DRY SOCKET

Dry socket it is also called alveolitis sicca dolorosa, alveolagia or postoperative osteitis.It is basically focal osteomyelitis in which blood clot has disintegrated or is lost.Dry socket is a temporary dental condition that sometimes occurs after extraction of a permanent tooth. The term alveolar refers to the alveolus, which is actually the part of the jawbone which surrounds the teeth, and osteitis means simply "bone inflammation".Dry socket occurs when the blood clot at the site of the tooth extraction is dislodged, exposing underlying bone and nerves and causing increasing pain. Dry socket is the most common complication following tooth extractions. When it occurs, dry socket usually strikes one to three days after a tooth extraction. The most common hallmark of dry socket is significant pain.

DRY SOCKET

Complications of Dry Socket

Complications as well as problems that dry socket may cause or be associated with consist of:

1. pain
2. Postponed healing after tooth extraction
3. Infection
4. grayish slough
5. foul odor
6. Unpleasant taste in your mouth

Causes of Dry Socket

Usually, a blood clot forms at the site of a tooth extraction. This blood clot serves as a protective coating over the underlying bone and nerve endings in the empty tooth socket. The clot provides the foundation for the growth of new tissue and bone. In some cases,either the clot doesn't form properly or is physically dislodged before complete healing. With the clot is dislodged, bone and nerves in the socket are exposed to air, fluids and food. This can cause intense pain, not only in the socket but also along the nerves radiating to the ear and eye on the same side of the face. The precise cause of dry socket is still not known. Some causes, including:

• Bacterial contamination of the socket
• Difficult or traumatic tooth extraction surgery
• Roots or bone fragments remaining in the wound after surgery

Dry socket occurs in about 3 to 5 percent of all tooth extractions. It's much more common after extraction of wisdom teeth and impacted wisdom teeth.

Signs & Symptoms of Dry Socket

1. Severe pain within a few days after  tooth extraction
2. Partial or total loss of the blood clot at the tooth extraction site, which may be noticed as an empty looking  socket.
3. Visible bone in the socket
4. Pain that radiates from the socket to  ear or eye on the same side of  face
5. Bad breath or a foul odour coming from  mouth
6. Unpleasant taste in mouth
7. Swollen lymph nodes around  jaw or neck

Diagnosis of Dry Socket

Severe pain following a tooth extraction is often enough for your dentist to suspect dry socket  dentists checks to see if any blood clot in the tooth socket and whether their is  exposed bone. You may also need to have X-rays taken of your mouth and teeth to rule out other conditions.

Treatments of Dry Socket

• Medicated dressings. This is the main way to treat dry socket. The socket is packed with medicated dressings.The active ingredients in these sedative dressings usually include substances like soluble aspirin, zinc oxide, eugenol, and oil of cloves. It is usually necessary to have this done for two or three consecutive days, although occasionally it can take longer.  The severity of your pain and other symptoms determines how often you need to return for dressing changes or other treatment.
• Flushing out the socket.  the socket is flushed out with betadine  to remove any food particles or other debris that has collected in the socket and that contributes to pain or infection.
• Pain medication. mostly analgesics are prescribed for pain control.
• Self-care. You may be instructed how to flush your socket at home to promote healing and eliminate debris.you are instructed to do  warm salt water rinses  into the socket for atleast 5-6 times in a day. You may need to continue to do this daily for three or four weeks.
• Once treatment is started, you may begin to feel some relief in just a few hours. Pain and other symptoms should continue to improve over the next few days. Complete healing typically goes smoothly and generally takes about 10 to 14 days.

Prevention of Dry Socket

What your dentist  may do

Your dentist or oral surgeon may discuss with you the following medications that may help prevent dry socket:

• Antibacterial mouthwashes or gels immediately before and after surgery
• Oral antibiotics, particularly for people with compromised immune systems
• Antiseptic solutions applied to the wound
• Medicated dressings applied after surgery
• Experiment by placing sulfanilamide
• Oxidase cellulose-inserted for haemostatic purpose, produces retardation of healing similar to that of combined sulfonamide.
• Sulfathiazole in 60% glycerine base reduces the frequency of occurance of dry socket.
• ureomycin-causes significant reduction in decomposition of blood clot. these is decreased incidence of postoperative pain & swelling after 1 week.
• Tetracycline hydrochloride- if tablet is placed in extraction socket, it helps in reduction of dry socket to 0.78 %.
• Trypsin-digest necrotic tissue & debris & restrains bacterial growth.

What you can do before surgery

You can take the following steps to help prevent dry socket:

• Seek a dentist or oral surgeon with experience in tooth extractions.
• If you take oral contraceptives, schedule your extraction, if possible, during days 23 to 28 of your menstrual cycle, when estrogen levels are lower.
• Stop smoking and the use of other tobacco products at least 24 hours before tooth extraction surgery. Consider talking to your doctor or dentist about a program to help you quit permanently.
• Talk to your dentist about any prescription or over-the-counter medications or supplements you're taking, as they may interfere with blood clotting.

What you can do after surgery

• You'll receive instructions about what to expect during the healing process after a tooth extraction and how to care for the wound. These instructions will likely address the following issues that can help prevent dry socket:
• Activity.For at least a week, avoid rigorous exercise and sports that might result in dislodging the blood clot in the socket.
• Beverages. Drink lots of water after the surgery. Don't drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don't drink with a straw for at least a week because the sucking action may dislodge the blood clot in the socket.
• Food. Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
• Cleaning your mouth. Don't brush your teeth, rinse your mouth, spit or use a mouthwash during the first 24 hours after the surgery. After that time, gently rinse your mouth with warm salt water every two hours while awake and after meals for a week after your surgery. After the first 24 hours, resume brushing your teeth, being particularly gentle near the surgical wound.
• Tobacco use. If you smoke, don't do so for at least 24 hours after surgery. If you chew tobacco, don't use it for at least a week. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications.