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PubMed2005

Rinsing with chlorhexidine may reduce incidence of dry socket after third molar surgery.

DATA SOURCES: Medline and the Science Citation Index were used and searches were made by hand for studies published in any language. STUDY SELECTION: Studies included were human clinical trials evaluating the effect of a chlorhexidine (CHX) rinse on the incidence of alveolar osteitis (AO), following extraction of mandibular third molars, if they randomly assigned individuals to control and CHX rinse groups that used similar criteria to diagnose AO. DATA EXTRACTION AND SYNTHESIS: Studies were screened by three examiners independently. Due to protocol differences, studies were separated into two groups. Group 1 included studies that evaluated subjects who rinsed with CHX only on the day of surgery and Group 2 studies that evaluated patients who used multiple rinses with CHX. RESULTS: The relative risk for the single-rinse group was 1.36 (95% confidence interval (CI), 0.80-2.33; P>0.05), whereas for the multiple-rinse group, relative risk was 1.90 (95% CI, 1.46-2.47, P<0.05). CONCLUSIONS: It was not possible to determine if a single rinse with CHX on the day of surgery significantly reduced the incidence of AO. The results of this study do, however, support the conclusion that rinsing at least on the day of surgery and for several days following the removal of the teeth reduces the incidence of AO associated with the extraction of mandibular third molars. The minimum number of days of rinsing needed to produce this effect could not be determined by this analysis. Further studies using a standard definition for AO, and stratification of patients by gender, difficulty of extraction, smoking etc., are needed to determine the best use for CHX rinses in subjects having the mandibular third molar removed.

Comment↗
PubMed2001

An evaluation of complications following dental extractions using either sterile or clean gloves.

This randomized prospective study aims to evaluate any differences in the postoperative infection rate from dental extraction using either sterile or clean surgical gloves and to determine any predisposing factors that may complicate socket healing. A total of 609 patients were randomly assigned to two groups, with the operators wearing either sterile or clean gloves in performing forcep extractions. 551 patients, who had 811 extractions performed, returned for the postoperative assessment visit. There was no difference in the incidence of an acutely inflamed socket, acutely infected socket and dry socket and also no significant predisposing factors found between the sterile and clean glove groups. The pre-operative diagnosis of caries, periodontal disease or retained root had a higher tendency of producing an acute-inflamed socket, whereas an acutely infected socket only developed in the cases of retained root. On the pain intensity level, an acutely inflamed socket caused mild to moderate pain, on acutely infected socket caused moderate to severe pain; and a dry socket caused severe pain in the majority of cases. The study concluded that the use of sterile surgical gloves does not offer an advantage over clean gloves in minimizing socket inflammation, infection, as well as a dry socket following dental extraction.

Adolescent↗
PubMed1989

A double-blind study on the effectiveness of tetracycline in reducing the incidence of fibrinolytic alveolitis.

This study presents the results of a double-blind study evaluating the effectiveness of topical tetracycline used as a suspension in a square of gelatin sponge and placed in the sockets of extracted mandibular third molars for the prevention of dry socket. An assessment of the relationship between the amount of bone relief (trauma) incidental to the surgery and the occurrence of dry socket also is made. Dry socket occurred in 20.4% of the placebo-treated sockets, whereas the incidence in the tetracycline-treated sockets was 3.9%. No correlation was observed between the amount of bone relief attendant to the surgery and the incidence of dry socket. It is concluded that tetracycline is an effective prophylaxis for fibrinolytic alveolitis.

Double-Blind Method↗
PubMed1992

Healing after dental extractions in men with HIV infection.

To determine the incidence of delayed healing after dental extractions in men with HIV infection, a retrospective audit was conducted of all extractions performed in a dedicated dental clinic over a 26-month period. The incidence of delayed healing in patients with HIV was compared with the incidence in those patients without HIV. Eighty men with HIV had 163 teeth extracted, which resulted in five dry sockets (3.01%). Thirty-six men thought not to have HIV had 70 extractions and three dry sockets (4.28%). All three dry sockets in the control group occurred in men who had tested negative for HIV antibodies in the year before their extraction. There were no other incidents of delayed healing. These findings contrast with other reports since they reveal no increase in delayed healing after extractions in men with HIV and do not support recommendations that prophylactic antimicrobials are required for extractions in this group of patients.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Alveolar osteitis prevention by immediate placement of medicated packing.

