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PubMedDate not supplied

Alveolar osteitis: a review of its etiology, prevention, and treatment modalities.

Alveolar osteitis (AO), commonly referred to as dry socket, is by far the most common complication following dental extraction. It represents a breakdown of healing after clot formation but before wound organization. This paper will review the literature associated with the etiology of AO, the risk factors which contribute to AO, and treatment regimens for AO once it is diagnosed. It will conclude with a summary of the current measures that hold the highest promise for the prevention of AO.

Age Factors↗
PubMed1991

The effect of pre-operative perioral skin preparation with aqueous povidone-iodine on the incidence of infection after third molar removal.

A study was carried out to measure the incidence of dry socket and wound infection following third molar removal under endotracheal general anaesthetic. One group of patients received pre-operative preparation of the perioral skin with a 10% solution of povidine-iodine, while the other received no skin preparation. Routine skin preparation imposes a risk of contact dermatitis and necessarily involves expense. In relation to postoperative wound infection, this practise was of no benefit. The results of this study provide evidence that skin preparation with povidine-iodine prior to third molar extractions should be discontinued.

Administration, Cutaneous↗
PubMed2004

Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications.

OBJECTIVES: The aim of this study was to identify risk indicators for extended operation time and postoperative complications after removal of mandibular third molars. STUDY DESIGN: There were 388 molars included in the study. The teeth were removed using the buccal approach under local anesthesia. Four hours postoperatively the patient recorded his or her pain perception on a visual analogue scale (VAS). After surgery a surgeon recorded parameters regarding the tooth and if the mandibular nerve had been visible during the operation. One week postoperatively the postoperative pain and complications were recorded. Logistic regression models were made to identify risk indicators for extended operation time, postoperative pain, and complications. RESULTS: Females were at higher risk for postoperative pain and dry socket than males. Older patients were at higher risk for extended operation time than younger patients. Radiographically fully impacted molars increased the risk of postoperative general infection. If the nerve was visible during surgery there was a higher risk of a high VAS score, postoperative pain, and general infection than if the nerve had not been visible. CONCLUSION: Several indicators were found to increase the risk of postoperative complications, but a visible alveolar inferior nerve during the operation was repeatedly found to be the highest single risk indicator.

Adolescent↗
PubMed2000

A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England.

OBJECTIVE: To study the therapeutic prescribing of antibiotics by general dental practitioners. DESIGN: A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities. SUBJECTS: General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. MAIN OUTCOME MEASURES: The questionnaires were analysed and the responses to each question expressed as absolute frequencies. RESULTS: Responses to the questionnaire were received from 929 (60.1%) practitioners. More than 95% of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5%) prescribed antibiotics for acute pulpitis and (3.3%) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69%) and by 23% after drainage. Practitioners were generally not influenced by patient's expectations of receiving antibiotics (92%), but would prescribe when under pressure of time (30.3%), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5%). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections. CONCLUSIONS: The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in National Health Service general dental practice.

Abscess↗
PubMed2006

Comparison of two chlorhexidine rinse protocols on the incidence of alveolar osteitis following the surgical removal of impacted third molars.

PRINCIPLES: Alveolar osteitis (dry socket) is the most common complication following the extraction of permanent teeth. This study was undertaken to compare the effect of two chlorhexidine rinse protocols on the incidence of alveolar osteitis in patients undergoing surgical removal of impacted mandibular third molar teeth. METHODS: A prospective randomized clinical trial was conducted among 99 subjects. Patients were randomly assigned into two groups. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine rinse 30 seconds for one week before and one week after surgery (group I) or one week after surgery (group II). Postoperatively, all patients were instructed to return in one week or sooner if bothersome pain increased or persisted. Data were collected regarding abnormal healing, presence of necrotic tissue, exposed bone, and absence of clot. RESULTS: The results indicated group I and group II were not statistically significant different in the reduction of alveolar osteitis. CONCLUSIONS: To reduce alveolar osteitis after impacted third molar surgery, it was observed use of postoperative chlorhexidine rinse was adequate. The postoperative use of chlorhexidine is more feasible than both preoperative and postoperative use.

Adolescent↗
PubMed1986

Myospherulosis of the alveolus secondary to the use of Terra-Cortril and Gelfoam. Report of a case.

