Dry Socket; Dry socket or alveolar osteitis or localized osteitis alveolalgia or alveolar osteomyelitis also known as Fibrinolytic alveolitis It involves a part of or whole of the walls of socket; or the lamina dura. According to Geoffrey Howe it as well recognized, but less understood complication of extraction of teeth. Characteristics: The condition is characterized by acute pain; bony walls of the socket are denuded of blood clot after 2-3 days of extraction.
Dry Socket Cause is not clear/obscure yet but there are various studies which show some factors increases incidence of dry socket.
Dry Socket Causes
Trauma and infection
Together they cause inflammation of bone marrow spaces of alveolar bone. That releases tissue activators which convert plasminogen in blood clot to plasmin. This chemical reaction dissolves blood clot and releases kinins from kininogen; which is present in blood clot. This finally result in dissolution of normal blood clot forming in extraction socket which is supposed to be there for healing and severe pain.
Infection of socket occurring either before, during or after the extraction may be an exciting factor.
Trauma during extraction is also noted as a cause of Dry socket via various study. In many clinical cases if there is excessive trauma due to complicated extraction that increased chance of having dry socket but not always. However, it is not always the case; and complications may even occur after very easy extractions.
Many authorities feel that vasoconstrictors that are used in local anaesthetic solution may predispose to dry socket, by interfering with blood supply of bone, and they point out that the condition occurs more frequently under Local anaesthesia than General anaesthesia. Thus, one of the contributor factors for cause of dry socket may be the vasoconstrictor present in local anaesthesia but it cannot be the basic cause of the dry socket.
According to published literature on dry socket it shows mandibular teeth have higher incidence of dry sockets than that of maxillary teeth. Main cause of it is mandible has much more dense bone and is less vascular than maxilla. However, various anatomical studies finding revealed that the normal blood supply to alveolus in lower molar region is not inferior than that of the other regions of the jaw. Lower teeth face usually more difficulty during extraction than that of upper teeth.
Mandibular sockets become contaminated with food debris.
Existence of systemic etiological factor.
There is a lacking of evidence to support this as cause of dry socket. However, patient with increased in fibrinolytic substances has been demonstrated in alveolar bone of patients afflicted with dry socket.
A number of bacteria with various study are known to possess fibrinolytic activity. It has been recently postulated that bacteria Treponema denticola may have a property to cause dry socket. Pregnant women and those taking oral contraceptives appear to be more susceptible than other.
Birn hypothesis of dry socket
Birn hypothesized that trauma occur during an extraction or the presence of a bacterial infection in socket somehow facilitates the release of plasminogen tissue activators in the post-extraction socket, which is resulting in the plasmin induction of fibrinolysis that dislodges the blood clot that formed after the extraction and causing a dry socket.
How to know if you develop dry socket
Generally after extraction pain will be slowly decreasing as healing progress but if there is some inflammation going on and clot is not stabilized then after 3-4 days of extraction patient start suffering with pain over the exaction socket which is very peculiar characteristic of dry socket pain and another identifying feature is that is worsen than that of day after extraction. This is more commonly seen in lower jaw extraction.
Pain in dry socket may radiate to neck or ear as well. Many people also noticed bad breath after 2-3 days of extraction. Dry socket doesn’t have typical feature of inflammation such as redness, swelling or fever so it is difficult to identify by signs but those symptoms of pain and bad breath after 3-4 day of extraction can help to get clue on it. If there was excessive trauma and patient having many predisposing factors then dentist already counsel patient regarding chance of having dry socket.
From above explanation if you feel that you have symptoms of dry socket then without further ado visit dentist. It can be simply treated in dental clinic after observation of status of socket. Medicine hat are placed in socket will make you relief from pain.
Home remedy for dry socket
There is no such home treatment for dry socket because it is inflammation of the extraction site. It is very painful condition so you can take a clove oil from nearby grocery store, pharmacy, or supermarket and can apply over the extraction socket. Which can help to relieve a pain temporarily. But it is mandatory to visit dentist if you are suspecting dry socket after extraction so that further complication will not arises.
If you are suffering from moderate or severe pain then you can take painkiller that was previously prescribed by your dentist during extraction of that tooth such as Ibuprofen or paracetamol in every 6-8 hours. But these all are treatment strategy that will help you to relief from pain and visit dentist as soon as possible.
Dry Socket Pictures
Treatment of dry socket
- Local treatment to the socket is the most effective measure. Irrigate the socket gently with warm saline or 0.12% chlorhexidine to remove the debris. Place a dressing into the mouth of the socket to prevent impaction of further food.
- Effective socket cleansing and socket hygiene are more important than the type of dressing used and the patient should be recalled every 2 days for retreatment if necessary.
- The trismus should be monitored and should reduce.
- Antibiotics should not be prescribed because they are ineffective. A nonsteroidal anti-inflammatory drug should be adequate for most cases.
- Improvement of symptoms will usually be noted within minutes or up to an hour, and more quickly if the dressing contains a local anaesthetic agent.
- Pain may start again a day or two after dressing, gradually increasing in severity. After a few days the pain will reduce and re-dressing may not be necessary
What drugs might you prescribe?
Antibiotics should not be prescribed because they are ineffective. Analgesics are also largely ineffective in the absence of local measures. A nonsteroidal anti-inflammatory drug should be adequate for most cases.
How quickly will the pain be relieved?
- Improvement of symptoms will usually be noted within minutes or up to an hour, and more quickly if the dressing contains a local anaesthetic agent. Pain may start again a day or two after dressing, gradually increasing in severity.
- After a few days the pain will reduce and re-dressing may not be necessary. After about 10 days the socket should be filled with tissue and it will probably be asymptomatic for the last a few days of healing.
What if the condition persists for longer than this or appears to be worsening?
- Failure to resolve in the longer term usually indicates the presence of small sequestra of devitalized lamina dura or root fragments.
- These are a normal sequela of extraction and are usually resorbed in the remodelling process during healing.
- Larger pieces may delay healing and sometimes sequestrate through the alveolar ridge mucosa many weeks after extraction, though they are not usually associated with significant pain.
- Periapical radiographs should be taken because only these have the resolution required to see the small sequestra, which may be less than half a millimetre in size.
- Occasionally, larger sequestra of lamina dura may be seen to be separating radiographically. If these are associated with symptoms and are not shed, surgical removal may become necessary.
- In practice this intervention is extremely rarely required, and sequestra are usually small and lost without being noticed.
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