What is a dry socket?

A dry socket is a fairly common complication of tooth extraction characterized by severe pain. It occurs when the tooth socket loses the blood clot that forms after a tooth is extracted and the bone inside the socket becomes exposed. It is one of the most painful dental problems one can experience. A dry socket is also referred to as alveolar osteitis.

What causes a dry socket?The blood clot that forms after tooth extraction is essential for optimal healing of the underlying tissue. Destruction or loss of the blood clot prevents normal healing and causes alveolar osteitis. There are a variety of reasons why the initial blood clot could be lost or destroyed prematurely. The body reacts to local infection and inflammation, trauma, bacteria, and estrogen to destroy the blood clot, leaving an exposed socket. So it is important to minimize these risk factors as much as possible.

the socket has a dry appearance because of exposed bone. The blood clot helps in stopping the bleeding and lays framework for new tissues to develop there but in case of dry socket, the clot is dislodged and the bone is exposed. This bare bone is exposed to bacteria in the saliva and the food which the patient consumes and the bone becomes infected and painful.

How common is a dry socket?

A dry socket will occur in only 1% to 3% of all tooth extractions, but it becomes much more common in the extraction of lower (mandibular) wisdom teeth. In lower impacted (covered) wisdom teeth, as many as 25% to 30% of cases result in a dry socket.

What are signs and symptoms of dry socket?

A patient may first notice signs of a dry socket 3 to 4 days after extraction of the tooth by feeling moderate-to-severe pain that could last anywhere from 10 to 40 days. The exposed bone of a dry socket is very sensitive and leads to an intense dull aching pain that throbs and radiates around the affected side of the jaw often to the patient's ear. Frequently, the patient affected by a dry socket will also complain of a bad odor or bad taste in their mouth.

Alveolar osteitis. Note exposed bone as marked by the arrow

TreatmentThe pain from alveolar osteitis usually lasts for 24–72 hours. There is no real treatment for alveolar osteitis; it is a self-limiting condition that will improve and disappear with time, but certain interventions can significantly decrease pain during an episode of alveolar osteitis.

These interventions usually consist of a gentle rinsing of the inflamed socket followed by the direct placement within the socket of some type of sedative dressing, which soothes the inflamed bone for a period of time and promotes tissue growth. This is usually done without anesthesia. The active ingredients in these sedative dressings usually include substances like, 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. Because true alveolar osteitis pain is so intense, additional analgesics are sometimes prescribed.

ALVOGYL PASTE

Alvogyl is a dry-socket treatment and post-extraction dressing which every dental office should have on hand . Alvogyl is a one-step, self-eliminating treatment which rapidlyalleviates pain and provides a soothing effect throughout the healing process. Its fibrous consistency allows for easy filling of the socket and good adherence during the entire healing process. The active ingredients of Alvogyl include eugenol for analgesic action, butamben for anaesthetic action, and iodoform for anti-microbial action.

PROPERTIES

•Antiseptic and analgenic paste.•Butamben – provides moderate anaesthetic action .•Iodoform – effective antimicrobial action•Eugenol – effective analgesic action.•Alvogyl easily adheres to the alveolus and assisted by the patients tongue movements, itgradually self eliminates.

CONTRA-INDICATIONS

• Alvogyl is not to be used on patients having a history of allergic reactions to procaine type anaesthetics or to iodine compounds.• Do not suture in place. DIRECTIONS FOR USEUsing a pair of tweezers apply 0.2g of Alvogyl to adequately cover the bottom of the socketand pack gently into place.

PRECAUTIONS Contents should be used within 2 years.

STORAGE To be kept in a cool dry place.

PRESENTATION 12g Paste in a Jar .