DRY SOCKET

 Definition:  

Dry socket is a post-operative complication that occurs after a dental extraction. It has been called as post-operative pain in and around the dental alveolus. The severity of pain increases between the first and third day after a dental extraction.It is followed by partial or total disintegration of the intra-alveolar clot, causing foul smell. 

Etiology:  

1. Difficult or traumatic extraction. 

2. Use of oral contraceptives. 

3. Normal changes. 

4.Tobacco.

5.Inadequate intra-operatory irrigation. 

6.Advanced age.

                              
                                                                  

Clinical Feature:      

          

 1. Pain typically appears on the second or third day after the extraction and it usually lasts either with or without treatment for 10 to 15 day.      

2. Pain is localised to the extraction socket which will be sensitive to even gentle probing. 

3. Bad breath is present. 

4. It is common for the pain to spread to   the ear and one side of the head. 

5. Clot in the socket which may be empty.

6. Radiological studies do not show important alternatives. 

Management: 

1. Patient should be radiographed to the possibility of retained fragments of tooth or foreign body. 

2. The affected socket should be gently irrigated with 0.12 % warmed chlorexidine and all debris dislodged and aspirated.

3. Intra-alveolar pastes consisting of zinc oxide eugenol paste, anesthetic drug (drug for pain) and an antibiotic (Metronidazole) can be placed. They act principally by increasing the drug concentration locally, reducing their secondary effects, avoiding the entrance remains of food to the alveolus and protecting the exposed bone from local irritation in addition to the use of eugenol as abundant. 

4. The complications secondary to the placement of dressings in the treatment of dry socket are ignored. 

5. The topical application of an emulsion of oxytetracycline and hydrocortisone & use of parahydroxybenzoic acid (PHBA) in extraction site decreased the incidence of mandibular third molar dry socket. Appropriate analgesics as the NSAIDs drugs are useful in managing pain. 

6. When it is considered that socket dressings are no longer needed the patient can be instructed in home socket irrigation techniques using 0.12% chlorehexidine. Patient should be kept under review until they are pain free and socket healing in ensured. 

 

HERPES SIMPLEX VIRUS

HERPES SIMPLEX VIRUS:

Also know as HSV, is an infection that causes herpes. It can occur in various parts of the body, most commonly on the genitals/mouth.The term herpes means to "creep"- which means easily spreading nature.

TYPES 

HSV 1: It causes oral herpes. This type can cause cold sores & fever blisters around the mouth & on the face. This spreads by contact with infected saliva.

HSV 2: It causes genital herpes. Said to be transmitted by sexual contact.

PATHOGENESIS:

Man is the only natural host to HSV, the virus is spread by contact, the usual site for the implantation is skin /mucous membrane.

Incubation period is around 3 to 7 days.

Local symptoms incluse- pain, itching, vaginal & uretheral dischrage & lymphadenopathy

HSV 1( Gingivostomatitis):

Oropharynx is the most commonly affected site. Usually it starts with a tingling

Tiny blisters show up & quickly break open, causing a painful sore which eventually scabs over time.

It is most common to haveout breaks 2 to 3 times a year.

Herpes is contagious, but its possible for one person in a family to have it , while the others dont.

Herpes is spread through direct skin to skin contact.

HSV 2 (GENITAL HERPES) :

Genital herpes is a common sexually transmitted infection caused by HSV. This occurs in the absence of symptoms.

There is no cure  for genital herpes, but medications can ease symptoms& reduce the risk of infecting others.

Symptoms begin about 2 to 12 days after exposure to the virus

Babies born to infected mothers can be exposed to the virus during the birthing process. This may result in brain damage , blindness or death of the newborn.

CLINICAL FEATURES:

1. High temperature.

2.Malaise.

3.Cold sores around the mouth.

4. Red bisters on skin.

5.In most cases , ulcers will heal & the individual will not have any lasting scars.

 

TREATMENT:

1. There is no cure for herpes.

2. Medicines such as acyclovir & valaciclovir fights the herpes virus.

3. Avoid touching an active outbreak site, washing hands frequently.

4.If the medicines are being used to treat a repeat outbreak, they should be started as soon as you feel any tingling, burning or itching.

GINGIVAL RECESSION

 WHAT IS GINGIVAL RECESSION ?

It is defined as the exposure of the root surface by a shift in the position of the gingiva.

ETIOLOGY:

1. Plaque induced gingivitis

2. Plaque induced periodontitis

3. Age

4.Faulty tooth brushing

5.Tooth malposition

6. Gingival inflammation

7.Trauma from occlusion

TYPES OF RECESSION:

1. Visible.

2. Hidden.

3. Localised.

4. Generalised.

5. Narrow.

6. Shallow.

 
    

MILLERS CLASSIFICATION OF RECESSION:

CLASS 1: Marginal tissue recession not extending to the mucogingival junction. 

                   No loss of interdental bone/ soft tissue.

CLASS 2: Marginal tissue recession extends to or beyond the mucogingival junction. 

                  No loss of interdental bone / soft tissue.

CLASS 3: Marginal tissue recession extends to or beyond the mucogingival junction

                  Loss of interdental bone /soft tissue is apical to the CEJ, but coronal to the apical extent of                       marginal tissue recession.

CLASS 4: Marginal tissue recession extends beyond the mucogingival junction .

                  Loss of interdental bone extends to a level apical to the extent of the marginal tissue                                recession.

 

     

WHAT CAN GINGIVAL RECESSION LEAD TO ?

 

1.The exposed root surface are susceptible to caries. 

2.Abrasion /erosion of the cementum leading to sensitivity.

3.Interproximal recession creates oral hygiene problems & results in plaque accumulation.

4. Finally resulting in aesthetically unacceptable teeth.

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