[Letter: Treatment of dry socket. Antifibrinolytic agents in dry socket].
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Aminocaproates↗
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A review of dry socket: a double-blind study on the effectiveness of clindamycin in reducing the incidence of dry socket.
This double blind clinical study was undertaken to evaluate the effectiveness of locally applied clindamycin in Gelfoam in reducing the incidence of dry socket formation after third molar surgery. A total of 1,021 third molar extractions were performed, and 520 mandibular third molar extractions of varied surgical difficulty were evaluated. The results indicated that this technique was effective. This study also demonstrates that the incidence of dry socket after third molar surgery is significantly higher in the mandible than the maxilla, in smokers than in non-smokers, and in females currently on oral contraceptives.
Adult↗
"Dry socket": etiology and management.
Dry socket is a postoperative complication that most oral surgeons will encounter with some frequency. Its etiology remains obscure, and prevention and management techniques vary considerably. This article will discuss probable etiologies of dry socket and its prevention and successful management.
Dry Socket↗
Update on dry socket: a review of the literature.
Dry socket is a postoperative complication that occurs after a dental extraction and has been defined as an inflammation of the alveolus. If this inflammation should surpass the alveolar walls, it would result in a located osteitis. The frequency of appearance of dry socket has been reported in a very wide margin, from 1% until 70%. It is generally accepted that most dry sockets appear after extraction of third retained molars, in which the occurrence of this complication is about 20-30% of dental extractions, ten times more than in the rest of dental extractions. In this work we review the forms of clinical appearance, the risk factors related to this affection and the etiopathogenic theories that try to explain its appearance. The treatment management is also examined. Fibrinolitic agents, laundries, antiseptic, and antibiotics have been studied for its prevention, according to the pathogenic theories of dry socket. We analyze and criticize the different drugs and their results. In conclusion from the revised data, we think it is possible to defend a pathogenic model in which the bacterial fibrinolytic mechanisms and the microorganism of the own patient may contribute to produce the dry socket.
Dry Socket↗
A clinical study of "dry socket".
A total of 1274 extractions carried out by the author resulted in a dry socket incidence of 2.6%. There was no sex predilection in the occurrence of dry socket. Incidence of dry socket formation was highest in the first and second molar region. Forceful infiltration of an extra 2 ml of local anesthetic into the tissues resulted in a higher incidence of dry socket; however this difference was not statistically significant. Dry sockets occurred more frequently in difficult extraction cases as compared to routine extractions; this difference was statistically significant. However, when 20 teeth in difficult extraction cases were removed by the open surgical method there were no cases of dry socket formation. Teeth removed principally due to a periodontal involvement did not give rise to a single case of dry socket. Treatment of dry socket with intra-alveolar dressings did reduce the pain; however, the healing time was invariably prolonged. The best results, in the form of reduction of pain and rapid healing, were obtained with the surgical method of reflection of a flap and debridement of the socket.
Anesthetics, Local↗
Quantifying the healing of dry socket using a clinical volumetric method.
OBJECTIVES: To quantify the healing of dry sockets using a simple clinical volumetric method that measures the reduction in the volume of dry sockets and to study the effects of sex and smoking on socket healing. STUDY DESIGN: Volumes of 28 mandibular dry sockets were measured under standard conditions by injecting sterile normal saline solution into them and aspirating the solution back into a calibrated syringe. Measurements were done at diagnosis (T0), at 4 days after diagnosis (T4), at 7 days after diagnosis (T7), and at 14 days after diagnosis (T14). Differences in socket volumes at different intervals were analyzed using paired samples t test and differences between males and females or between smokers and nonsmokers were analyzed using independent samples t test. RESULTS: Average socket volume in all patients decreased by an average of 5.16% daily from 1.44 (+/- 0.36) mL at T0 to 1.08 (+/- 0.43) mL at T4, 0.74 (+/- 0.35) mL at T7, and 0.40 (+/- 0.28) mL at T14. These differences were statistically significant (P = 0.00). No statistically significant difference in the rate of socket healing was found between males and females or between smokers and nonsmokers. CONCLUSION: Dry socket healing can be quantified using the volumetric method described in this study. Sex and smoking do not appear to affect the rate of dry socket healing.
