socket.

o   Smoking:- Smoking causes vasoconstriction of the blood vessels thus by can be a cause of dry socket.

o   Surgical trauma:- A inexperienced surgeon or a traumatic extraction can also cause dry socket.

o   Vasoconstrictors:- Mostly present in L.A causes a reduction in blood supply that can also be the cause.

o   Radiotherapy :-causes a reduction in the blood supply.

·        TREATMENT:-

1.    First of all pain should be controlled with various available dressing material like  Alvogy paste, DRESSOL-X, zinc oxide and eugenol impregnated cotton pellets, dentalone, bismuth subnitrate and iodoform paste (BIPP) on ribbon gauze and metronidazole and lidocaine ointment.

o    Site should be irrigated with saline or chlorhexidine.

o    Instruct the patient to maintain good oral hygiene.

o    Instruct patient to avoid local irritating factors.

2.    Use postoperative analgesics such as NSAIDs.