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What are the local and systemic interventions for the prevention of dry socket? An evidence-based update

Inflamed teethThis summary is based on the article published in the British Dental Journal: Interventions for the prevention of dry socket: an evidence-based update (July 2014)

M. O. Sharif, B. E. S. Dawoud, A. Tsichlaki and J. M. Yates

 

 

 

Context

  • Infection control and knowledge of common infectious agents is a cornerstone of safe dental practice.
  • Alveolar osteitis (AO) or ‘dry socket’ is a relatively common post-operative complication that is reported to be associated with up to 37% of dental extractions. (1)
  • The condition develops when a blood clot fails to form or becomes dislodged from the socket of an extracted tooth.
  • The development of AO is not only associated with patient morbidity, but is also associated with other significant implications, which are multifaceted and include both societal (2) and healthcare costs.
  • Effective modalities for the prevention and management of AO are crucial for dentists carrying out extractions both in a practice and hospital setting.

Purpose of the Article

  • This paper reviews the latest evidence for local and systemic interventions for the prevention of alveolar osteitis (dry socket).
  • Dry socket is a painful and common post-operative complication following exodontia. Any interventions for the prevention of dry socket could reduce both its incidence and help avoid this painful complication.
  • Prophylactic measures proposed in the literature are discussed. Furthermore, this article discusses both the clinical and histological stages of a normal healing socket.

Key Messages

  • It is important to remember that the speed of healing is variable between individuals with significant factors impairing the speed regeneration such as older age, (3) compromised medical status (such as diabetes, anaemia) (3) or in smokers. (4)
  • Prevention
  • There is some evidence that the use of chlorhexidine gel (0.2%) placed into extraction sockets immediately post treatment could help to prevent approximately 60% AO. (5)
  • There is some evidence that rinsing with chlorhexidine (0.12% and 0.2%) also provides some benefit in preventing dry socket.
  • In terms of treatment, the use of systemic therapy showed that antibiotics might reduce the risk of AO by 38%. (6)
  • Measures to minimize dry socket include:
  • Reducing the amount of vaso-constrictive local anaesthetic used, carrying out the extraction with minimal trauma as possible, or advising on smoking cessation. (7)
  • Identifying patients that are at high risk of developing AO is important. Risk factors include: (7, 8, 9)
    • Oral contraceptives
    • Radiotherapy
    • Previous history of AO
    • Lower molar extractions
    • Smokers
    • Female gender
    • Osteosclerotic disease (Paget’s disease)
    • Older age group (4)
    • Experience of surgeon.

Conclusion

There is potential for the use of local and systemic prophylactic interventions for the prevention of AO; however, further well conducted research in primary/specialist care is required for conclusive guidance.

References 

  1. Vezeau P J. Dental extraction wound management: medicating post-extraction sockets. J Oral Maxillofac Surg 2000; 58: 531–537.
  2. Nusair Y M, Younis M H. Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching centre. J Contemp Dent Pract 2007; 8: 53–63.
  3. Gosain A, DiPietro L A. Aging and wound healing. World J Surg 2004; 28: 321–326.
  4. Guo S, Dipietro L A. Factors affecting wound healing. J Dent Res 2010; 89: 219–229.
  5. Daly B, Sharif M O, Newton T, Jones K, Worthington H V. Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database Syst Rev 2012; 12: CD006968.
  6. Lodi G, Figini L, Sardella A, Carrassi A, Del Fabbro M, Furness S. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev 2012; 11: CD003811.
  7. Cawson R A, Odell E W. Cawson’s essentials of oral pathology and oral medicine. 8th ed. UK: Churchill Livingstone, 2008.
  8. Larsen P E. Alveolar osteitis after surgical removal of impacted mandibular third molars. Identification of the patient at risk. Oral Surg Oral Med Oral Pathol 1992; 73: 393–397.
  9. Sisk A L, Hammer W B, Shelton D W, Joy E D Jr. Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 1986; 44: 855–859.

 

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3 comments

  1. Placing gel foam or a similar product into the socket helps to prevent AO. I think it stabilizes the clot so it harder to dislodge. Patients who smoke are a problem, but I have noticed they have less dry sockets

  2. How about using A-PRF on ALL extractions and you will prevent AO.

    Prevention of Localized Osteitis in Mandibular Third-Molar Sites Using Platelet-Rich Fibrin
    Donald R. Hoaglin and Gary K. Lines

  3. I would be interested in finding out the effect of providing and adherence to good post-op care instructions. That, in my mind, has a significant impact on the entire healing process, including the occurrence of AO.

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