Adolescent↗
[Using Metronidazole and Hydroxyapatite for preventing dry socket after extraction of impacted mandibular 3rd molar]
Dry socket is one of the most frequent complications after teeth extraction,especially in impacted mandibular third molars.The etilogy and prevention is not clear.This study id based on principles of clinical epidemiology.Randomized double-blind method was carried out in 549 patients to test the value of the prophylactic use of Hydroxyapatite,to test the value of the prophylactic use of Hydroxyapatite and Metronidazole,placed in the sockets of extracted impacted mandibular third molars.The results of the incidence of DS was 7.1% of Metronidazole treated sockets,and 2.1% of Hydroxyapatite treated sockets,It is concluded that Hydroxyapatite is an effective preventive factor for dry socket,The possible mechanism of Hydroxyapatite and the dry socket etiology were discussed.
Journal Article↗
On the genesis of "dry socket".
One major school of thought regarding the pathogenesis of a dry socket occurring following tooth extraction is based on the concept that a blood clot fails to form, a concept that is, however, refuted by the clinical symptoms associated with the phenomena of a dry socket. A second theory maintains that, initially, clot formation takes place, but that the clot is subsequently lysed, bringing about the severe symptoms of a dry socket. Fibrinolysis generated by tissue activators only partly explains the occurrence of a dry socket. Based on the data accumulated in the literature, it is postulated that bacterial agents are involved in the fibrinolysis and that Treponema denticola may play a leading part in this process.
Blood Coagulation↗
A clinical evaluation of dry socket in a Nigerian teaching hospital.
PURPOSE: We sought to determine the incidence of dry socket in a Nigerian teaching hospital and to evaluate the patients' demographic pattern, predisposing factors, the treatment given, and treatment outcome. PATIENTS AND METHODS: A retrospective review of records of dental extractions complicated by dry socket in Obafemi Awolowo University Teaching Hospital, Ile-Ife, between January 1996 and December 2000 was undertaken. Information retrieved included patient sociodemographic data, indications for extraction, tooth extracted, status of attending surgeon, onset of symptoms, relevant findings of the examining clinician, interval before presentation, treatment given, and its outcome. RESULTS: Of the 3,319 dental extractions performed in 3,008 patients, 136 (4.1%) were complicated by dry socket. The patients' mean age was 33.4 (15.4) years and a peak age incidence of 21 to 30 years was found. A slight female preponderance (1.4:1) was observed. The majority of patients were in the low-income group, and presentation in the hospital was prompt in the high-income group. Mandibular teeth were affected 3 times more than maxillary teeth (P =.00080). Most cases of dry socket resulted from extractions performed by undergraduates and house officers. Various underlying systemic conditions were found in 11.0% of cases, none of which included use of oral contraceptives. Treatment was usually the use of zinc oxide eugenol dressing in an irrigated socket, combined with antibiotic therapy in 45.3% of cases. No adverse reaction to zinc oxide eugenol was observed. CONCLUSION: The incidence of dry socket in our hospital is 4.1%. The mandible was involved 3 times more than the maxilla. With the use of zinc oxide eugenol dressing, 70.6% of patients completed treatment satisfactorily and 29.2% were lost to follow-up.
Adult↗
Clinical management and control of alveolalgia ("dry socket") with vitamin C.
PURPOSE: To monitor the incidence of dry socket in a sample of 696 consecutive tooth extraction patients and to test the possible therapeutic effects of vitamin C. MATERIALS AND METHODS: Following standardized extractions, 24 dry socket patients were provided 4,000 mg/day dosages of Vitamin C. Demographic and health history data were collected. RESULTS: The occurrence of dry socket (3.5% overall) was greater in females and individuals with lower overall health status, and supplemental Vitamin C was associated with rapid recovery.
Adolescent↗
[Dry socket. Prevention and treatment].
Although dry socket is a frequent and painful affection, its pathogenesis is still unknown. We present here a review of the literature to propose a logical preventive and therapeutic attitude. The clinical and histological aspects are also tackled.
Dry Socket↗
The effect of chlorhexidine irrigation on the incidence of dry socket: a pilot study.
A pilot study was conducted to measure the reported incidence of dry socket following pre-operative irrigation and mouthrinsing with either 0.2% (w/v) chlorhexidine gluconate or normal saline or with no irrigation (control). Three hundred and twenty-four patients presenting for the single extraction of a lower premolar or molar under local anaesthesia were divided into three equal groups; no irrigation, irrigation with saline and irrigation with a 0.2% (w/v) chlorhexidine gluconate solution. After administration of the local anaesthetic agent, 10 ml of the test solutions were applied to the gingival crevice using a blunted needle. The solutions were retained in the patients mouth for 2 min following irrigation. Pre-operative irrigation of the gingival crevice and mouthrinsing with 0.2% (w/v) chlorhexidine gluconate significantly reduced the number of dry sockets. There was no significant reduction in the number of dry socket cases following irrigation and rinsing with normal saline. The irrigation technique, using 0.2% (w/v) chlorhexidine gluconate is safe, inexpensive, easy to apply and can be recommended for routine use in dental practice, to reduce the incidence of dry socket.
