Dry Socket

Alveolar ostitis is common healing disorder that occur after tooth extraction. It is also known as a dry socket. There are many factors that can cause alveolar ostitis, jet etiology for this disorder is not completely understood. These factors are extraction trauma, infection, blood supply, sex, oral contraceptives and other systemic factors. Risk of aveolar ostitis is much higher in the mandible than maxilla, especially in the lower molar region. Dry socket is more common after complicated extractions. Some researchers say that alveolar ostitis is more frequent in women than man, and the risk is higher in elderly patients. The menstrual cycle may be another risk factor in the prevalence of alveolitis. Studies have found that because of hormonal changes, women in the middle of menstrual cycle and the ones taking oral contraceptives (birth control pills) have a higher risk of suffering alveolar ostitis after tooth extraction.

The use of local anesthetics with vasoconstrictors is also associated with an increased risk of dry socket prevalence. Vasoconstrictors in anesthetics are added to increase the length of analgesia by reducing blood supply to the region which reduces the amount of local anesthetic solution that is absorbed into the circulation and carried from the local tissues.

The risk is much higher when teeth with acute apical periodontitis or pulpitis are extracted, compared to extraction of healthy teeth or periodontally damaged teeth. For example wisdom teeth are not associated with pericoronitis and they are less likely to develop a dry socket when extracted.

Smoking is another risk factor of alveolar ostitis. This may be explained partially due to the vasoconstrictive effect of nicotine on small blood vessels.

Main cause of alveolar ostlitis is the loss of blood cloth in extraction socket. Dry socket usually develops between third and fifth day after extraction. Loss of the blood cloth leaves an empty socket where the alveolar bone is exposed to oral cavity. In a dry socket, healing is prolonged because tissue must grow from the surrounding gingival tissue, which takes more time than the usual organization of a blood clot. The first symptom of dry socket is dull, aching, throbbing pain in the area of the extraction socket, which can be from moderate to severe. The pain usually starts on the second to fourth day after the extraction. Other common symptoms are intraoral halitosis and bad taste in mouth.

Therapy of alveolar ostitis is based on the elimination of pain and infection. Infection of the socket following tooth extraction is different from dry socket, although in dry socket secondary infection may occur in addition. Infection can be easily eliminated with antibiotic therapy and inflammatory drugs. However, it is very important to discover the cause for occurrence of dry socket and fix it because it has high likelihood of relapse. In addition to antibiotic therapy, doctor will perform mechanical cleaning of contaminated wall of extraction socket. After removing pus doctor will wash extraction wound. Pain can be eliminated by use of analgesics and anesthetic lotions several times a day until the healing is complete.