Myospherulosis is a recently discovered disease apparently caused by the placement of mineral oil- or petrolatum-based products into various tissues. Terra-Cortril (a tetracycline/steroid ointment in a petrolatum base) on Gelfoam has been placed in the sockets of surgically removed third molars in an attempt to eliminate the occurrence of dry sockets. The case report presented here documents the radiographic progress of the disease for 6 years, showing an attempt by the bone to repair itself. A surgical procedure was performed to remove the affected tissue, and photographs were taken to illustrate the clinical appearance of the disease. The specimen consisted of a black, tarlike material which was completely encased in bone. Histologic examination was consistent with a diagnosis of myospherulosis.

Administration, Topical↗
PubMed2004

The role of cemented sockets in 2004: is there one?

Cement fixation of the acetabular cup in total hip arthroplasty (THA) has evolved through multiple generations of cement technology. Whereas cement technology has produced improvements in cemented femoral fixation, the cemented socket still produces inconsistent results. Even with our current knowledge that cemented cups require exposure of cancellous bone, a clean and dry socket, and adequate bony coverage of the cup, surgeons such as myself are unable to control radiolucency at the bone-cement interface. The technical difficulty of cementing the acetabular cup has led to the increasing prevalence of cementless acetabular cups. Although cementless fixation has resulted in increased incidence of osteolysis, the surgical procedure is less technically demanding, and the long-term mechanical fixation results have been more consistent. Given the experiential learning curve that most orthopedic surgeons face with cemented fixation of the acetabular cup component, the role of the cemented socket in THA today is limited.

Acetabulum↗
PubMed2005

A comparison of post-operative complications following wisdom tooth surgery performed with sterile or clean gloves.

This randomised prospective study aimed at evaluating possible differences in the post-operative complication rate following lower wisdom tooth surgery performed with either sterile or clean surgical gloves. The microbiological profiles of the tooth sockets and glove surfaces were also evaluated and compared. A total of 275 ASA I, non-smoking and non-drinking patients consented to be randomly assigned into two groups for lower wisdom tooth surgery, performed by operators wearing either sterile or clean gloves. All the patients returned for a post-operative assessment visit one week later. An additional 40 patients were recruited and randomised into the sterile glove group (n = 20) or the clean glove group (n = 20) for the microbiology study. Specimens were taken from the glove surfaces and the post-operative socket wounds during wisdom tooth surgery. This clinical trial showed no significant difference between the sterile and clean glove groups in the incidence of acute inflammation, acute infection and dry sockets in the wounds. No single peri-operative factor had a statistically significant effect on post-operative pain intensity. Most of the bacterial isolates from the clean gloves were Gram-positive cocci or spore-forming bacilli. The total number of colony forming units and the variety of bacterial isolates from the socket wounds in the sterile and clean glove groups were similar. The study concluded that there was no advantage in using sterile surgical gloves rather than clean gloves to minimize post-operative complications in wisdom tooth surgery. There was also no apparent relationship between the bacteria contaminating the clean glove surfaces and those isolated from the socket wounds.

Adolescent↗
PubMed1981

The effects on extraction wound healing of a new drug combination introduced for use in the prevention of post-extraction complications. A preliminary report.

Fifteen extraction sockets packed with a new drug combination which includes a local anaesthetic (cincain chloride), a local antiseptic (tri-iodomethane) and two drugs with a potent antifibrinolytic activity (tranexamic acid and propyl-hydroxy-benzoic acid) in an absorbable gelatin sponge (Gelfoam) as a vehicle, were histologically assessed with special reference to the parameters related to wound healing. As a control, the same number of sockets were allowed to heal spontaneously and similarly assessed. Healing of the extraction wounds seemed to follow the normal sequence in both series, and no histological signs suggestive of a delay in the healing process could be found in any of the sockets studied. Also the mast cell count previously considered to be of importance in the connective tissue repair was found to be unaffected by the test substance. These results, together with the previously presented data on the clinical efficacy of the drug combination studied, suggest that a larger clinical study should be carried out to assess its value as a preventive measure against the development of the post-extraction symptoms, including dry socket.

Adolescent↗
PubMed1978

Constant perfusion for dry eyes and sockets.

Several techniques have been used to treat dry eye, to irrigate the eye surface, or to apply drugs in solution. The commonest method is to apply drops. But a technique is needed for giving solutions over long periods either as drops or continuously. The apparatus described here consists of a replaceable plastic tank under mechanical pressure attached to capillary tubing which is kept in contact with the inner canthus of the eye. It was found to alleviate symptoms in severe dry eye conditions not alleviated by other methods.

Humans↗
PubMed1991

Increased postoperative pain and consumption of analgesics following acupuncture.

Acupuncture was given to patients before (preoperative-acupuncture group, PRE-ACU, n = 25) or after (postoperative-acupuncture group, POST-ACU, n = 25) operative removal of impacted mandibular third molars. Sixty patients did not receive acupuncture and participated as a control group (CG). All patients completed a questionnaire in order to characterize state tension and stress, degrees of neuroticism, extroversion, depression and psychosomatic disorders. We also recorded intraoperative discomfort and pain intensity, postoperative pain intensity and consumption of analgesics for 72 h. The PRE-ACU was significantly more tense following surgery and found the operative procedure more unpleasant than the other two groups. The PRE-ACU further rated intraoperative pain intensity higher than the CG and experienced higher pain intensity immediately postoperatively compared with POST-ACU and CG. Of the PRE-ACU patients 15/24 needed additional local anesthesia intraoperatively while none in the POST-ACU or CG requested extra lidocaine. Postoperatively patients in both PRE- and POST-ACU reported a higher total sum of pain scores (pain intensity) and the PRE-ACU consumed more analgesics compared with the CG. A significantly larger number of patients suffering from "dry socket" (a complication during wound healing) was found in both PRE- and POST-ACU compared with the CG. No correlation was found between assessed personality characteristics and reported postoperative pain/consumption of analgesics in any group and could thus not explain the observed differences between the groups. The reason for our unexpected "negative" findings is unclear but some hypothetical explanations are discussed.

Acupuncture Therapy↗
PubMed2004

Risk of osteoradionecrosis after extraction of impacted third molars in irradiated head and neck cancer patients.

PURPOSE: This study was performed to compare the risk of osteoradionecrosis (ORN) in head and neck cancer patients in whom 1 or more impacted third molars were extracted before radiotherapy with patients whose impacted third molars were left intact. PATIENTS AND METHODS: Eighty-one patients were selected from the medical records from 1989 to 1998. Patients had at least 1 impacted third molar and received radiotherapy for a head and neck cancer. These patients were divided into 2 groups on the basis of preirradiation extraction: group 1, patients who had impacted third molars extracted before radiotherapy (n = 55), and group 2, patients whose impacted third molars were left intact before radiotherapy (n = 38). In 12 patients of combined groups 1 and 2, at least 1 but not all of the impacted third molars were extracted before radiotherapy. RESULTS: Before radiotherapy, a total of 99 impacted third molars were extracted from the 55 patients in group 1 and a total of 55 impacted third molars were left intact in the 38 patients in group 2. After radiotherapy, a total of 7 impacted third molars were removed from 5 patients as treatment for infection (5 lower molars) or discomfort (2 upper molars). A total of 4 patients (2 from group 1 and 2 from group 2) developed ORN in the mandible. Of these 4 cases of ORN, 1 from group 1 appeared to be related to a dry socket that developed after preirradiation extraction of a lower impacted third molar, 1 from group 2 seemed to be related to infection of a lower impacted third molar after radiotherapy, and the remaining 2 cases appeared to be unrelated to an impacted third molar. CONCLUSION: Because few patients in this study developed ORN, the study failed to demonstrate whether preirradiation extraction versus retention of impacted third molars affects the risk for ORN.

Adolescent↗
PubMed1977

Blood fibrinolytic activity before and after oral surgery.

