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The aetiology of dry socket continues to be the subject of intense research. Local disturbances of fibrinolytic activity appear to be the most satisfactory explanation for the pathogenesis of this disorder. The factors that are responsible for local changes in fibrinolytic activity are reviewed and evaluated. In the management of this disorder attention should be directed towards the prevention of local changes in fibrinolytic activity.
Use of oral contraceptives and trauma during extraction are substantiated factors that contribute to dry socket. They appear to act by enhancing fibrinolytic activity in the alveolar bone followed by lysis of the clot. The influence of bacteria and antibiotics on the development and prevention of dry socket remains unclear. No convincing evidence can be found that factors such as age, sex, or nutritional status affect the incidence of dry socket.
Clindamycin and other agents were compared for efficacy in preventing the entity "dry socket." A total 765 patients were treated with clindamycin, per os, and 408 patients were treated with other antibiotics or were non-treated controls. All patients underwent surgical removal of impacted mandibular third molars. The incidence of dry socket in untreated control and in non-clindamycin antibiotic-treated patients varied from 15 to 31 percent, while in those patients receiving clindamycin, the incidence was 0.65 percent. The results demonstrate a remarkable effectiveness of clindamycin in reducing the incidence of dry socket following surgical removal of impacted mandibular third molar.
To determine whether the use of intraligamentary anesthesia increases the incidence of dry socket, results of 305 extractions of mandibular molars in two groups of patients were studied. In the first group, inferior alveolar nerve block was applied, and, in the second, intraligamentary anesthesia was applied. A solution of 2% lidocaine with 1:80,000 epinephrine was used. Statistical analysis of the postoperative occurrence of dry socket indicated that the use of intraligamentary anesthesia did not result in a higher frequency of dry socket than did conventional anesthesia.
A clinical investigation was undertaken to find the incidence of dry socket as a post-operative complication of dental extraction on an out-patient basis. Two thousand three hundred and sixty three extractions were carried out under local anaesthesia by clinical staff and students over a four month period. The results are presented and their significance discussed, the incidence of dry socket being found to be dependent upon the site of the tooth extracted, the relative difficulty of the extraction and upon the integrity and size of the blood clot in the extraction socket.
This clinical study was undertaken to evaluate the effectiveness of locally applied 9-aminoacridine in Gelfoam in reducing the incidence of dry socket formation after third molar extractions. Results indicated that this technique was not effective. The incidence of dry socket formation in smokers and nonsmokers was compared. Also, the influence of surgical trauma on dry socket formation was examined.
At a hospital in Damman, Saudi Arabia, it was noticed that many patients had developed dry socket after surgical removal of wisdom teeth. To enhance haemostasis, Surgicel (oxidized cellulose) gauze was sometimes used in the tooth socket in patients who were operated under general anaesthesia. An analysis was made of the records of 104 lower wisdom teeth removed surgically from 86 patients. The incidence of dry socket in the 20 Surgicel-treated teeth was 25.0%, compared with 6.0% among the 84 non-Surgicel-treated teeth. The use of Surgicel in wisdom tooth extraction seems to be associated with an increased incidence of dry socket.
An investigation into the incidence and other features of dry socket in Sri Lanka was considered worthwhile as working conditions, general health of patients and related factors may be different in developing countries. The present study was conducted at two institutes which provide differing facilities and conditions. The overall incidence was found to be 3.5% which is similar to figures reported in the U.K. and Europe. The pattern of dry socket as seen at the two institutes regarding delayed onset, lower molar site specificity, female predominance and relation to difficulty of extraction was similar to each other and to those described in previous studies. These findings support a multifactorial aetiology as does a review of the recent literature.
PURPOSE: Chlorhexidine is a good prophylactic agent for post-extraction dry socket alveolitis. The bio-adhesive 0.2% chlorhexidine gel could improve this action since its intra-alveolar positioning would allow a more direct action on the alveolus and more prolonged action of the medication. MATERIALS AND METHOD: We present a single blind, randomised study on 30 patients to evaluate the efficacy of the bio-adhesive 0.2% chlorhexidine gel, placed only once within the alveolus, on the reduction of the incidence of impacted third molar post-extraction dry socket alveolitis and its post-operative effects on patients. RESULTS: A reduction of 42.65% in the occurrence of alveolitis and a more favourable post-operative period in the experimental group was observed. In the control group, the appearance of alveolitis was 30.76% opposite to 17.64 % in the experimental group. CONCLUSIONS: The bio-adhesive 0.2% chlorhexidine gel, applied only once after the extraction of impacted third molars, seems to be an appropriate option for the reduction of alveolitis. It improves the buccal aperture and oedema in the post-operative period, although further double blind studies with larger samples are necessary.
1533 single intra-alveolar permanent tooth extractions in males were investigated in a study to determine if the type and technique of local anaesthesia influenced the occurrence of dry socket. The results show that the incidence of dry socket was significantly greater after the use of Xylocaine compared to Citanest and that the use of repeated injections or intraligamental techniques increased the likelihood of this painful post-extraction condition.
OBJECTIVE: The purpose of the study was to determine if the intra-alveolar application of topical metronidazole gel could reduce the incidence of alveolar osteitis (dry socket) following routine tooth extraction in molar and premolar extraction sites. DESIGN: This was a multicentre, double blind, randomised, placebo-controlled clinical trial. A total of 302 patients took part, of which 23 returned with alveolar osteitis. Of these, eight had received the metronidazole gel and 15 the placebo. SETTING: The study was carried out in three general dental practices by general dental practitioners working in England over the period 2000-2003. MAIN OUTCOME MEASURES: Following extraction of either a molar or premolar tooth, either a 25% metronidazole gel or KY Jelly was syringed gently into the socket. A painful post operative complication was recorded if either a dry socket was present or the patient returned with pain. RESULTS AND CONCLUSIONS: The difference in the incidence of alveolar osteitis between the placebo and the active gel groups was not significant and it was concluded that 25% topical metronidazole gel was not effective in reducing the incidence of alveolar osteitis. It was found that the incidence of alveolar osteitis reduced with increasing age and was more likely to occur in a patient with a previous history of the condition.
We randomised 119 patients who had been referred for removal of partially impacted mandibular third molars to be given either metronidazole 1600 mg or placebo as a single dose 45 min before operation. Ten of the fifty-nine patients who were given metronidazole and 13 of the 60 given placebo developed dry sockets. Two variables were significantly associated with the development of a dry socket: pericoronitis and oral contraceptives.
The aim of this study was to examine the effect of antibiotic prophylaxis for mandibular third molar surgery from the viewpoint of the duration of administration. A comparative study was conducted on postoperative infection, dry socket, and the healing process in 178 healthy patients receiving 1-day or 3-day prophylaxis with lenampicillin (LAPC; 1.5 g/day). Postoperative infection developed in only 1 (1.1%) of the 91 patients in the 3-day group, while there was no patient with infection in the 87 patients in the 1-day group. Dry socket developed in 8.0% of the 87 patients in the 1-day group and in 7.7% of the 91 patients in the 3-day group. However, the incidence of these complications, in relation to the degree of impaction of the molars, did not significantly differ between the 1-day and 3-day groups. Scores indicating clinical symptoms for the 7 days after surgery also reflected no significant difference between the groups, irrespective of the degree of impaction. These results suggest that 1-day therapy with LAPC in our regimen may at least be recommended as a prophylaxis for mandibular third molar surgery in medically healthy patients.
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