Bicuspid↗
Incidence of dry socket in surgical removal of impacted third molar.
In a search for dry socket five hundred and thirty six (536) impacted third molars were surgically removed among 435 patients. Each patient was examined clinically and radiographically before surgery. 108 impacted teeth were removed for prophylactic and 428 for therapeutic reasons. A standard operating procedure was performed for each case and pre-operative and post-operative regimens was employed. After surgery each case was followed to determine the absence or presence of signs and symptoms of dry socket. It was found that total incidence of alveolar osteitis (dry socket) was 10.26%.
Adolescent↗
Metronidazole in the prevention of 'dry socket'.
Prophylactic metronidazole was found to be an effective means of preventing 'dry socket' after routine dental extractions. The oral anaerobic bacterial may be implicated therefore in the development of the disorder. It has been confirmed in this study that 'dry socket' occurs following three per cent of routine dental extractions and almost exclusively in the mandible. The causes of the condition are probably numerous and may even vary from patient to patient, but the control of infection by anerobic organisms may be important in its prevention or early resolution. The prophylactic administration of metronidazole (Flagyl) has been shown to be a simple and effective method of prevention which would suggest the implication of anaerobic organisms in 'dry socket'. The drug appears to be free from side effects when a dosage of 200 mgs eight hourly for three days is given.
Adult↗
Effect of oral contraceptive cycle on dry socket (localized alveolar osteitis).
Use of oral contraceptives was associated with a significant increase in the frequency of dry socket after extraction of mandibular third molars. The probability of dry socket increases with the estrogen dose in the oral contraceptive. The risk of dry socket associated with oral contraceptives can be minimized by performing extractions during days 23 through 28 of the tablet cycle.
Contraceptives, Oral↗
Tetracycline compound placement to prevent dry socket: a postoperative study of 200 impacted mandibular third molars.
PURPOSE: Our objective was to study whether the placement of intra-alveolar tetracycline prevents dry sockets or improves the postoperative period. PATIENTS AND METHODS: A comparative clinical study of the surgical removal of 200 impacted mandibular third molars is made, with particular reference to postextraction pain, inflammation, trismus, and the incidence of dry socket. In 50% of these cases, a pharmacologic preparation that includes tetracycline was placed in the socket after removal of the impacted molar. RESULTS: Dry socket was diagnosed in 4 cases (2%), with no relation to intra-alveolar tetracycline placement being observed. The patients who were administered intra-alveolar tetracycline had less pain and trismus and consumed fewer analgesics than the patients who received no such treatment, although statistical significance was not reached. CONCLUSIONS: The intra-alveolar placement of tetracycline compound after the surgical removal of impacted mandibular third molars did not affect the incidence of dry socket.
Administration, Topical↗
Effect of chlorhexidine rinse on the incidence of dry socket in impacted mandibular third molar extraction sites.
This nonrandomized prospective study was conducted in a private practice setting to determine the effect of a 0.12% chlorhexidine gluconate rinse (Peridex, Proctor and Gamble, Cincinnati, Ohio) on the incidence of dry socket after removal of impacted mandibular third molars. Over a 3-year period, 371 patients (total of 654 impacted mandibular third molars) received either no treatment (group 1), 2 weeks of twice daily Peridex rinse postsurgery (group 2), or one rinse presurgery (group 3). The group that used Peridex twice daily for 2 weeks after surgery (group 2) showed a significant reduction (56%) in the incidence of dry socket when compared with either the group that did not rinse (group 1) or the group that rinsed only once just before surgery (group 3). The incidence of dry socket was higher in smokers and in females who used oral contraceptives. Twice daily use of Peridex for 2 weeks also yielded significant reductions in dry socket in smokers, nonsmokers, and in females who did not use oral contraceptives. Results from this study demonstrate that the use of Peridex for 2 weeks after surgery is effective in prevention of dry socket after surgical extraction of impacted molars.
Adult↗
Alveolar osteitis (dry socket)--a review.
The literature on "dry socket" is reviewed. The diagnosis, incidence and predisposing factors are discussed in relation to its aetiology. Treatment regimes are outlined; in particular, the use of anti-fibrinolytic drugs.
Adult↗