Introduction
Alveolar/Dry Socket Osteitis is the most frequent painful complication of extractions caused by destruction of the clot that normally fills the socket.
Predisposing factors
- Excessive extraction trauma
- Limited local blood supply
- Local anaesthesia
- Oral contraceptives
- Osteosclerotic disease
- Radiotherapy
- Female gender
Symptoms and clinical features of alveolar osteitis
- Pain delayed for few days up to a week after extraction
- Deep seated, throbbing pain
- Mucosa around socket is red and tender
- No clot in socket – bare whitish alveolar bone exposed
Differential diagnosis
- Osteomyelitis
Complication of alveolar osteitis
Osteomyelitis
Treatment for alveolar osteitis
Treatment bobjective
- Alleviate pain and suffering of the patient
- Optimize condition for epitheliasation of the extraction socket
- Keep open socket clean and protect exposed bone
Non-drug treatment
- Irrigate with mild warm saline and antiseptic
- Fill with an obtudant dressing containing some non-irritant antiseptic
- Warm saline mouth rinse
Drug treatment
- Local anaesthesia
- Lidocaine 2% (1in 80,000)
- Amoxicillin Clavulanic acid
- for Severe dental infection with spreading cellulitis
- 250/125 mg orally every 8 hours for 5 days (dose/doubled in severe infections)
- Chlorhexidene gluconate 2% 10 ml for mouth washes three times daily
Prevention of alveolar osteitis
- Minimal trauma during extractions
- Immediately after extraction, squeeze socket edges firmly together and hold for a few minutes till clot has formed
- Antibiotics if patients have had irradiation, or have Paget’s disease