dry socket

[fasiha]

hi,
can anyone suggest what is the best treatment for a dry socket and any data they have to support their results?

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[groundhog]

I had one many years ago. They do hurt. The solution back then was to suture it closed. There may be better less intrusive methods today. I do not know. I was also told at the time that I created the problem because I was too aggressive with mouth wash after the extraction and flushed out the blood clot.

 

[Itsmoney]

Well...I really don't have any data to link to you, but I will tell you what I treat my patients with at school when they come in after an extraction with a dry socket in the emergency room.
First I irrigate the area of the socket with Peridex (Strong Rx Mouth wash, chlorohexedine) and remove any food particles trapped, then I will place dry socket packing medication into the Socket which is combination of Zinc Oxide Eugenol and other suthing oils! And advise patient not to smoke, or drink alcohol for 3 days untill the socket heals completely.
In worst case senerios we may sometimes prescribe antibiotics (Pen V K) depending on the situation of the socket, however suturing a socket is usually not recomended for a dry socket cause its best for a socket to fill in with granulation tissue.
Regards
Itsmoney!

 

[groundhog]

We have come a long way. For the extraction which resulted in my dry socket, I had been literally torn from my mom's arms by a macho nurse, strapped into the chair and gassed (that childhood introduction to the dentist is another story). During that same period, it was common to smell the odor of tobbaco on the breaths of most health care workers and MD's or folks portraying themselves as MD's appeared on TV commercials extolling the virtues of various brands of cigarretes.

 

[DrJeff]

Dry sockets, probably one of the worst dental related pains that our patients will ever experience. I have women tell me that the dry socket pain was "20 times worse than childbirth!"

Step #1, ANESTHETIZE QUICKLY, your patients will GREATLY appreciate this. Preferable use Marcaine since the added the the anesthesia wil be appreciated

Step #2, one fully anesthestized, debride the socket, make the socket bleed, irrigate, irrigate, irrigate

Step #3 Dry Socket Paste. This will likely be the worst smelling dental material that you'll have in your office. Liberally coated either some guaze or some gel-foam and insert into the bleeding socket. Basically, I tell the patient that the dry socket paste "looks like S---, smells like S---, and tastes like S---, but you'll feel infinetly better when the anesthetic wears off"

Step #4, Break out the prescritpion pad, and get your patient some potent narcotic anelgesics

Step #5, repeat steps 1-3 2 to 3 times over then next week.

The biggest key to avoiding having to deal with the dry socket patient (believe they're not the best word of mouth practice builders ) is to attempt to "scare" the high risk patients (smokers with lower molar extraction site(s)). What I tell them is that smoking will GREATLY increase the risk of a dry socket, and that the pain associated it will be 4 to 5 times GREATER than pain they've had before (often you can insert the phrase "greater than the tooth ache you have" since many of the dry socket patients are smokers with poor oral hygiene and not wanting to spend the $$ to fix the apical periodontitis via a root canal/crown)

Dry sockets are some of the worst and best things that you'll experience. Worst because you won't like having to see your patients experience it. Best because with anesthesia, dry socket paste and pain medication you can GREATLY improve your patients comfort level in just a few minutes(suddenly you're the greatest thing since sliced bread in your patients eyes again)!

 

[fasiha]

thanks everyone for your interesting replies.i read that some dentists infiltrate too much anaesthesia into the patient's soft tissues which also ultimately leads to dry socket.do you agree?

 

[DrJeff]

There have been isolated reports of localized tissue necrosis in and around injection sites that may or may not lead to a true alveolar osteitis (dry socket). Most of these reported incidents have been in situation where higher concentration local anesthetics with a vasoconstrictor (i.e. 4% Articaine with 1:100,000 epinephrine) is used to "blanche" the ATTACHED gingiva around the tooth to be extracted (especially the lingual attached gingiva of maxiallry teeth). Why this is happening, or atleast being reported more with Articaine as opposed to with epinephrine or bupivicaine local anesthetics with vasocontrictors, I'm just not sure. I can't comment on any personal experiences with this phenomena (yet??).