Blood smaples were collected in cold O.1 M sodium citrate from 30 healthy young persons whose mandibular impacted molars were to be removed. Blood sampling was repeated immediately after operation. Fibrinolytic activity of the euglobin fraction, precipitated at pH 5.9, was measured by the fibrin plate method. Three different fibrinogen solutions were used: 1) bovine fibrinogen, 2) bovine plasminogen-free fibrinogen, and 3) human fibrinogen. The differences between preoperative and postoperative fibrinolytic activity were evaluated. No increase of fibrinolytic activity was seen in general, indicating that oral surgery does not necessarily influence the fibrinolytic activity of the blood. Dividing the patients according to sex or to a long/short surgical procedure did not influence the activity either. However, in four patients who developed alveolitis sicca (dry socket), a significant rise of activity on all the fibrin plats was seen (P less than 0.01) when compared with the variations measured in patients with normal healing. The result suggests that a rise of blood fibrinolytic activity of a certain magnitude during oral surgery may predispose to the devlopement of alveolitis sicca. Four females who took oral contraceptives showed a higher postoperative fibrinolytic activity (P less than 0.05) than the other females. The importance of this observation is to be investigated in further studies.

Fibrinogen↗
PubMed1980

Platelet function and fibrinolytic activity after a single dose of diflunisal (Donobid).

ADP and collagen-induced platelet aggregation and parameters related to the fibrinolytic system were studied in groups of healthy persons who had ingested 500 mg of diflunisal. A single dose of diflunisal resulted in a depression of platelet function in most cases. However, the effect was limited and only of clinical relevance in patients with a defective platelet function. A frequent finding was an enhanced fibrinolytic activity in plasma and saliva 2 h after ingestion of diflunisal. In approximately one-third of the cases studied, the fibrinolytic activity in saliva rose to levels that induced clot lysis within a few minutes. This could explain the clinical observation that administration of diflunisal prior to dental surgery is followed by dry socket symptoms in one-third of the patients.

Adenosine Diphosphate↗
PubMed2003

A randomized, double-blind crossover trial of paracetamol 1000 mg four times daily vs ibuprofen 600 mg: effect on swelling and other postoperative events after third molar surgery.

AIMS: To evaluate the effect of a 3-day regimen of ibuprofen 600 mg x 4 on acute postoperative swelling and pain and other inflammatory events after third molar surgery compared with a traditional regimen of paracetamol 1000 mg x 4. METHODS: A controlled, randomized, double-blind, cross-over study where 36 patients (26 females, 10 males) with mean age 23 (range 19-27) years acted as their own controls. All patients were subjected to surgical removal of bilateral third molars. After one operation the patients received tablets of ibuprofen 600 mg x 4 for 3 days. After the other operation they received an identical regimen of paracetamol 1000 mg tablets. Swelling was objectively measured (mm) with a standardized face bow and the patients scored their pain intensity (PI) on a 100-mm visual analogue scale. RESULTS: There was no statistically significant difference between paracetamol and ibuprofen treatment with respect to effect on acute postoperative swelling. Swelling after paracetamol on the third postoperative day was 1.8% less than that after ibuprofen. Mean (95% CI) difference between treatments was -0.3 (-4.7, 4.1) mm. On the sixth postoperative day swelling after ibuprofen was 2.3% less than that after paracetamol. Mean (95% CI) between treatments was 0.2 (-2.4, 2.8) mm. There was no statistically significant difference in pain intensity between the paracetamol and the ibuprofen regimen on the day of surgery. The mean (95% CI) difference between the treatments for summed pain intensity on the day of surgery (SUMPI 3.5-11) was 3.31 (-47.7, 54.3) mm. Two patients developed fibrinolysis of the blood clot (dry socket) after receiving ibuprofen while none did this after paracetamol treatment. There was no noticeable difference between treatments with respect to appearance of haematomas/ecchymoses or adverse effects which all were classified as mild to moderate. CONCLUSIONS: A 3-day regimen of ibuprofen 600 mg x 4 daily does not offer any clinical advantages compared with a traditional paracetamol regimen 1000 mg x 4 daily with respect to alleviation of acute postoperative swelling and pain after third molar surgery.

Acetaminophen↗
PubMed2005

Tooth loss in a sub-urban Nigerian population: causes and pattern of mortality revisited.

