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PubMed2005

A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars.

We randomised 128 patients who required operations on mandibular third molars and who had radiological evidence of proximity of the third molar to the canal of the inferior alveolar nerve to one of two operations: extraction [n=102], and coronectomy [n=94]. Some roots were dislodged during intended coronectomy and were therefore removed, resulting in two subgroups (successful coronectomy n=58, and failed coronectomy n=36). The mean (S.D.) follow up was 25 (13) months. Nineteen nerves were damaged (19%) after extraction, none after successful coronectomy, and three (8%) after failed coronectomy (p=0.01). The incidence of dry socket infection was similar in the three groups (10/102, 10%, 7/58, 12%, and 4/36, 11%, respectively). No root required removal or reoperation. To our knowledge this is the first clinical trial of the efficacy of coronectomy in preserving the inferior alveolar nerve. The length of follow up was about 2 years, which for the assessment of delayed eruption of the root fragments is not sufficient as this process may continue for up to 10 years. However, it seems that coronectomy reduces the incidence of injury to the inferior alveolar nerve without increasing the risk of dry socket or infection.

Adult↗
PubMed1992

Alveolar osteitis after surgical removal of impacted mandibular third molars. Identification of the patient at risk.

One hundred thirty-eight impacted mandibular third molars were surgically removed. A prospective study of risk factors associated with the development of alveolar osteitis (dry socket) postoperatively was undertaken. Two surgeons, one experienced and one inexperienced, removed the teeth. Patients were controlled for age, sex, use of oral contraceptives, radiographic difficulty of the extraction, and tobacco use. Patients treated by the inexperienced surgeon and those using tobacco had a significantly greater incidence of alveolar osteitis. Previously identified risk factors of increased age, female sex, oral contraceptive use, and increased surgical time were not associated with an increased incidence of dry socket. Recommendations are made regarding prevention of alveolar osteitis in those patients identified as being at high risk.

Adolescent↗
PubMed2006

Azithromycin as prophylaxis for the prevention of postoperative infection in impacted mandibular third-molar surgery.

Rotational use of antimicrobials is one of the strategies that have been suggested to reduce the development of drug-resistant bacteria. Cycling of homogeneous antimicrobial exposure is, however, unlikely to control the emergence of antimicrobial resistance. Penicillins and cephalosporins have been extensively used for therapeutic and prophylactic management of oral infection. The aim of the study was to investigate the clinical effects of azithromycin as prophylaxis on the prevention of postoperative infection in impacted mandibular third-molar surgery. The study design was a retrospective, single-center review. One (2.2%) of all 45 patients exhibited dry socket infection. In several categories, there was significant effectiveness of azithromycin in comparison with other antimicrobials, although there was no significant difference in the occurrence rate of dry socket infection. Azithromycin might be of value for prophylactic use in impacted mandibular third-molar surgery in which penicillins and cephalosporins were mainly used. Therefore, it might be available for one of the rotational agents.

Adolescent↗
PubMed1978

The analgesic and anti-inflammatory efficacy of diflunisal and codeine after removal of impacted third molars.

A double-blind, randomized trial was carried out in 90 patients to compare the analgesic and anti-inflammatory efficacy of 500 mg diflunisal twice daily with that of 25 mg codeine phosphate 4-times daily and placebo in relieving pain and swelling after surgical removal of impacted third molars. Diflunisal was found to be superior to codeine and placebo on the first post-operative day, but the difference in efficacy of the drugs had diminished by the third post-operative day. In the diflunisal group of 30 patients, 10 (33%) developed 'dry socket' or alveolitis sicca dolorosa. Only 2 patients in the codeine group and 1 patient in the placebo group developed this very painful condition. The possible explanation of 'dry socket' is discussed.

Adolescent↗
PubMed1990

[Postextraction complications and the choice of anesthesia].

The aim of the investigation is to evaluate the dependence of the most frequent postextraction complications (pain, hemorrhage, hematoma, swelling and dry socket) in relation to the choice of anesthesia. The total of 447 teeth was extracted in 319 male and female persons between 11 and 80 years of age. The most important conclusion of the investigations is that vasoconstrictor in local anesthetic solutions does not influence the incidence of postextraction complications. Clot disturbance, higher incidence of dry socket and unpredicted time of pain appearance were found in the local anesthetic group with lower concentration of vasoconstrictor. Statistically significant difference between local and general anesthesia does not exist in relation to blood clot disturbances, although a great number of clot fails is evident in local anesthetic group. The pain intensity is lower when teeth extraction were performed under general anesthesia.

Adolescent↗
PubMed2005

No benefit from prophylactic antibiotics in third molar surgery.

