DR.K.THANGAVELU

DRY SOCKET VIDEO

DRY SOCKET PICTURE

DRY SOCKET IS A COMPLICATION

OF TOOTH EXTRACTION

IT IS A PAINFUL CONDITION WHICH

OCCURS MOSTLY AFTER LOWER3RD MOLAR EXTRACTION DUE TO

TRAUMATIC EXTRACTION

IT IS CHARACTERISED BY SEVERE PAIN IN

AND AROUND THE EXTRACTION SITE USUALLY STARTS ON THE 2 – 4 POST-

OPERATIVE DAY AND CAN LAST FOR 10 – 40

DAYS.

THE PAIN IS USUALLY DESCRIBED AS A

THROBBING ACHE AND IS CAUSED BY CHEMICAL AND THERMAL IRRITATION OF

THE EXPOSED NERVE ENDINGS IN THE

PERIODONTAL LIGAMENT AND ALVEOLAR BONE.

PAIN RADIATES TO THE EAR AND TEMPORAL

REGION.  POST-EXTRACTION

BLOOD CLOT IS ABSENT IN THE TOOTH SOCKET;

BONY WALLS OF THE SOCKET ARE BARE AND EXTREMELY SENSITIVE

 BAD BREATH AND AN

UNPLEASANT TASTE IN THE MOUTH ARE

PRESENT.

INITIALLY THE CLOT HAS A DIRTY GRAY

APPEARANCE AND THEN IT DISINTEGRATES,

LEAVING A GRAY OR GRAYISH YELLOW BONY

SOCKET BARE OF GRANULATION TISSUE..

DRY SOCKET IS THE MOST COMMON CAUSE OF DELAYED POST EXTRACTION PAIN.

DRY SOCKET, ALSO KNOWN AS 1.DENTO-

ALVEOLAR OSTEITIS, 2.ALVEOLAR OSTEITIS,

3.ALVEOLITIS, 4.FOCAL OSTEOMYELITIS

WITHOUT SUPPURATION,

5.ALVEOLAGIA

6.ALVEOLITIS SICCA DOLOROSA AND

7.ALVEOLAR PERIOSTITIS,

CAUSES FOR DRY SOCKET

THE CONDITION ARISES AS A RESULT OF A

COMPLEX INTERACTION BETWEEN SURGICAL TRAUMA, LOCAL BACTERIAL

INFECTION AND VARIOUS SYSTEMIC

FACTORS

THEORIES OF DRY SOCKET

1.TRAUMATIC EXRACTION RELEASE TISSUE

ACTVATORS NEAR MARGINS OF SOCKET WHICH

CONVERTS PLASMINOGE TO PLASMIN WHICH IS RESPONSIBLE FOR

PRODUCTION OF DRY SOCKET AND PAIN

PATHOGENESIS

FOLLOWING TRAUMA AND INFECTION , INFLAMMATION OF BONE MARROW OCCURS –WHICH RESULTS IN RELEASE OF TISSUE ACTIVATORS WHICH CONVERTS PLASMINOGEN IN THE CLOT TO PLASMIN

PLASMIN CAUSES LYSIS OF BLOOD CLOT

PLASMIN RELEASES KININ FROM KININOGEN WHICH IS ALSO PRESENT IN THE CLOT

KININ IS RESPONSIBLE FOR SEVERE PAIN

2.TRAUMA TO ALVEOLAR BONE REDUCE

RESISTANCE TO INFECTION WHICH

CAUSE DRY SOCKET(Birn’S

theory)

3. PRIOR INFECTION,

4.FREQUENT WASH BY PATIENT,

5.ACTION OF ADRENALINE IN LA SOLUTION

6.INFECTION FOLLOWING EXTRACTION

THE DIAGNOSIS IS CONFIRMED BY GENTLY

PASSING A BLUNT INSTRUMENT INTO THE

SOCKET

INSTRUMENT FINDS NO RESISTANCE IN EMPTY

SOCKET

WHEN CLOT IS PRESENT PASSAGE OF INSTRUMENT IS PREVENTED BY CLOT.

TREATMENT

SOCKET SHOULD BE IRRIGATED WITH

SALINE

CURETTAGE SHOULD NOT BE DONE

STERILE GAUZE TO THE SIZE OF SOCKET

IS DIPPED IN EUGENOL AND PLACED INSIDE THE SOCKET

THE PACK ACTS AS AN OBTUDENT TO PROTECT THE EXPOSED BONE

THE PACK SHOULD BE REMOVED AFTER 3

DAYS

ANOTHER PACK SHOULD BE GIVEN FOLLOWING

REMOVAL FIRST DRESSING

THE DRESSING PREVENTS THE

ACCUMULATION OF FOOD DEBRIS IN THE

EXTRACTION SOCKET, PROTECTS THE EXPOSED

BONE FROM LOCAL IRRITATION AND

CALMS DOWN THE INFLAMMATION-

INFECTION WITHIN THE EXTRACTION SOCKET WALLS.

DRUGS TO BE PRESCRIBED METRANIDAZOLE 400MG TWICE DAILY FOR 3 DAYS

AMOXICILLIN 500MG TWICE DAILY FOR 3 DAYS

BRUFEN600MG TWICE DAILY FOR 3 DAYS

END