An interesting article titled “Alveolar osteitis: a critical review of the aetiology and management” written by Veale appears in the 2015 edition of Oral Surgery (vol. 8, pp. 68-77). The article attempts to provide guidance on the best treatment and prevention of alveolar osteitis more commonly known as dry socket. Dry socket is a common complication after wisdom teeth removal that typically occurs around 2 to 4 days after surgery. With dry socket there is a total or partial loss of the blood clot from the socket, which results in an inflammatory response and intense pain. Dry socket is believed to occur up to 5% of the time after a wisdom tooth extraction and some studies show it more often occurs after a lower wisdom tooth removal.
In the article many risks factors of dry socket are attempted to be identified. One well accepted risks factor is a long surgery during the extraction of a wisdom tooth. Another well accepted risk factor is a surgeon who does not have much experience. A more contested risk factor is if the person is a smoker. Some studies have shown that smokers are more likely to experience dry socket where as others have not shown any statistically significant results. Regardless of these studies if one is a smoker and has a wisdom tooth extracted they should stop smoking for at least 24 hours after surgery. Another well accepted risk factor of a dry socket occurring is if the patient is a woman taking oral contraceptives. Most studies seem to indicate that a female taking oral contraceptives is at least twice as likely to experience dry socket after a wisdom tooth extraction than someone who is not. Another accepted risk factor of dry socket occuring after a wisdom tooth extraction is if one has a lot of bacteria in the mouth which could occur due to having periodontal disease or pericoronitis. A more contested factor is if irrigating the socket after a wisdom tooth extraction with saline can disrupt the clotting process and lead to dry socket.
In the article several preventive techniques to minimize dry socket occurrence are discussed. The first is to use chlorhexidine rinses and some evidence has shown that this can help reduce dry socket occurrence. Another prevention technique is taking systematic antibiotics such as penicillins, macrolides, clindamycin, and metronidazole which have all been shown to be effective at reducing dry socket occurrence. Even so much literature has been presented over the years to show that antibiotics should not be routinely given to healthy patients because of antibiotic resistance. Another prevention technique is applying a topical antibiotic such as clindamycin, tetracycline and metronidazole which have all been shown to be effective at reducing dry socket occurrence. A more controversial prevention technique is antifibrinolytic agents such as tranexamic acid and para-hydroxybenzoic acid but do not necessarily having clear indications that they are able to prevent dry socket. Another technique used to prevent dry socket is to pack the socket with gauze right after wisdom teeth surgery. However caution should be used when applying gauze because in some cases it has been reported to cause infection. Lastly plasma rich in growth factors have shown to be able to prevent dry socket after a wisdom tooth extraction.
In the article several management techniques on how to treat dry socket when it does occur are presented. The first is a Eugenol based treatment such as Alveogyl. The second is a product called SaliCept. The third is applying a topical anesthestic agent although all this will do is to help ease the pain associated with dry socket. Antibiotics and low level laser therapy are also mentioned as possible treatment options for dry socket. Finally plasma rich in growth factors may serve as a treatment option for dry socket because it can accelerate wound healing.
The author seems to indicate that his preferred approach is to make sure the patient is practicing good oral hygiene prior to surgery to reduce bacterial load. Then chlorhexidine rinses can be used both before and after surgery to help prevent dry socket. If dry socket occurs a topical anesthestic can be applied to reduce pain and a Eugenol-based medication can also be used.