DESIGN: This was a randomised controlled trial in a hospital environment. INTERVENTION: After surgical removal of third molars postoperative treatment was with oral amoxicillin-clavulanic acid (AC) or clindamycin (CL) or no antibiotics (C). The surgical technique was the same in all cases, and the follow-up period was 4 weeks. OUTCOME MEASURE: Parameters evaluated were pain, differences in mouth opening, infection, the occurrence of dry socket, and adverse postoperative side effects. RESULTS: A total of 528 lower third molars were surgically removed in 288 patients during a period of 30 months. The patients' mean age was 20.7 years (age range, 14-61 years). No severe complications such as perimandibular abscess or cellulitis occurred in any patient in any group. There was no significant difference between the groups in the overall occurrence of local infection symptoms after surgery (range, 3.4-4.4%; mean, 3.98%), nor for other parameters. Interestingly, 69.6% of the patients with dry sockets had partially erupted third molars. This rate was the same in each group (62.5% versus 75%) and did not vary significantly. Reported adverse effects were similar in each group (15.3% for AC, 12.2% for CL, 13.9% for C). CONCLUSIONS: The results show that specific postoperative oral prophylactic antibiotic treatment after the removal of lower third molars does not contribute to better wound healing, less pain nor increased mouth opening, and could not prevent the cases of inflammatory problems after surgery, respectively. It is therefore not recommended for routine use.

Comment↗
PubMed1999

Disturbed healing of extraction wounds.

Disturbed healing of a dental extraction wound can cause severe pain and can jeopardize attempts at dental implants or other treatments. The pathogenesis of disturbed healing was studied by histological examination of 221 postoperative biopsies taken for diagnostic purposes from human extraction wounds at different stages of healing. A relationship was observed between the healing stages and different disturbances such as dry socket, suppurative osteitis, necrotizing osteitis, and fibrous healing.

Dry Socket↗
PubMed1978

[The effect of local anesthetics and injuries on the angiographic picture of the cat mandibular blood vessels].

The authors examined the effects of local anesthetics and traumata (traumatic dental extractions) on the angiographic picture of the mandibular vessels of the cat in the 10th, 70th and 120th minutes. The application of local anaesthetics results in a reduced filling of the inferior alveolar artery in the 10th and 70th minutes. The picture returns to normal in the 120th minute. The traumatic extraction produces more marked changes up to complete spasm of the vascular system of the common carotid artery. In the 120 th minute, the blood supply is restored; and the normal number of vessels appears on the aniograph, but their lumina are still reduced. The vasoconstriction caused by local anesthetics and traumata plays an important role in the pathogenesis of the primary dry socket.

Anesthetics, Local↗
PubMed1981

Fibrinolytic activity of blood and saliva before and after oral surgery.

Blood and saliva samples were collected from 120 healthy persons whose bilateral mandibular impacted molars were to be removed surgically. The samples were collected at preoperative examination, immediately after the operation and in the postoperative period. The fibrinolytic activity of the euglobulin fractions, precipitated at pH 5.9 from plasma and mixed saliva, was measured by the fibrin plate method. The clinical variables were: age, sex, use of peroral contraceptives and menstrual cycle, daily tobacco consumption, duration of operation and amount of local anesthetic. The fibrinolytic activity of blood was lower in smokers than in nonsmokers (P less than 0.01). Women taking oral contraceptives showed higher fibrinolytic activity in blood and saliva (P less than 0.01). Multiple regression analysis revealed that the following independent variables were significant as predictors estimating the postoperative fibrinolytic activity of blood (R2 = 0.42, P less than 0.001): preoperative fibrinolytic activity, operation time, tobacco consumption and amount of local anesthesia. No relationship was demonstrated between the preoperative fibrinolytic activity in blood and mixed saliva, whereas postoperative fibrinolytic activity in blood significantly influenced the activity in saliva, because of direct contamination from the oral ulcer (P less than 0.05). Patients who developed alveolitis sicca dolorosa ("dry socket") showed significantly higher fibrinolytic activity in the blood postoperatively (P less than 0.01).

Blood↗
PubMed1997

Treatment of fibrinolytic alveolitis with rifamycin B diethylamide associated with gelfoam: a histological study.

The most common complication in the healing of extraction wounds is fibrinolytic alveolitis, which may also be termed "dry socket". Reduction in the incidence of this condition after the application of topical antibiotics and the use of systemic antibiotics has been reported. A histological study of disturbed alveolar socket healing in rats was carried out to analyze the influence of application of rifamycin B diethylamide (Rifocin M) associated or not with Gelfoam. Sixty-four male rats (Rattus norvegicus albinus, Wistar), weighing 120-150 g, were divided into 4 groups of 16 animals each. In the second group of rats which received implants of Gelfoam, there was an intense resorption of bone walls in the initial stage. The rats that received implants of Gelfoam saturated with Rifocin M (fourth group) showed better results than the second group. The third group (only irrigation with rifamycin) showed better bone formation in the alveolar socket compared to the first, second and fourth groups. Thus, these results showed that rifamycin irrigation is useful in the control of alveolar infections.