OBJECTIVE: The purpose of this study was to evaluate whether immediate placement of medicated dry socket packing would decrease the incidence of alveolar osteitis (dry socket) with lower third molar extractions. STUDY DESIGN: In 100 patients, 200 lower third molars were extracted. One half of the sockets were packed to the crest of the alveolar ridge with a one-quarter-inch radiograph-detectable filament gauze that contained 9% eugenol, 36% balsam of Peru, and 55% petroleum jelly. The medicated packing was removed 1 week after surgery. None of the patients were taking antibiotics. Patients were instructed to increase their oral hygiene before and after surgery and were to use 0.12% chlorhexidine gluconate 2 days before and 3 days after surgery. RESULTS; Two hundred bilateral lower third molars of varying difficulty were extracted. The overall alveolar osteitis rate was 34 (17%). The immediately packed lower third molar sites had an alveolar osteitis rate of 8 (8%). The sockets that were not packed with medicated packing the day of surgery had an alveolar osteitis rate of 26 (26%). The difference was statistically significant (P =.001). CONCLUSION: The results of this study suggest that placement of medicated dry socket packing immediately after lower third molar extraction decreases the alveolar osteitis rate.

Adolescent↗
PubMed2006

Post-operative sequelae of lower third molar removal: a literature review and pilot study on the effect of Covomycin D.

Pain, swelling and dry socket formation commonly follow third molar surgery. The objective was to investigate the effect of intrasocket Covomycin D, an antibiotic/anti-inflammatory medication, on pain, swelling and dry socket following lower third molar removal. Nineteen subjects had bilateral lower third molars removed. The patients were blinded to the side of medication; the opposite side acted as the control; post-operatively a pain visual analogue scale was completed, the side of the worst swelling and the incidence of dry socket noted. The data was analysed using the Wilcoxons matched pairs signed ranks test. Results showed that the pain score was lower for the medicated side in 11 patients on day one and in 16 patients over the six day post-operative period (p < 0.6). The swelling was less on the medicated side in fourteen patients. Three dry sockets developed in non-medicated sockets. In conclusion this study shows that the use of intra-socket Covomycin D favourably influences post-operative sequelae following lower third molar removal.

Administration, Topical↗
PubMed2003

Does oral contraceptive use affect the incidence of complications after extraction of a mandibular third molar?

OBJECTIVE: This study investigated whether oral contraceptive use affects the incidence of complications (pain, trismus, dry socket) in women undergoing removal of impacted mandibular third molars. PATIENTS AND METHOD: Two hundred and sixty seven women, aged 17 - 45 years, underwent removal of an impacted mandibular third molar. Eighty seven of the women were regular users of oral contraceptives. All patients were evaluated for postoperative pain, trismus and dry socket (localized alveolar osteitis). RESULTS: Mean trismus values (measured as maximum interincisal distance) were similar in the two groups of patients. Postoperative pain was significantly more frequent among women taking contraceptives, both on day 1 (30% of women taking contraceptives used analgesics, versus 11% of women not taking contraceptives, p < 0.001) and on day 5 (14% versus 5%, p = 0.024). Similarly, dry socket occurred more frequently among women taking contraceptives than among women not taking contraceptives (11% versus 4%, p = 0.017). CONCLUSIONS: The results of this study support the view that oral contraceptive use favours the appearance of dry socket and postoperative pain after extraction, but has no effect on trismus.

Adolescent↗
PubMed2000

The prevalence of post-extraction complications in an outpatient dental clinic in Kuala Lumpur Malaysia--a retrospective survey.

The aim of this retrospective study is to report on the prevalence of post-extraction complications among patients attending the Oral Surgery outpatient clinic of the Faculty of Dentistry, University of Malaya over a 12-month period from January to December, 1992. The prevalence of post-extraction complications which required further treatment was only 3.4% (n = 100), out of a total of 2968 patients who had extraction of one or more permanent teeth. Analysis based on complete clinical reports (n = 79) showed that dry socket accounted for nine out of ten cases of post-extraction complications. However the aetiology was largely unknown. No obvious association with medical history could be made. Lower teeth were more likely to have complications. The most common teeth associated with dry socket were the molars (76%) and premolars (19%). The most common molars to be affected are the first, followed by the third and lastly the second molars. A brief review of current aetiological factors of dry socket was discussed.

Adolescent↗
PubMed1981

A new combination of drugs intended to be used as a preventive measure for the postextraction complications. A preliminary report.

Fifteen extraction sockets packed with a new drug combination, including a local anesthetic (cincain chloride), a local antiseptic (tri-iodomethane) and two drugs with a potent antifibrinolytic activity (tranexamic acid and propyl-hydroxybenzoic acid) in Gelfoam as a vehicle, were assessed clinically with special reference to the development of the postextraction symptoms, dry socket included. As a control series, 15 extraction sockets allowed to undergo a spontaneous healing were similarly evaluated. All the sockets in both series were found to heal according to the normal sequence. There were, however, statistically highly significant differences between the two series with regard to the clotting time, postextraction pain and the need for adjunct analgesics, in favor of the sockets packed with the compound in test. The observed beneficial effects of the test compound are discussed in the light of the recently elucidated etiologic and pathogenetic mechanisms leading to the development of dry socket, and a conclusion is drawn that the present results, although preliminary due to the limited number of patients, advocate further evaluation of the new drug combination and its applicability in the prevention of the troublesome postextraction complications, including dry socket.

