Alveolar Osteitis (Dry Socket)
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Introduction
- The most frequent painful complication of extractions. Caused by destruction of the clot that normally fills the socket.
Predisposing Factors
- Excessive extraction trauma
- Limited local blood supply
- Local anaesthesia
- Oral contraceptives
- Osteosclerotic disease
- Radiotherapy
- Female gender
Clinical Features
- Pain delayed for few days up to a week after extraction
- Deep seated, throbbing pain
- Mucosa around socket is red and tender
- No clot in socket - bare whitish alveolar bone exposed
Differential Diagnoses
- Osteomyelitis
Complications
- Osteomyelitis
Treatment Goals
- Alleviate pain and suffering for the patient
- Optimize condition for healing and epitheliasation of the extraction socket
- Keep open socket clean and protect exposed bone
Non-drug Treatment
- Irrigate with mild warm saline and antiseptic
- Fill with an obtundant dressing containing some non-irritant antiseptic
- Warm saline mouth rinse
Drug Treatment
- Local anaesthesia: lidocaine 2% (1 in 80,000)
- Co-amoxiclav: 250/125 mg orally every 8 hours for 5 days (dose doubled in severe infections)
- 10mL of 2% chlorhexidine gluconate solution for mouth wash three times daily
Prevention
- Minimal trauma during extractions
- Immediately after extraction, squeeze socket edges firmly together and hold for a few minutes till clot has formed
- Antibiotics if patients have had irradiations, or have Paget's disease