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.