AIM: To determine the current causes and pattern of tooth loss in Ile-Ife Nigeria. DESIGN: A retrospective review of records of dental extraction patients. SETTING: The dental hospitals of the Obafemi Awolowo University Teaching Hospital situated in South Western Nigeria. PARTICIPANTS: All patients that had dental extractions between January 1996 and December 2002. METHOD: Patients' case records were analysed for demographics, reason(s) for dental extraction, tooth/teeth extracted, method of extraction and complication(s). MAIN OUTCOME MEASURE: Reasons for tooth extraction and the pattern of tooth loss. RESULTS: 6348 (12.3%) of hospital attendees aged 4-102 years (mean 35 +/- 16.8 years) had extraction of 8338 teeth. A statistically significant female preponderance was observed. Dental caries was the leading cause of tooth loss (56.4%) followed by periodontal disease (24.6%). This shows a reversal of a trend reported in a previous study in the same location. Over half (69.2%) of the extracted teeth were molars (mostly mandibular). Only 4.1% extractions were trans alveolar. 3.9% were complicated by dry socket. CONCLUSION: 12.3% of the hospital attendees had undergone dental extraction. Despite previous warnings of a steady rise in dental caries, it has become the leading cause of tooth loss in our hospital. The urgent need to institute standardised preventive measures was highlighted.

Adolescent↗
PubMed2004

Individual patient meta-analysis of single-dose rofecoxib in postoperative pain.

BACKGROUND: Individual patient meta-analysis to determine the analgesic efficacy and adverse effects of single-dose rofecoxib in acute postoperative pain. METHODS: Individual patient information was available from 14 trials; 13 in dental and one in postsurgical pain. For each patient the percentage of maximum possible pain relief (%maxTOTPAR) was determined at different time points. The proportion of patients with at least 50% maxTOTPAR, and number-needed-to-treat (NNT) for at least 50% maxTOTPAR, were then calculated, with time when 50% of patients had remedicated (TTR50) and number-needed-to-harm (NNH) for adverse effects. RESULTS: In dental pain, for rofecoxib 50 mg (1330 patients) compared with placebo (570 patients) the NNT was 1.9 (95% confidence interval 1.8 to 2.1) for six hours, 2.0 (1.8 to 2.1) at eight, 2.4 (2.2 to 2.6) at 12, and 2.8 (2.5 to 3.1) at 24 hours. The TTR50 was 15.5 hours. Adverse effects were uncommon, though post-extraction alveolitis (dry socket) occurred more often with rofecoxib 50 mg than with placebo, NNH 24 (14 to 80). For postsurgical pain in one trial (163 patients), the NNT for rofecoxib 50 mg for six hours was 3.9 (2.6 to 7.8), the TTR50 was 5.8 hours, and multiple-dose adverse effects over five days occurred at similar rates with rofecoxib 50 mg and placebo. CONCLUSIONS: Single-dose rofecoxib 50 mg is an effective treatment with long-lasting analgesia and few adverse effects in dental pain. More information is required to confirm efficacy in postsurgical pain.

Journal Article↗
PubMed2003

Emergency dental services: review of the Community Health NHS Trust Service in Birmingham between 1997 and 2000.

AIMS AND OBJECTIVES: To confirm the need for an emergency dental service in Birmingham and to review the emergency dental service run by the South Birmingham Community Health NHS Trust. DESIGN: A retrospective study of patients attending the emergency dental service from March 1997 to August 2000, using computerised patient records and a supplementary questionnaire for a nine-month period between August 1997 and April 1998. SETTING: Birmingham Dental Hospital. RESULTS: A review of the computerised records revealed that a total of 10,799 patients were seen during the study period. In the first year, on average five patients were seen on weekday evening sessions and 13 patients at weekends/public holidays. By the final year of the study, these figures increased to ten on weekday evenings and 16 at weekends/public holidays. Forty-three per cent of the attendees were in the 31-50 year age group and 33% in 19-30 year age group. Twenty-five per cent of patients required extractions, 20% received temporary dressings, 17% a prescription for antibiotics and 9% were treated for acute mucosal conditions such as pericoronitis. The remainder received other items of treatments, such as for dry sockets. The supplementary questionnaire revealed that during the period August 1997 to April 1998, 67% of the patients lived in Birmingham and the other 33% in the surrounding areas, and some 59% of patients claimed that they were registered with a dentist of whom 60% of patients were not exempt from NHS charges. CONCLUSIONS: The results indicate that the service was widely and increasingly used during the study period. A similar pattern of emergency dental care in dedicated clinics could be established throughout the United Kingdom. A profile of users of the service during its first three-and-a-half years has been established.

Adolescent↗