Dry socket/alveolar osteitis (AO) is one of the most common and severly painful post operative complication ocurring after the extraction of a permanent tooth .
The term “dry socket” has been used in literature since 1896, when it was first described by Crawford . Efforts have been made to define dry socket more accurately through the use of terms such as AO, localized osteitis, post extraction osteomyelitis syndrome, alveolalgia, avascular socket, alveolitis sicca dolorosa, delayed extraction wound healing, and fibrinolytic alveolitis. However the term dry socket continues to be used popularly.
The condition has generally been characterized by degraded or delayed healing associated with clot degradation and is usually accompanied by persistent, radiating postoperative pain in and around the extraction site that is not easily relieved by analgesics. it occurs within 2 to 4 days after extraction, and accompanied by premature loss or necrosis of the blood clot and exposure of the underlying bone. AO can also be accompanied by halitosis. And Factors such as a difficult or traumatic extraction, pre-existing infection, gender, smoking , oral contraceptive use, menstruation, and an inadequate blood supply might play important roles in the formation of AO. AO has a reported incidence of 3% to 4% after routine dental extractions and 1% to 45% after extraction of the mandibular third molars.
AO can be a burden for both patients and surgeons. This painful condition can result in a loss of productivity, because at least 45% of patients require multiple visits to the surgeon’s office. AO can also be costly in terms of the clinic time required to manage the patient’s symptoms. Prevention of AO remains the best strategy that can be achieved by providing an aseptic environment, avoiding inadvertent instrumental trauma, drinking through straw, smoking, excessive mouth rinsing. There should be sufficient irrigation when using rotary instruments. Incidence can also be decreased by use of antiseptic mouth washes, antifibrinolytic agents, antibiotics, steroids and clot supporting agents.Any treatment modality is considered effective if it improves patient’s quality of life by reducing cost of therapy and relieving patient’s pain.
Various treatment options are available for dry socket. Topical application of a combination of eugenol, benzocain and balsam of Peru; and Honey have been tried for pain relief. Prophylactic administration of systemic beta lactamase inhibitor containing antibiotic have been claimed in reducing incidence of AO.Since dry socket is the most common post extraction complication, many researchers have attempted to find a successful method for its prevention.
Systemic antibiotics, topical antibiotics, chlorhexidine, para-hydroxybenzoic acid, tranexemic acid, polylactic acid, steroids, eugenol containing dressings, lavage, 9-aminoacridine, etc., have been proposed to assist in the prevention of dry socket. However, this area remains controversial as no single method has gained universal acceptance