Signs and symptoms : Dry Socket usually occurs 3-5 days after tooth extraction and causes severe throbbing and radiating pain which is difficult to localize. Dry Socket is characterized by detritus, grayish slough, severe pain and foul odor. The foul odor, in particular, is a result of the disintegration of the blood clot by putrefaction rather than by orderly resorption. If a probe is gently passed in the tooth extraction socket, then bare bone is encountered which is very sensitive. Signs and symptoms
Causes: : Multiple types of dry socket can result from disturbances in the healing process. The type that is commonly referred to as "dry socket" is one in which the disturbance is from the time a blood clot forms immediately after tooth extraction to the initiation of healing in the 4-5 day period after extraction occurs. The healing tissue that is supposed to replace the blood clot, known as granulation tissue , may fail to grow or be disrupted after beginning to grow, leading to the well known symptoms of dry socket. Causes:
Alveolar osteitis, "dry socket" type. Note exposed bone, as marked by arrow.: Alveolar osteitis, "dry socket" type. Note exposed bone, as marked by arrow.
Causes: : Wound healing is a complex process and can be positively and negatively affected by many factors . Alveolar osteitis is the most common healing disturbance of extraction sockets . Suppurative osteitis results when the disturbance of extraction socket wound healing occurs later, during the third stage of healing from day 14-16 after extraction, and is a manifestation of the disruption of connective tissue development. This form usually results from an infection and exhibits a purulent discharge (pus) from the extraction socket . Disruption of the extraction socket during an even later stage of healing might result in necrotizing osteitis in which encapsulated shards of bone (bony sequestrae) will be noted alongside inflammatory cells . Causes:
Prevention : True alveolar osteitis, as opposed to simple postoperative pain, occurs in only about 1-3% of extractions . No one knows for certain how or why dry sockets develop following dental extraction but certain factors are associated with increased risk. One of these factors is the complexity of the extraction. Smoking may be a contributing factor, possibly due to the decreased amount of oxygen available in the healing tissues. It is advisable to avoid smoking for at least 48 hours following tooth extraction to reduce the risk of developing dry socket. Women are generally at higher risk than men of developing alveolar osteitis, because estrogen slows down healing. Dentists recommend that their female patients have extractions performed during the last week of their menstrual cycle, when estrogen levels are lowest, to minimize chances of developing alveolar osteitis Prevention
Treatment : The 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. Treatment