In normal conditions after extraction of a permanent tooth, a blood clot is formed at the site by granulation tissue, then gradually replaced by fibrillar bone and finally, replaced by mature bone.
If that blood clot is dislodged or disintegrated too early there is not an appropriate healing and it causes the clinical condition known as “Dry Socket” or alveolar osteitis.
The main symptoms of dry socket are severe pain and foul odor without suppuration in the mouth. Usually, pain and swelling after a tooth extraction get better over the course of a week, when dry socket occurs the symptoms generally set in on the second or third day after the surgery, get significantly worse, and they may last from 10 to 40 days.
The pain may feel like covering the whole side of the mouth or face. The affected extraction site is initially filled with a dirty gray clot that is then lost and leaves a bare bony socket (dry socket). The diagnosis is confirmed only by a dentist or oral surgeon.
The patient may be extra sensitive to cold drinks, since soft tissues and ending nerves are exposed. On post extraction evaluation of the patient, severe pain is the main complaint and on inspection of the socket the exposed and extremely sensitive bone is observed.
The prevalence of dry socket is between 1% to 3% of all extractions, and most commonly after removal of wisdom teeth, and is most frequent in the lower jaw and posterior areas. The overall prevalence is highest between 20 to 40 years of age, although the likelihood of developing alveolar osteitis appears greatest for extractions in the 40 to 45 years old age group.
The patients with the highest risk of developing dry socket are those who:
- Don’t follow adequately post-surgery instructions, e.g. make strong sucking movement ore remove gauze from the extraction site too early, make vigorous mouth rinsing
- Have preexisting infections, such as periodontal (gum) disease
- Smoke, because blood supply is reduced in the mouth
- Have a traumatic tooth extraction surgery
- Have denser jaw bones
- Take oral contraceptives, as certain hormones may increase this risk
- Prior history of alveolitis
- A radiograph of the affected area should be taken to check for the possibility of retained root tip or a foreign body
- Cleaning of the extraction site with warm saline solution and placing a medicated dressing in the socket
- Changing the dressing daily until the pain diminishes and the socket begins to heal
- Giving a special mouthwash, antibiotics, or prescription pain medication
Every case of dry socket is different. Only a dentist can evaluate personal risk factors for dry socket. To prevent dry socket, it’s very important t to follow dentist’s instructions for recovery.
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