Infected Socket

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A post extraction complication due to infection of the clot due to contamination (infected socket). The  condition is painful and if not managed well could lead to osteomyelitis. 

Clinical presentation 

  • Severe painful socket 2–4days after tooth extraction
  • Fever
  • Necrotic blood clot in the socket
  • Swollen gingiva around the socket
  • Sometimes there may be lymphadenopathy and trismus (inability to open the mouth)

Non-pharmacological Treatment 

Socket debridement under local anesthesia with lignocaine 2% and irrigate with hydrogen peroxide  3% followed with copious amounts of normal saline. The procedure of irrigation is repeated the 2nd  and 3rd day and where necessary can be extended to the 4th day if pain persists.   

Pharmacological Treatment 

Patient is instructed to rinse with 3% hydrogen peroxide or 2% povidone iodine 3–4 times a day.  Antibiotics should be prescribed to prevent progression to osteomyelitis: 

A: amoxicillin (PO) 500mg 8hourly for 5–7days 

OR 

B: azithromycin (PO) 500mg 24hourly for 3days 

AND 

A: metronidazole (PO) 400mg 8hourly for 5days 

Investigation 

  • Periapical  X-ray  of  the  socket  may  be  necessary  when  there  is  limited  improvement  despite  treatment