Alveolar / Dry Socket Osteitis

Introduction

Alveolar/Dry Socket Osteitis is the most frequent painful complication of extractions caused by destruction of the clot that normally fills the socket.

Predisposing factors

  • Excessive extraction trauma
  • Limited local blood supply
  • Local anaesthesia
  • Oral contraceptives
  • Osteosclerotic disease
  • Radiotherapy
  • Female gender

Symptoms and clinical features of alveolar osteitis

  • Pain delayed for few days up to a week after extraction
  • Deep seated, throbbing pain
  • Mucosa around socket is red and tender
  • No clot in socket – bare whitish alveolar bone exposed

Differential diagnosis

  • Osteomyelitis

Complication of alveolar osteitis

Osteomyelitis

Treatment for alveolar osteitis

Treatment bobjective

  1. Alleviate pain and suffering of the patient
  2. Optimize condition for epitheliasation of the extraction socket
  3. Keep open socket clean and protect exposed bone

Non-drug treatment

  1. Irrigate with mild warm saline and antiseptic
  2. Fill with an obtudant dressing containing some non-irritant antiseptic
  3. Warm saline mouth rinse

Drug treatment

  1. Local anaesthesia
    • Lidocaine 2% (1in 80,000)
  2. Amoxicillin Clavulanic acid
    • for Severe dental infection with spreading cellulitis
    • 250/125 mg orally every 8 hours for 5 days (dose/doubled in severe infections)
  3. Chlorhexidene gluconate 2% 10 ml for mouth washes three times daily

Prevention of alveolar osteitis

  1. Minimal trauma during extractions
  2. Immediately after extraction, squeeze socket edges firmly  together and hold for a few minutes till clot has formed
  3. Antibiotics if patients have had irradiation, or have Paget’s disease