Adolescent↗
PubMed2000

Postsurgical complications.

The most common complications of oral surgery include bleeding, pain, swelling, infection, dry socket, and fracture. Bleeding can be controlled by applying gauze pressure to the area or through the use of hemostatic agents. A dry socket should have a dressing with eugenol applied, whereas a prescription for antibiotics or analgesics can take care of some of the other problems. Patients with fractures should be referred to a dentist or oral surgeon for treatment.

Dry Socket↗
PubMed1990

Effects of a chlorhexidine gluconate oral rinse on the incidence of alveolar osteitis in mandibular third molar surgery.

Alveolar osteitis (dry socket) continues to be a frequent sequela of third molar surgery. Chlorhexidine 0.12% used as an oral rinse has been reported to reduce the incidence of dry socket. This study compares the effectiveness of 0.12% chlorhexidine used as a preoperative rinse and immediate postextraction irrigant with 1) similarly used 0.05% cetylpyridium, preoperative chlorhexidine rinse and postextraction saline irrigation, and 2) only postextraction irrigation with normal saline in the reduction of alveolar osteitis in mandibular third molar extractions. The results indicate that chlorhexidine and cetylpyridium were no more effective in the reduction of alveolar osteitis than postextraction irrigation with normal saline.

Adolescent↗
PubMed2004

Postoperative prophylactic antibiotic treatment in third molar surgery--a necessity?

PURPOSE: We evaluated the need for prophylactic postoperative oral antibiotic treatment in the removal of asymptomatic third molars. MATERIALS AND METHODS: In a prospective study of more than 30 months, a total of 528 impacted lower third molars were surgically removed in 288 patients. All patients were referred to our department by a dentist or a general practitioner. No patient showed any sign of pain, inflammation, or swelling at the time of removal. Three groups were established. In the first group, antibiotic treatment with amoxicillin/clavulanic acid as an oral medication was carried out for 5 days postoperatively. In the second group, we used clindamycin. In the third group, the patients received no antibiotic treatment. Clinical and radiologic factors were recorded for each case, and the rationale for assigning the patients to the groups was strictly random. The surgical technique was the same in all cases, and the follow-up period was 4 weeks. Parameters that were evaluated were pain, differences in mouth opening, infection, the occurrence of dry socket, and adverse postoperative side effects. RESULTS: We could not find any significant difference between the 3 groups regarding the evaluated parameters, but in 69.6% of the patients with dry socket, the teeth were partially erupted, which showed a significant difference. CONCLUSIONS: The results of our study show that specific postoperative oral prophylactic antibiotic treatment after the removal of lower third molars does not contribute to a better wound healing, less pain, or increased mouth opening and could not prevent the cases of inflammatory problems after surgery, respectively, and therefore is not recommended for routine use.

Adolescent↗
PubMed2005

Are sterile gloves necessary in nonsurgical dental extractions?

PURPOSE: The aim of the study was to compare the incidence of healing complications of extraction socket with the use of sterile or clean nonsterile gloves during nonsurgical dental extractions. MATERIAL AND METHODS: This was a randomized prospective study conducted at the exodontia clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (Nigeria), between October 2002 and January 2003. Patients who were referred for nonsurgical extractions of permanent teeth and who satisfied the inclusion criteria into the study were randomly allocated into 2 groups. One group had their extractions performed with the surgeon wearing a pair of sterile gloves and the second group had their extractions performed with the surgeon wearing a pair of clean nonsterile gloves. Two hundred sixty-nine patients who had 301 teeth extracted and satisfied the inclusion criteria for socket healing assessment were assessed for postoperative socket healing. RESULTS: Three different types of socket healing complications were identified (dry socket, acutely inflamed socket, and acutely infected socket). A total of 32 patients (11.9%) developed socket healing complications. Nineteen of 122 patients in the sterile glove group and 13 of 147 patients in the clean nonsterile glove group developed socket healing complications (P = .09). CONCLUSION: The study confirmed that the use of sterile surgical gloves offers no advantage over clean nonsterile gloves in minimizing extraction socket healing complications following dental extraction. Therefore, nonsurgical dental extraction can be safely performed with the surgeon wearing clean nonsterile gloves.

Adolescent↗