Administration, Topical↗
PubMed1991

Evaluation of 0.12% chlorhexidine rinse on the prevention of alveolar osteitis.

A double-blind study evaluated the ability of 0.12% chlorhexidine rinse to decrease the incidence of localized alveolar osteitis after the removal of mandibular third molar teeth. One hundred sixty extraction sites in 80 patients were evaluated. A statistically significant decrease in the incidence of dry socket was seen in patients using the chlorhexidine rinse with no significant adverse reactions. Thus a 0.12% chlorhexidine rinse is shown to be an effective means of decreasing alveolar osteitis that may follow removal of third molar teeth.

Adult↗
PubMed2002

Iron and vitamin B12 deficiency anaemia in a vegetarian: a diagnostic approach by enzyme-linked immunosorbent assay and radioimmunoassay.

This article presents the case of a 46-year-old vegetarian who had a painful dry socket in the left third molar areas. Since the patient's general appraisal was anaemic, investigations for haematological status, folic acid and vitamin B12 were performed. The results revealed that the patient was severely iron deficient and slightly vitamin B12 deficient.

Anemia, Iron-Deficiency↗
PubMed1977

[Pain in the maxillofacial area: diagnosis and treatment].

Based on characteristic case-reports the mostly occurring patterns of maxillo-facial pain are discussed. A description is given of pain in case of pulpitis, dento-alveolar abcess, dry socket, deep local periodonitis, temporomandibular joint arthrosis, dehiscence of the mandibular canal, maxillary sinusitis, malignant neoplasm. Trigeminal neuralgia, atypical facial neuralgia and psychogenic pains are discussed. The article concludes with a survey of the most important symptoms of these pain-syndromes in order to facilitate a correct diagnosis.

Adult↗
PubMed1978

Considerations in the management of patients taking oral contraceptives.

Among the undesirable effects associated with the use of oral contraceptives are an increased incidence of thromboembolic events, an increased risk of myocardial infarction, and, in certain users, a significant elevation in blood pressure. An altered fibrinolytic activity may have a direct effect on the occurrence of localized osteitis, "dry sockets." It is also possible that gingival inflammation and loss of attachment may occur even under conditions of adequate plaque control. Salivary changes and alterations in the bony trabecular pattern of the mandible have been observed, but the clinical significance is as yet undetermined (Illustration).

Contraceptives, Oral↗
PubMed1975

Complications after removal of mandibular third molars with special reference to local anaesthetics with different vasoactive properties.

Nhe symptoms after surgical removal of 379 mandibular wisdom teeth when Xylocain-Exadrin 2% and Citanest-Octopressin 3% were used, were evaluated according to a three grade scale. The severity of the symptoms, which were mild and normal in 53% and severe in 47%, did not demonstrably vary with the type of anaesthetic agent used. The symptoms were, on the average, more severe among the women than among the men. The symptoms were correlated with the duration of the operation, which was most obvious in the men. For the men the frequency of symptoms also increased with age. In the men there was also a tendency to a correlation between dry socket and long duration of operation. It thus appeared as if only the men reacted in the way expected from a biologic point of view. The investigation also showed that Xylocain-Exadrin had a better anaesthetic and ischemic effect.

Adolescent↗
PubMed1977

The prophylactic use of propylic ester of p-hydrobenzoic acid on alveolitis sicca dolorosa. A preliminary report.

A double-blind experiment was performed to test the possible prophylactic effect of the antifibrinolytically active propylic ester of p-hydroxybenzoic acid (PEPH) on alveolitis sicca dolorosa (dry socket). Tablets containing PEPH or placebo were inserted at random selection into the alveoli of forty-five consecutive patients, each of whom had had an impacted mandibular third molar removed. The prophylactic effect of PEPH in this study was found to be highly significant as compared to that of placebo, and no patients in the experimental group developed alveolitis sicca dolorosa.

Adolescent↗
PubMed1990

[Economic aspects of alveolitis].

In 1680 cases of alveolitis ("dry socket") the national economic-loss is more than 339,693.-marks. Nearly 3 million teeth will be extracted in one year in the DDR. By a valuation of nearly 3% of the alveolitis 90,000 patients have this complication. That will be a economic-loss of 18.1 million marks in one year. The prophylaxis of this complication is therefore a most important problem.

Costs and Cost Analysis↗