DRY SOCKET

DEFINITION
Post operative pain surrounding the alveolus that

increases in severity for some period from 1 -3 days after extraction,followed by partial or total clot loss in the interior to alveolus with or without halitosis Reffered as : Alveolar osteitis,localised osteitis,necrotic socket,localized osteomylitis,fibrinolytic alveolitis,alveolalgia,alveolitis sicca dolorosa,avascular socket,painful socket.

CLINICAL CONCEPTS $ PATHOPHYSIOLOGY

Clinical concepts-the alveolus empties,osseous

surroundings are denuded and covered by a yellow grey necrotic tissue layer and surrounding mucosa usually becomes erythematous Intense pain that radiates to ear and neck. Commonly observed in age of 40-45 yrs

CLASSIFICATION
*HERMSECH et al classified this into 3 types:

Superficial alveolitis marginal

Suppurative alveolitis Dry socket

*OIKARINEN classified in 1989:

Real alveolitis Non specific alveolitis

ETIOLOGY
Hypovascularisation of alveolar bone,vascular and

hematologic impairment,osteonecrosis induced by radiotherapy,pagets disease Incerases local fibrinolytic activity Presence of dental and osseus remains within the socket Poor aral hygeine and consequent alveolar contamination Smoking Foreign bodies left in socket Infection during or after the extraction

PREVENTION
ANTIFIBRINOLYTIC AGENTS,ANTIBIOTICS,ANALGESICS

Antifibriolytic agent ester propyl topically applied Clot support agents such as polyglactic acid Alveolus irrigation after extracton with physiologic saline Antibiotics metronidazole Tinidazole Amoxycillin Penicillin with clavunate plus chlor hexidine mouth wash

pre and post operatively. Chlorhexidine mouth wash-antiseptic

TREATMENT
1929-irrigation with heated saline solution,gauze

with iodoform,powdered sodium perborate,prescription of codeine and subsequent irrigation with a concentrated solution of sodium perborate Saline irrigation followed by dressing with gauze impregnated with 5% iodoform and eugenol 1967-antibiotic therapy and zinc oxide eugenol dressing Metronodazole 400 mg/day for 5 days

 1984- Mitchell-10% metronidazole paste

Paste of collagen after irrigating with saline

2000-Poi paste composed of metronidazole,2%

lidocaine,carboxymetilcellulose and 5% ascorbosaline Topical antiseptic combinations-sodium iodide and hydrogen peroxide 1990-6% hydrogen peroxide 2005-3% hydrogen peroxide for 2 minutes followed by suturing

 Sodium iodide

Combination of iodine based substances with

hydrogen peroxide

CURRENT RECOMMENTATIONS
Irrigation of alveolus with 3 % hydrogen peroxide

and 2 % sodium iodide at 1:1 proportion followed by superficial curettage of debris 0.12 % chlorhexidine mouth wash Amoxycillin 1500 mg/day,patients allergic,clindamycin 1200 mg/day+analgesics